Your doctor will examine your back and check for tenderness. To determine the source of your pain, your doctor might ask you to lie down and then move your legs around. To check your neurological health, your doctor might also conduct a neurological exam.
- Reflexes
- Muscle strength
- Walking ability
- Feeling light touch, pinpricks or vibration
A physical exam and a medical history are sufficient to diagnose most cases of herniated discs.
Questions to Expect
It is common to ask questions about the time and manner in which the pain began, especially if there were any traumatic injuries. You might also be interested in:
- The type of pain. The pain may be described by the patient, including its location and what activities or positions make it worse.
- Other medical conditions. Other medical conditions may also be a factor. For example, osteoporosis can increase the chance of a fracture.
- Work and home life. A lumbar disc can be put under pressure if you have a physically demanding job, or if you are doing repairs or any other hard work at home.
- Your medical history. Most likely, the doctor will ask about any injuries or previous treatments.
- Medical history. If a relative has the condition, a lumbar herniated disk is more likely.
- Talk about any experience with anxiety or depression. This information can be very helpful in planning treatment.
Your doctor may order the following tests if he suspects you have another condition, or to determine if nerves are affected.
Imaging tests
- X-rays. While plain X-rays can’t detect herniated discs, they can rule out other causes such as infection, tumors, spinal alignment issues or broken bones.
- CT scan. CT scanner uses a combination of X-rays taken from different directions to create cross-sectional images that show the spine and structures surrounding it.
- MRI. Images of the internal structures of the body are created using radio waves and strong magnetic fields. This test can be used for confirming the location of the herniated disc and to determine which nerves are affected.
- Myelogram. Before a CT scan can be taken, a dye is injected into your spinal fluid. This can be used to determine if there is pressure on the spine or nerves from multiple herniated discs or other conditions.
Lumbar Herniated Disc: Physical Examination
A physical exam is essential to diagnose a condition. It usually involves observing the patient bend and stretch. These types of assessments are common:
Neurological examination. The doctor will usually look for signs of loss or weakness in the foot and leg to determine if there is a neurological problem. To check for foot drop, the doctor may ask the patient to walk on tiptoes and normal to see if the muscles that flex the toes and ankles are weakening. Reflexes and muscle strength in other areas may also be tested. Reflexes might be slower or not at all normal.
A range of motion tests. You may ask the patient to bend to one side or both.
- Leg raise test. Straight leg raise (or LaSegue) is a common way to check for a herniated disk. The doctor will gently lift the affected leg until the patient feels the pain. It is possible to have lumbar disc herniation if the leg is raised at an angle of 30 to 70 degrees. It is possible that the nerve root has been impinged. These stretches can be performed in a variety of ways, including while the legs are crossed or seated. The straight-leg-raise test has not been shown to be as effective in detecting lumbar herniated disks in older people than 60.1
- Vital signs check. A rise in blood pressure or pulse rate can indicate pain. An elevated temperature could be a sign that there is an infection.
- Gait monitoring. The doctor will examine the patient’s gait to determine if they are walking slowly or abnormally due to pain.
- Lumbar spine area exam. Examen the area around the lumbar spine for inflammation. Skin may feel sensitive or abnormal.
Imaging tests are not necessary if the doctor does not see any signs that there is a serious problem. Some doctors prefer that the patient wait six weeks to see if the symptoms resolve. This is what most people do.
Nerve tests
The ability to measure the electrical impulses moving along nerve tissue is measured by nerve conduction studies and electromyograms. This helps pinpoint nerve damage.
- Nerve conduction study. The electrodes are placed on the skin to measure electrical nerve impulses and function in the muscles and nerves. This study measures electrical impulses in nerve signals, when a small current passes through the nerve.
- Electromyography (EMG). An EMG is when a doctor inserts an electrode through the skin to various muscles. This test measures the electrical activity of muscles at rest and contract.
You can also use other tests to diagnose a herniated disc
Your spine specialist may recommend additional tests to ensure the best diagnosis.
- Discogram, also known as discography, is a sterile procedure that injects dye into one of your vertebral discs. The dye can then be viewed under special conditions (fluoroscopy). It is intended to identify which discs may be causing your pain.
- Bone scan. This method creates film or computer images of bones. A small amount of radioactive material is injected into the blood vessels and then distributed throughout the bloodstream. The radioactive material collects in the bones and is detected using a scanner. This allows doctors to detect problems like arthritis, tumors, and infections in the spine.
- Laboratory tests. Blood is usually drawn (venipuncture), and the cells are tested to see if they are normal or abnormal. A metabolic disorder could cause back pain by causing chemical changes in your blood.
