At the beginning of an initial doctor’s visit for back or neck pain, a nurse or physician’s assistant is likely to conduct a pre-examination to prepare the doctor for the exam.
This process typically includes collecting information about current symptoms, the duration of symptoms, and how and when symptoms arose. Information on blood pressure, height, weight, current medications, and other relevant health information are also collected.
What is a Medical History?
A medical history provides a doctor with the context necessary to understand current symptoms and narrow down possible causes. For example, gathering information on exercise habits can indicate muscles or other spinal structures that may be aggravated by activity.
Typically, information collected in a medical history includes:
- Detailed list of current symptoms, including when pain began, where pain is felt, if pain is constant or intermittent, how pain feels (sharp, dull, stabbing, shooting), and any other symptoms that accompany the pain
- Past occurrences of back or neck pain, including diagnoses and treatment methods
- Past or recent injuries that may be contributing to pain
- Regular exercise, diet, and sleeping habits
- Past medical history, including information on back or neck pain, cardiac issues, diabetes, and overall health
Other factors, such as social or emotional health, may also be included in a medical history.
Similar information may be collected during a pre-examination. It is important to supply as much detail as possible during both the pre-examination and the doctor’s medical history.
What is a Physical Exam?
A physical examination builds off the information gleaned from a medical history to further narrow down or identify causes of pain. A physical exam for back/neck pain may consist of a variety of methods and tests, including:
- Palpation, or feeling by hand, along the spine to check for abnormalities such as abnormal bony alignment, muscle spasms, or areas of tenderness
- Strength testing to determine if there is any weakness in specific muscle groups in the arms or legs
- Sensation testing, which involves seeing if your skin can feel light touch or pin pricks
- Reflex tests, in which muscle reflexes are tested with a reflex hammer; poor or weakened reflexes may indicate nerve root irritation
- Movement tests, which may be used to check range-of-motion or to recreate pain; common movement tests include bending forward, backward, or side-to-side, or a straight leg raise test, used to recreate leg pain typically caused by a herniated disc.
In most cases a physical exam and medical history are sufficient for diagnosing and treating back and neck pain.
When are Diagnostic Tests Needed?
Additional testing is typically not needed for diagnosing and/or treating back or neck pain initially. If more testing is needed for a diagnosis, the following tests may be used:
- X-ray scan, or a radiographic, two-dimensional image of the bones and joints
- CT scan or CT with myelogram, which uses x-rays to create a series of images that is then processed to provide a detailed, cross-sectional image of the bones; if a myelogram is performed, a dye is injected around the spine to provide additional detail on the spinal cord and nerves
- MRI (Magnetic Resonance Imaging) scan, which creates a detailed image of the spine and is able to provide detail on the spinal cord, nerve roots, and soft tissues, such as muscles, ligaments, and spinal discs.
- Injection tests, which are primarily used to confirm the location of the pain source and consist of injecting an anesthetic and/or steroid into the painful area of the spine
Diagnostic testing is usually only necessary to confirm a suspected cause of pain, such as a herniated disc, stenosis, or arthritis. If surgery is being considered to treat pain, imaging tests are necessary to confirm the diagnosis and plan the procedure.
In many cases, only one diagnostic test is needed to confirm or locate a pain source, but a combination of tests may be used to provide extra confirmation.