For many people, back pain seems like an unavoidable discomfort. But you may have more control than you think.
You can wreck your back in any number of ways, but a few major offenders stand out: Not stretching, not paying attention to your movements, and years of wear and tear, says Nick Shamie, MD, associate professor of orthopedic neurosurgery at UCLA and a spokesman for the American Academy of Orthopaedic Surgeons.
Here are five habits that put your spine at risk and simple strategies to stop...
During the physical exam, your doctor will watch how you
sit, stand, and walk. You will also be asked to do certain movements while
standing, sitting, and lying down. This allows your doctor to assess the
flexibility of your spine, any areas of pain or tenderness, and any muscle or
nerve problems that typically occur with a herniated disc.
tests may include:
Muscle strength tests. Your doctor will test the
strength of specific muscles (in your legs or feet) for signs of
nerve root compression.
Sensory testing. Sensory testing measures your
ability to feel light touch, a pinprick, or hot and cold.
Deep tendon reflexes (knee and ankle jerk). Your
doctor will tap your knees and ankles with a reflex hammer. If there is nerve
root compression in your lower back, you may have little or no reflex in either
the knee (patellar tendon) or the ankle (Achilles tendon).
Lying straight-leg test. You will lie on your back
with both legs extended. Your doctor will raise the affected leg toward your
head. A positive test for herniated disc produces pain down the back of the
leg, below the knee, when the leg is raised up.
Sitting straight-leg test. You will sit on the exam
table with both knees hanging over the edge of the table, bent at 90 degrees.
Your doctor will slowly extend one leg until the knee is straight. Your leg is
released, and the test is done on your other leg. A positive test for herniated
disc produces pain down the back of the leg, below the knee, when the leg is
Femoral stretch test. You will lie face down on the
exam table with your legs extended. Your doctor will raise one leg toward the
ceiling and then bend your knee. If this test produces pain that travels
(radiates) toward the front of the thigh, it is likely that one of the nerve
roots located high in the lumbar region (lower back) is irritated.
Valsalva maneuver. You will cough or bear down, as
during a bowel movement. If you have a herniated disc, a Valsalva maneuver may
increase pain or other disc-related symptoms.
In addition to the above tests, the physical exam may
also include general abdominal, pelvic, and rectal exams.
Why It Is Done
A history and physical exam are done
when symptoms of a herniated disc (such as leg pain or numbness) are
Findings from the history and physical exam
may include the following.
Pain, weakness, or nerve-related symptoms cannot be
reproduced during the physical exam. Laboratory tests and additional physical
exams may be done to determine whether some other medical condition is causing
Your history provides information that suggests
irritation of and pressure on a nerve root may be a cause of your symptoms.
Testing done during the physical exam causes pain and/or nerve-related symptoms
that are typical of a herniated disc.
Treatment (pain relievers,
gradual increase in activities, and other home treatment) may be started at
this point. Imaging studies will probably not be needed unless your doctor
suspects a more serious cause of nerve root compression, such as an infection or
What To Think About
A herniated disc can usually be
diagnosed using a medical history and physical exam.