Exams and Tests for Back Pain
If you have back pain that persists more than a few days or is severe and accompanied by other symptoms, you should make an appointment to see a spine specialist. (If you don't already have a spine specialist, you can find one using our Find a Professional in Your Area feature.) Both sudden and persistent back pain can indicate a spinal condition that is more serious than a muscle sprain or strain, which should heal itself within a few weeks.
During your visit, your spine specialist will ask you questions and perform some basic exams. This is to try to identify the cause of your back pain and develop a treatment plan for you—a way to manage your pain and other symptoms and to help you recover.
First, your spine specialist will ask about your current symptoms and remedies you have already tried. He or she will ask some typical questions, such as:
- When did the pain start?
- What activities did you recently do?
- What have you done for your back pain?
- Does the pain radiate or travel to other parts of your body (e.g., down your leg—that would be sciatica)?
- Does anything reduce the pain or make it worse?
Your spine specialist will also perform physical and neurological exams. In the physical exam, your doctor will observe your posture, range of motion (how well and how far you can move certain joints), and physical condition, noting any movement that causes you pain. Your doctor will feel your spine, note its curvature and alignment, and feel for muscle spasm. This exam often involves some patient participation. For example, you may be asked to bend in various directions and to move your arms and legs—perhaps even lie on a table and raise your legs.
During the neurological exam, your spine specialist will test your reflexes, muscle strength, other nerve changes, and pain spread (that is—does your pain travel from your back and into other parts of your body?).
To diagnose the cause of your back pain, you may need to undergo some imaging tests. You may have an x-ray, which can help your doctor "see" the bones in your spine. X-rays are effective at showing narrowed spinal channels (spinal stenosis), fractures, bone spurs (osteophytes), or osteoarthritis. A Computerized Axial Tomography scan (a CT or CAT scan) or a Magnetic Resonance Imaging test (an MRI) may be required. These tests are more effective than x-rays at showing the soft tissues in your spine, and can help to identify problems such as a bulging disc or a herniated disc.
You also may be asked to undergo additional tests, such as:
- Bone scan: To help your doctor detect spinal problems such as osteoarthritis, sacroiliac joint dysfunction, fractures, or infections, you may have a bone scan. You will have a very small amount of radioactive material injected into a blood vessel. That will travel through your blood stream and be absorbed by your bones. More radioactive material will be absorbed by an area where there is abnormal activity—such as an inflammation. A scanner can detect the amount of radiation in all your bones and show the "hot spots" (the areas with more radioactive material) to help your doctor figure out where the problem is.
- Discogram: This is a procedure that confirms or denies the disc(s) as the source of your pain. You will have a harmless dye injected into one of your discs. If there's a problem with your disc—like it's herniated—the dye will leak out of the disc. The doctor will be able to see that on an x-ray, and that will show him/her that there's something wrong with your disc.
- Myelogram: To see if you have a spinal canal or spinal cord disorder—perhaps nerve compression causing pain and weakness—you may have a myelogram. In this test, you'll have a special dye injected into the area around your spinal cord and nerves. (Before that happens, the area will be numbed.) Then you'll have an x-ray or a CT scan. The image will provide a detailed anatomic picture of your spine, especially of the bones, that will help your doctor to identify any abnormalities.
It isn't always a quick and simple process to diagnose back pain. Your spine specialist will need to narrow down the causes and perhaps run several rounds of tests to confirm the diagnosis. Be a good patient—and be patient. Once there is a diagnosis, your spine specialist will be better able to develop a treatment plan that fully meets your needs.