Tests and Diagnosis
How the Consultation Works
1. The Medical Interview
Your doctor will start by asking you detailed questions about your symptoms.
Questions You May Be Asked
| Question | Why It Is Asked |
|---|---|
| "When did the pain start?" | To determine whether this is acute or chronic |
| "Where does it hurt?" | To find out whether only the back is affected, or the legs as well |
| "When does it hurt most?" | To understand the relationship between posture, activity, and pain |
| "How far can you walk?" | To assess the severity of intermittent claudication |
| "Do you have any numbness?" | To check for nerve involvement |
| "Any problems with urination or bowel control?" | To assess severity (this may indicate an emergency) |
| "Have you had any previous back treatments?" | To review your treatment history |
Information That Helps Your Doctor
Before your appointment, it may help to jot down:
- Where the pain is -- lower back, buttock, thigh, calf, foot, etc.
- How far you can walk continuously -- in meters or minutes
- Positions that bring relief -- leaning forward, sitting, etc.
- How daily life is affected -- shopping, housework, work, etc.
- Medications you are currently taking
You may sometimes feel that your doctor did not ask enough about the detailed timeline of your pain. In reality, the precise chronological history is less important than you might expect. Focus on briefly communicating when the pain started and where it hurts.
2. The Physical Examination
After the interview, your doctor will examine you physically.
Key Tests
| Test | How It Is Done | What It Reveals |
|---|---|---|
| Visual inspection | Observing your posture and how you walk | Deformity, abnormal gait |
| Palpation | Pressing on your lower back | Tender spots, muscle tension |
| Range of motion | Bending forward and backward | Which movements provoke pain |
| Neurological exam | Testing reflexes, sensation, and strength | Which nerve is affected |
| SLR test | Raising your leg while lying on your back | Helps distinguish a herniated disc |
Neurological Examination in Detail
| Test | How It Is Done | What It Means |
|---|---|---|
| Knee reflex (patellar reflex) | Tapping below the kneecap with a reflex hammer | Assesses the L4 nerve |
| Ankle reflex (Achilles reflex) | Tapping the Achilles tendon | Assesses the S1 nerve |
| Sensory testing | Checking your ability to feel touch | Identifies which nerve is affected |
| Muscle strength testing | Testing the power of your ankles and toes | Assesses nerve motor function |