Physical Exam To Diagnose Back Pain
The physical evaluation is also essential, especially in all types of back pain. It is sometimes a brief physical exam, but in other cases, it has to be very extensive, especially in patients with subacute and chronic symptoms.
The physical exam gathers data visible at the time of the evaluation. For instance, doctors may ask patients to walk around the office to evaluate their mobility and gait. They may need to assess their mood, judgment, behaviors, distress signs, and other elements that help them trace psychosocial factors relevant to the diagnosis. They will also run a neurological examination, especially concerning motor strength of the lower, upper extremities, and back muscles. Other evaluations include tendon reflex testing and sensitivity evaluations. Once doing this, doctors will be able to identify problems with the spinal cord or nerve roots.
Palpation is also an important part of the physical exam; doctors will evaluate the spine to look for any abnormality in the normal curvatures. In severe cases, this aspect is clearly noticeable after simple inspection. Also, sometimes patients with back pain experience tenderness when palpating the spinous processes of the spine, which may suggest the presence of vertebral compression, tumor, fractures, or an abscess.
Another essential part of the physical exam has to do with mobility and joint function. Patients can be asked to move their articulations in certain ways, and sometimes, doctors would perform maneuvers to evaluate the range of motion and associated symptoms.
For example, we have Patrick’s test, which rules out hip and sacroiliac pathologies. In this maneuver, the doctor would flex, abduct, and rotate the hip. If this maneuver triggers groin pain, it is a sign of hip pathology.
Another maneuver is the straight leg raise, which determines lumbar nerve or hamstring muscle damage. In this case, doctors will ask the patient to lay down with their back on the table. The doctor takes the heel and lifts the leg with the knee straight. When reaching a determinate angle, the test turns out positive if patients feel radiating pain from the back to their hip or ankles.