Low Back Pain Diagnosis

5 Steps to a Lower Back Pain Diagnosis

Peer Reviewed

A thorough physical and neurologic assessment may reveal the cause of your lower back pain—the underlying spinal condition leading to pain.

Physical Examination: Step 1 in Low Back Pain Diagnosis

The physical examination begins with your current condition and medical history.  Your doctor will ask questions about:

  • when the pain began
  • what activities make it worse or better
  • what you've tried to relieve the low back pain

The doctor will then examine your range of motion. Your range of spinal motion is evaluated while standing straight, bending forward, and to the side. Asymmetry, posture, and leg length is noted. Methodical palpation of the spine can reveal muscle spasm, possible bony displacement, and tender points.

Abdominal palpation is performed to determine if the cause of low back pain is possibly organ-related (eg,. pancreas); pain can radiate from (travel from) the affected organ and cause low back pain.

Neurologic Examination:  Step 2 in Diagnostic Process

The neurologic assessment evaluates weakness, absence of reflexes, tingling, burning, pain, diminished function, and other signs that may indicate nerve involvement.

In some cases electrodiagnostic studies such as electromyography (EMG) or nerve conduction velocity (NCV) are performed to confirm a diagnosis or localize the site of nerve injury.

Imaging Studies:  Step 3 in Making Lower Back Pain Diagnosis

Doctor consulting with patient regarding her x-rayX-rays are performed when fracture or neurologic dysfunction is suspected.Plain radiographs (x-rays), CT Scan, and/or MRI studies are performed when fracture or neurologic dysfunction is suspected.

An MRI represents the gold standard in imaging today. An MRI renders high-resolution images of spinal tissues such as the spinal cord and intervertebral discs.

X-rays are still the imaging methods of choice to study the bony elements in the lower back.

Lab Tests:  Step 4

If infection, malignancy, fracture, or other risk factors are suspected, routine lab tests may be ordered. These tests may include complete blood count (CBC), erythrocyte sedimentation (ESR), and urinalysis.

Lower Back Pain Diagnosis:  Step 5

The results of the physical and neurologic examinations combined with test results (x-rays, MRIs, and any lab tests needed) are carefully evaluated to confirm a diagnosis—the underlying spinal condition causing your pain.

Commentary by Edward C. Benzel, MD

Dr. Fessler has eloquently and succinctly reviewed and presented the "basics" of low back pain. Of those who are seeking information regarding their back pain or the back pain of a family member or loved one will most assuredly use the information provided by Dr. Fessler effectively. This information can and should function as a springboard for further information gathering, some of which is provided in the related articles attached.

Updated on: 04/24/18
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Common and Uncommon Causes of Back Pain
Edward C. Benzel, MD
Neurosurgeon and Chairman
Cleveland Clinic
Department of Neurosurgery
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