Because many different conditions may cause back pain, your doctor will take a thorough medical history as part of the examination. Some of the questions may not seem pertinent to you. But the questions are important to your doctor in determining the source of your pain.
Your doctor will first ask questions about the onset of pain. (Were you lifting a heavy object and felt an immediate pain? Did the pain come on gradually?) He or she will want to know what makes the pain better or worse. He or she will ask if you have had the pain before.
The doctor also will ask about recent illnesses and their symptoms such as coughs, fevers, urinary difficulties, or stomach illnesses. If you are a woman, the doctor will want to know about any vaginal bleeding, cramping, or discharge. Pain from the pelvis is frequently felt in the back.
Your doctor will then give you a thorough physical exam. He or she will watch for signs of nerve damage while you walk on your heels, toes, and soles of your feet. The doctor may test your reflexes using a reflex hammer. This is usually done at the knee and behind the ankle. As you lie flat on your back, you'll be asked to elevate one leg at a time, both with and without the doctor's assistance. This is done to test nerves and muscle strength and to assess the presence of tension on the sciatic nerve. The doctor may test sensation using a pin, paper clip, broken tongue depressor, or other sharp object to assess any loss of sensation in your legs.
Depending on what the doctor suspects is wrong, he or she may perform an abdominal examination, a pelvic examination, or a rectal examination. These exams look for diseases that can cause pain referred to your back. The lowest nerves in your spinal cord serve the sensory area and muscles of the rectum, and damage to these nerves can result in inability to control urination and bowel movement. Thus, a rectal examination may be needed to make sure that you do not have nerve damage.