Medical history and physical examination for a herniated disc

Examination Overview

During the first visit to your health professional for a possible 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.
• 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 health professional will also ask questions to check for any underlying 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 examination, you will be asked to do certain movements while standing, sitting, and lying down. This allows your health professional 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 health professional 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 health professional 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 health professional 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 examination table with both knees hanging over the edge of the table, bent at 90 degrees. Your health professional 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 examination table with your legs extended. Your health professional 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 manoeuvre. You will cough or bear down, as during a bowel movement. If you have a herniated disc, a Valsalva manoeuvre may increase pain or other disc-related symptoms.

In addition to the above tests, the physical examination may also include general abdominal, pelvic, and rectal examinations.

Why It Is Done

A history and physical examination are done when symptoms of a herniated disc (such as leg pain or numbness) are present.

Results

Findings from the history and physical examination may include the following.

Normal

Pain, weakness, or nerve-related symptoms cannot be reproduced during the physical examination. Laboratory tests and additional physical examinations may be done to determine whether some other medical condition is causing your symptoms.

Abnormal

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 examination 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 necessary unless your health professional suspects a more serious cause of nerve root compression such as an infection or tumour.

What To Think About

A herniated disc can usually be diagnosed using a medical history and physical examination.

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Author:	Douglas Dana Shannon Erstad, MBA/MPH	Last Updated: October 4, 2006
Medical Review:	William M. Green, MD - Emergency Medicine Tom Bailey, MD - Family Medicine Robert B. Keller, MD - Orthopedics
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