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Health A-Z

Medical Content Created by the Faculty of the
Harvard Medical School

Diagnosis

Your health care professional will review your medical history, including any history of fever, cancer, steroid use or recent back injuries. Your doctor then will ask you specific questions about your pain:

  • Have you had milder episodes of back pain in the past?

  • Where is your pain located? Is it limited to your back or does it spread into your shoulder, arm, chest, buttock or leg?

  • When did your pain start? Did it begin when you tried to lift something heavy, or was it triggered by a sudden twist or bend of your back?

  • What makes it feel better, and what makes it worse?

  • Does the pain disappear when you rest the affected area, or is it present even at rest?

  • Have you noticed any numbness, tingling or muscle weakness in your arms or legs?

  • Are there problems with bowel or bladder control, rectal pain, or numbness in the buttocks or genital area?

After reviewing your medical history and symptoms, your doctor will do a thorough physical examination to rule out other illnesses that can cause back pain, such as cancer or a bone infection of the vertebrae.

This general physical exam will be followed by a more detailed examination of your back, during which your doctor will look for differences between your right and left sides, muscle spasms, abnormal curvature, limitation of movement, lack of flexibility, areas of numbness, and areas of tenderness. Your doctor's findings will help to rule out other types of back problems that can cause similar symptoms.

If you have symptoms of lumbar disk herniation, your doctor may ask you to do specific maneuvers, such as walking on your toes, walking on your heels, squatting and standing, and flexing your ankle against resistance. Your doctor will want to do a straight leg-raising test. You will lie on your back with your legs straight. While you relax, your doctor slowly raises each leg individually to determine the angle where your leg pain begins. Your doctor will do a neurological examination, looking for changes in your reflexes, as well as for any evidence of muscle weakness or decreased sensation.

Spinal X-rays, a computed tomography (CT) scan or magnetic resonance imaging (MRI) scan may be recommended if your initial diagnosis is not clear, if your symptoms persist or worsen after several weeks of treatment, or if you are considering surgery. Because imaging tests, such as MRI or a CT scan, may show disk abnormalities even in people without symptoms, the results must be interpreted carefully. It is common to find abnormalities that have no effect on symptoms. Your doctor also may recommend an electromyography, a test that analyzes muscle and nerve function to identify sites of nerve compression or irritation.

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From Health A-Z, Harvard Health Publications. Copyright 2007 by the President and Fellows of Harvard College. All rights reserved. Written permission is required to reproduce, in any manner, in whole or in part, the material contained herein. To make a reprint request, contact Harvard Health Publications. Used with permission of StayWell.

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