When you first see your doctor, you will be asked questions about your back pain, including how it started, how often it occurs, how severe it is, and what makes it better or worse. Your doctor will try to determine the cause of your back pain and whether it is likely to quickly get better with simple measures such as ice, mild painkillers, physical therapy, and proper exercises. Most of the time, back pain will get better using these approaches.
Physical exam
During the exam, your doctor will try to pinpoint the location of the pain and figure out how it affects your movement. You will be asked to:
- Sit, stand, and walk. While walking, your doctor may ask you to try walking on your toes and then your heels.
- Bend forward, backward, and sideways.
- Lift your legs straight up while lying down. If the pain is worse when you do this, you may have sciatica
, especially if you also feel pain, numbness, or tingling in one of your legs.
Your doctor will also move your legs in different positions, including bending and straightening your knees. All the while, the doctor is assessing your strength as well as your ability to move.
To test nerve function, the doctor will use a rubber hammer to check your reflexes. Touching your legs in many locations with a pin, cotton swab, or feather tests your sensory nervous system (how well can you sense or feel touch). Your doctor will instruct you to speak up if there are areas where the sensation from the pin, cotton, or feather is duller.
Tests
Most people with back pain recover within 4 - 6 weeks. Therefore, your doctor will probably not order any tests during the first visit. However, if you have any of the symptoms or circumstances below, your doctor may order imaging tests even at this initial exam:
- Pain that has lasted longer than one month
- Numbness
- Muscle weakness
- Accident or injury
- Fever
- If you are over 65
- You have had cancer or have a strong family history of cancer
- Weight loss
In these cases, the doctor is looking for a tumor, infection, fracture, or serious nerve disorder. The symptoms above are clues that one of these conditions may be present.
Followup
If you are following your doctor's initial instructions and do not improve after 1 - 3 weeks, you should call for a followup appointment. Your doctor will determine if you need to see a physical therapist
and can refer you to one in your area.
If your pain lasts longer than one month, your primary care doctor may order imaging tests and send you to see either an orthopedist (bone specialist) or neurologist (nerve specialist).
