Medical History and Physical Exam for a Lumbar Herniated Disc

Exam Overview

During the first visit to your doctor for a possible lumbar (low back) herniated disc, you will be asked about your medical history, including:

• The pattern, intensity, and duration of your leg or back pain (you may be asked to complete a pain drawing to identify the areas and types of pain you have).
• Previous accidents, injuries, or illnesses involving your back.
• Previous back surgery, procedures, or spinal or epidural injections.
• Family history of low back pain and herniated disc.
• History of cigarette smoking and drug and alcohol use.
• Employment history.
• Involvement in sports and other leisure activities.

Your doctor will also ask questions to check for any other conditions that may be causing your symptoms. This may include questions about:

• Signs of infection, such as fever and chills.
• Symptoms that can suggest severe nerve damage. Examples include:
  • Numbness in or between the genital and rectal areas (saddle anesthesia).
  • Significant weakness or loss of coordination in one or both legs.
  • New problems with bladder or bowel control or sexual function.
• Possible spinal fracture. This can result from:
  • A recent, severe injury involving the back, such as a fall, a car or motorcycle accident, or a sports-related injury.
  • A mild to moderate back injury (from twisting, or lifting a heavy object) in people older than 50 years of age, especially women (who are at high risk for osteoporosis).
  • Prolonged corticosteroid use.
• Any history of cancer, osteoporosis, bone disease, or certain other diseases.
• Any recent weight loss.

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.

These tests may include:

• Muscle strength tests. Your doctor will test the strength of specific muscles (in your legs or feet) for signs of a pinched nerve.
• 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 raised.
• 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 (belly), pelvic, and rectal exams.