Physical examination and medical history
Your doctor will take a medical history, and will likely ask about the frequency, duration and nature of the pain (whether piercing, throbbing, burning, etc.); when it began; whether it was triggered by an event, such as lifting something heavy; what worsens the pain (e.g. coughing, walking) and what relieves it (e.g. lying down, exercise). Tell your doctor about any previous back pain episodes and injuries involving your back, neck or hips.
Your doctor will then give you a full physical examination.
Most cases of back pain will not require complex tests for initial assessment and treatment. However, if pain is severe and does not respond to treatment, or if you have significant leg pain, some imaging tests may be necessary. These may include the following:
Can help show bone alignment and the presence of degenerative joint disease, tumours, infection or injury in some cases. Plain X-rays will not show soft tissue pathology such as the lumbar discs or nerves.
Magnetic resonance imaging (MRI) or computerised tomography (CT) scans
Generate images that help reveal conditions involving the bone and the soft tissues e.g. herniated discs. MRIs can also help detect other causes of back pain, including infection and cancer.
A scan is taken after a radioactive substance (tracer) has been injected into a vein to help detect bone tumours, stress fractures or osteoporotic insufficiency fractures.
Discs suspected of being the source of pain are injected with dye and X-rayed. This technique is generally used only to identify the injured disc as source of the back pain before the patient undergoes surgery.
A dye injected into the spinal canal shows up herniated discs or other lesions on X-rays or a CT scan. This procedure has largely been replaced by MRI scans, but is still used in individuals who had undergone a previous spinal fusion using stainless steel implants.
Electrical tests, such as EMG (electromyography), are used to study nerve conduction pathways, and can confirm nerve compression caused by spinal conditions (herniated discs or stenosis) and peripheral conditions (diabetic neuropathy or peripheral nerve compression).
Blood and urine samples may be used to test for conditions such as infections, cancer or arthritis.
When to see a doctor
Contact your doctor as soon as possible if back pain results from trauma, like a fall or blow to the back. Otherwise, contact your doctor if pain does not improve after about a week.
Occasionally back pain can signal a serious medical problem. Consult your doctor if you have back pain and:
- bladder or bowel control problems (such as difficulty passing urine)
- numbness in the groin or in the vicinity of the anal region
- weakness, numbness or "pins and needles" in the legs
- rapid weight loss
- a history of cancer
- abdominal pain
- pain running down one or both legs
- you feel unsteady on your feet
- the pain is increased by lying down
- the pain wakes you at night
- the pain is unrelated to movement
- the pain is localised in the upper back (thoracic spine)
- a history of corticosteroid use
- a history of intravenous drug use
- a history of urinary tract infection
- in children, any severe back pain that persists for more than three days
What is back pain?
Symptoms of Spinal problems
Causes of back pain
Reviewed by Dr Pradeep Makan, orthopaedic surgeon, Melomed Gatesville and Life Vincent Pallotti Hospital in Cape Town and part-time lecturer in the department of orthopaedic surgery at the University of Cape Town, 2016