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Arthritis Today

Diagnosing Back Problems

How your doctor can start to identify the cause of your back pain.

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If you are experiencing muscular back pain, there's a good chance it will go away on its own with time. But you should see a doctor right away if back pain is severe, occurs after a fall or injury, doesn't improve when you lie on your back or is accompanied by one or more of the following:

Weakness, pain or numbness in one or both of your legs
Fever or unintentional weight loss
Pain with urination or difficulty urinating

Diagnosing back pain will begin with a physical exam and medical history.

Medical History  
During the medical history your doctor will ask you questions, such as:

What symptoms are you experiencing?
Did they begin suddenly or come on gradually?
Are your symptoms worse after activity or rest?
Are there certain activities that make your symptoms worse – or better?
Are you experiencing pain or swelling in other joints?
Are you experiencing symptoms anywhere besides the back?
Have you ever had cancer?
Have you had unexplained weight loss?
Do any of your family members have arthritis or other back problems?
Do you have other medical problems that could be causing your symptoms?
Do you spend a lot of time sitting at a desk?
Do you exercise regularly? If so, what kind of exercise do you do?
Do you smoke? If so, how much?

Physical Exam
During the physical exam your doctor will check your posture and look for problems such as curvature of the spine.

Your doctor may ask you to stand and walk to determine if back pain is affecting your gait (the manner in which you walk) or if an awkward gait (perhaps due to leg-length discrepancy or arthritis in the knee or hip) may be contributing to your back pain.  

Your doctor may ask you to move, bend and change position to see if a particular activity or position makes your pain worse. Your doctor may also press on different parts of your body – even parts where you may not be aware of pain – to check for tender points (tender painful areas that are characteristic of fibromyalgia) and trigger points (areas of the body that, when pressed, cause pain elsewhere) to locate the source of your pain.  

As part of the physical exam your doctor may also perform one or more of the following tests:

• Lower body nerve evaluation. By running a device called a pinwheel along your skin, from your hips to your feet, your doctor can check for any areas that are either abnormally sensitive or insensitive to stimulus, which would suggest possible nerve involvement in the lower spine.

• Muscle-strength evaluation. By checking the strength of the different muscle groups in your lower body, your doctor can detect possible nerve problems. Because different nerves supply different muscle groups, a weakened muscle group may suggest damage to the nerve that supplies that group of muscles.

• Sciatic nerve stretch test. By raising your legs one at a time (while you extend and relax them) as you lie flat on a table, your doctor can determine whether stretching the sciatic nerve causes pain, suggesting possible nerve-root involvement.

Depending on the findings of your history and physical exam your doctor may also order one or more of the following: lab tests, nerve tests or imaging tests.

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