Neurology Basics: Neurological Exams
The process of diagnosing the precise cause of back pain, which occurs in about 80% of the population, can be a difficult. Back pain can result from muscular strain, degenerative spine disease (e.g. degenerative disc disease), wear and tear (e.g. osteoarthritis), anatomical defects, nerve compression, trauma, and a broad range of other disorders.
In some instances, the spine specialist could be compared to a detective who compiles clues and physical evidence to prove a case. The spine specialist gathers clues from patient history, physical examination, imaging studies and/or other tests, and a neurological assessment to confirm a diagnosis.
Many people associate a neurological exam with patients who are paralyzed, have suffered a stroke, or who have problems sleeping. Although this is true, assessing a patient’s neurological function is important to diagnosing and treating spinal problems too. A general neurological examination provides the physician with valuable insight into the patient’s brain, spinal cord, nerves, and muscles.
The spine specialist asks several questions about the patient in general and their symptoms. The list below is not all-inclusive. Depending on the patient and their symptoms, additional questions may be posed.
- Have you noticed weakness in your arms or legs?
- Does the weakness come and go or is it consistent?
- Do you experience muscle twitching?
- Do you have problems walking? What kind of problems?
- When do you have problems walking? Climbing stairs? Walking downhill?
- Do you experience cramps in your legs?
- Do you have any numbness, tingling, or pain in your back or extremities?
- Does changing position relieve your symptoms?
- What makes your symptoms worse?
- Do you have bowel or bladder problems?
Gait and Balance
Walking, or gait, simply means the way a person walks: rhythmical pattern and speed. Walking is a complex process involving different reflexes stimulated by the nervous system and the person’s awareness of where they are in space (termed ‘proprioception’), which is important for balance. The physician may ask the patient to walk across the room, turn and come back, walk heel to toe, on their toes and heels, hop in place on each foot, and/or rise from a sitting position. The physician observes any listing, erratic movement, or loss of rhythm. These movements may also indicate weakness and difficulty with balance.