Diagnosing Back or Neck Pain: The Physical Examination

Diagnosing your back or neck pain begins with a physical examination and includes an evaluation of your medical history and symptoms. Your doctor may perform special maneuvers (movements) to help diagnose your condition—but the details you provide during the exam are just as important to determine the source of your spine pain. The physical exam, like all spinal diagnostic tests, is most successful when both doctor and patient work together to find the cause of pain.
Male Doctor with patient in the examination roomThe physical exam is most successful when both doctor and patient work together to find the cause of pain.

What Happens During a Spinal Physical Exam?

Your doctor asks for details about your medical history and may also ask questions about your immediate family too. Being prepared with information about your family’s health history (eg, mother, father) can help streamline the exam process. Certain spinal disorders have a risk or tendency to be inherited, such as osteoporosis or scoliosis.

Below are other aspects of your medical history your doctor may want to know:

  • Your co-existing conditions (eg, diabetes, heart disease, osteoporosis, depression, anxiety)
  • Lifestyle habits (eg, smoking status, alcohol use, type of exercise and frequency)
  • If you’ve had a previous spine surgery.
  • Allergies
  • Medications you’re currently taking, including over-the-counter drugs, prescriptions, vitamins, and supplements.

Being clear, detailed, and honest in reporting your medical history is important, as your doctor weighs these details as he or she develops your treatment plan.

Your doctor needs an accurate description of your pain and symptoms. He or she may ask you the following questions:

  • How long have you experienced this pain?
  • Can you trace the pain back to a specific injury or event?
  • Do certain activities reduce your pain or make it worse?
  • Does pain radiate or travel into other parts of your body?
  • What therapies have you tried to treat your pain?
  • Has anything helped your pain or worsened it?

Rank Pain Intensity

Your doctor may ask you to “rank” your pain using a 0-10 scale (zero being no pain and 10 being the worst pain imaginable). Your doctor may also ask you to describe the intensity of your pain and its effect on your quality of life. This can help your doctor assess the nature of your pain, which is challenging given that pain is subjective. What’s manageable for one person may be life-altering for someone else. That’s why it’s important to provide detailed descriptions of your pain and how it is affecting you, which will paint a more complete picture for your doctor.
Pain scale from 1-10Your pain level helps your doctor understand how it affects quality of life.

Spinal Maneuvers, or Movements, to Diagnose Pain

After taking your medical history and reviewing your symptoms with you, your doctor will likely perform a physical exam in order to learn more about your back or neck pain.

Your doctor may ask you to:

  • Walk across the room to examine abnormalities in your gait (pattern of walking)
  • Bend or flex parts of your spine to assess spinal range of motion (eg, bend forward)
  • Simply stand to identify any problems with balance, posture and/ spinal alignment (such as scoliosis or kyphosis)

Your doctor may view your spine from several angles (front, back, and side). He or she may also palpate (by hand) areas of your body/spine to feel for tenderness, swelling, or masses.

Beyond these simple movements, your doctor may also perform special diagnostic maneuvers, or movements. If these maneuvers reproduce your pain, that helps your doctor identify the location and physical source of your pain. The maneuvers your doctor performs largely depend on the location of your pain.

Note: The maneuvers listed below are commonly used to diagnose the potential cause of spine pain, but this is not an all-inclusive list. Your doctor may perform maneuvers not listed below to diagnose your condition.

Neck pain maneuvers:

  • Spurling's maneuver: By turning your head and gently applying pressure, your doctor may reproduce radiating, nerve-related neck pain.
  • Manual neck distraction test: This test will help identify nerve pain in your neck. Your doctor will ask you to lift your head, which may relieve pressure on compressed nerves.

Low back and leg pain maneuvers:

  • Straight-leg raise test: This test is commonly used to diagnose herniated discs in your low back. While you’re lying on your back, your doctor will lift one of your straight legs in the air.
  • Femoral stretch test: While lying face down, your doctor will flex each knee to determine if you feel pain in your thigh. If you do, this indicates nerve compression in your lumbar spine.
  • Schober test: This test examines the range of motion in your lumbar spine. During this test, you will bend over, as if you are trying to touch your toes.
  • Trendelenburg test: This test can identify weakness in the muscles that support the hip. In this test, you’ll stand straight on one leg for 30 seconds. Your doctor will observe if your pelvis stays level.

Sacroiliac joint (SI) pain maneuvers:

  • Distraction: While lying on your back, your doctor will place his or her hands on the front of your SI joints. Your doctor will gently lean down, putting pressure on the joints.
  • Thigh thrust: While lying on your back, you will bend one leg. Your doctor will stand on the side of your bent leg and stabilize the opposite side of your hip with his or her hand. Meanwhile, your doctor will lean into the bent leg, gently moving it inward toward your abdomen.
  • Flexion Abduction External Rotation (FABER): While lying on your back, your doctor will cross one foot over the opposite thigh. He or she will stabilize the opposite side of your hip with his or her hand while gently applying downward pressure to the knee of the crossed leg.
  • Compression: While lying on your side, your doctor will stand behind you and put gentle force on the side of your hip.
  • Gaenslen: While lying on your back, you will hold one leg near the edge of the exam table, and the opposite leg will be bent on the table. While holding your bent knee, your doctor will stress the SI joints by applying downward pressure on the thigh near the table’s edge while also putting pressure on the bent knee.

You can read more about SI joint pain maneuvers Exams and Tests for Sacroiliac Joint Dysfunction.

Tips for Success During Your Physical Exam

You may think your doctor is solely responsible for diagnosing the cause of your back or neck pain, but you also play an essential role. Think of the diagnostic process as a partnership between you and your medical team. The following tips will help ensure you’re upholding your end of the bargain:

  • If you’re in pain, say it: Don’t try to hide it, downplay it, or view it as complaining. If a maneuver during your physical exam creates pain, describe it to your doctor.
  • Get detailed: Does your pain get better when you rest? Does it radiate down your leg when you walk more than 5 minutes? There’s no such thing as too much information, so consider writing down specific facets of your pain down and bringing the list to your appointment to give your doctor the full picture of your pain.
  • Mention all your symptoms: Even if you think they are minor, subtle, or completely disconnected to your back or neck pain, mention any painful or out of the ordinary symptoms to your doctor.
  • Answer your doctor’s questions honestly: Telling your doctor the truth about your medical history and symptoms will help your doctor correctly identify the cause of your pain and craft a safe, effective treatment plan.

What Happens After the Physical Exam?

In some cases, the result of the physical exam is critical and can diagnose the cause of your back or neck pain and recommend treatment. In other cases, the physical exam is the first step in the diagnostic process.

A very important part of your physical exam, is a detailed neurological exam to examine your reflexes and other nerve-related functions. You may read more about this type of exam in Neurology Basics: Neurological Exams.

The results of your physical exam will also help inform your doctor about what laboratory or spinal imaging tests, if any, are needed to confirm a spine disorder diagnosis.

Whether the physical exam reveals a diagnosis or more tests are needed, it’s important to keep the lines of communication open with your doctor. Don’t hesitate to ask your doctor why a specific test is needed to get to the bottom of your back or neck pain. You and your doctor are partners and being informed will help you build confidence in your care.

Updated on: 04/04/18
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6 Topics to Help You Talk with Your Spine Surgeon

SpineUniverse spoke with Lali Sekhon, MD, PhD, FACS to obtain his advice about preparing for and getting the most from an appointment or consultation with a spine surgeon.
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