bone, joint, and muscle disorders
Low Back Pain
Evaluation of Low Back Pain
The doctor aims to identify any serious disorders. Because low back pain is often caused by several problems, diagnosing a single cause may not be possible. Doctors may only be able to tell that the cause is a musculoskeletal disorder and how serious it is likely to be. In people with low back pain, certain symptoms and characteristics are cause for concern. They include A history of cancer Use of Some Drugs That Can Cause Immunodeficiency , Numbness, weakness in one or both legs, difficulty emptying the bladder ( Urinary Retention , or loss of bladder or bowel control ( Fever Weight loss Severe pain at night Abdominal or chest pain, or pulsing sensation in the upper abdomen—symptoms that suggest an Abdominal Aortic Aneurysms None Vomiting, severe abdominal pain, or stool that is black or bloody—symptoms that suggest a digestive disorder Difficulty urinating, blood in the urine, or severe crampy pain on one side radiating into the groin—symptoms that suggest a urinary tract disorder People should see a doctor immediately if they have fever or any of the warning signs that suggest nerve damage, an Abdominal Aortic Aneurysms , a digestive disorder, or a urinary tract disorder. People with most other warning signs should see a doctor within a day. If pain is not severe and people have no warning signs other than pain for more than 6 weeks, their need to see a doctor is not as urgent. Doctors first ask questions about the person's symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause and the tests that may need to be done (see table). Doctors ask questions about the pain: What is the pain like? When and how did it start? How severe is it? Where is it and where does it radiate to? What relieves or worsens it (for example, changes in position or weight bearing)? Are there other symptoms (such as numbness, weakness, retention of urine, or incontinence)? Certain characteristics of the pain can give clues to possible causes: Pain in an area that is tender to the touch and is worsened by changes in position or weight bearing is usually local pain. Pain that radiates down the leg, such as sciatica, is usually caused by compression of a spinal nerve root. Pain that is not affected by changes in position of the back and is not accompanied by tenderness may be referred pain. Pain that is constant, severe, progressively worse, and unrelieved by rest, particularly if it keeps the person awake at night, can be a disk herniation but may indicate cancer or an infection. The physical examination is focused on the spine and on evaluation of the nerves to the groin and legs to look for signs of nerve root compression. Signs of nerve root compression depend on which nerve roots are involved and include weakness of one of the muscle groups in a leg, abnormal reflexes (tested by tapping the tendons below the knee and behind the ankle), decreased sensation in an area of the leg, and, very rarely, Urinary Retention and Doctors may ask the person to move in certain ways to determine the type of pain. Doctors typically ask the person to bend forward and backward. They may have the person lie flat and then lift their leg without bending the knee to see if it brings on pain, which would suggest a herniated disc. Doctors may also check a person's abdomen for tenderness or a mass and the pulses, particularly in people over 55, who may have an Abdominal Aortic Aneurysms . They may examine the prostate in men by doing a digital rectal examination and the internal reproductive organs in women by doing a pelvic examination. With information about the pain, the person’s medical history, and results of a physical examination, doctors may be able to determine the possible cause. Usually, no tests are needed because most back pain results from osteoarthritis, strains and sprains, or other minor musculoskeletal disorders and resolves within 6 weeks. Imaging tests are often needed if Another cause is suspected Warning signs are present Back pain persists People who did not respond to initial treatment or those whose symptoms have worsened or changed may also undergo testing. X-rays of the lower back show only the bones. They can help detect degenerative changes due to Osteoarthritis (OA) , If compression of the spinal cord is suspected, MRI is done immediately. Rarely, when results of MRI are unclear, Myelography with CT is required. Rarely, if cancer or infection is suspected, removal of tissue (biopsy) is necessary. Occasionally, 