In the absence of red flags, their use is discouraged. Plain X-rays are generally not considered useful in the evaluation of back pain, particularly in the first 30 days. Because about 90% of people have improved within 30 days after the pain starts, most doctors will not order tests in the initial evaluation of acute, uncomplicated back pain. If there are no 'red flags,' there is little reason for imaging during the first 4 to 6 weeks of acute back pain. No single test is perfect in that it identifies the absence or presence of disease 100% of the time Thus, a rectal examination may be needed to make sure that you do not have nerve damage.ĭoctors can use several tests to 'look inside you' to get an idea of what might be causing the pain. The lowest nerves in your spinal cord serve the sensory area and muscles of the rectum, and damage to these nerves can result in inability to control urination and bowel movement. These exams look for diseases that can cause pain referred to your back.

The doctor may test sensation using a pin, paper clip, broken tongue depressor, or other sharp object to assess any loss of sensation in your legs.ĭepending on what the doctor suspects is wrong, they may perform an abdominal examination, a pelvic examination, or a rectal examination. This is done to test nerves and muscle strength and to assess the presence of tension on the sciatic nerve. As you lie flat on your back, you'll be asked to elevate one leg at a time, both with and without the doctor's assistance. This is usually done at the knee and behind the ankle. The doctor may test your reflexes using a reflex hammer. They will watch for signs of nerve damage while you walk on your heels, toes, and soles of your feet. Your doctor will then give you a thorough physical exam. Pain from the pelvis is frequently felt in the back. If you are a woman, the doctor will want to know about any vaginal bleeding, cramping, or discharge. The doctor also will ask about recent illnesses and their symptoms such as coughs, fevers, urinary difficulties, or stomach illnesses. They will ask if you have had the pain before. (Were you lifting a heavy object and felt an immediate pain? Did the pain come on gradually?) They will want to know what makes the pain better or worse. Your doctor will first ask questions about the onset of pain. But the questions are important to your doctor in determining the source of your pain. Some of the questions may not seem pertinent to you.

Because many different conditions may cause back pain, your doctor will take a thorough medical history as part of the examination.

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