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The arrival at a diagnosis, in medicine, requires a history, physical exam, and tests. Generally, 85% of the diagnosis relies upon the history. When it comes to low back and leg pain, important questions include:

*when did the pain begin
*what precipitated it; was there an injury, or did it occur spontaneousluy?
*does it stay in the back, or does it travel down the leg, and it so, where in the leg does it go
*what makes the pain better, and what makes it worse
*is there any weakness associated with it
*is there any loss of bowel or bladder control

Next, the physical exam should contribute 10 % to the diagnosis. During the exam, specific things the physician will watch for are:

1. Reflex changes can also result from pressure on a nerve. The S1 root is responsible for the achilles reflect, and injury to this root may result in an absent ankle jerk.

2.Sensory changes in the lower extremity, in the distribution of the nerve being affected. The S1 root supplies sensation the the lateral aspect of the foot, and injury to the root can result in numbness to the lateral foot and and little toe.

3.Seakness in the lower extremities. The lumbar and sacral nerve roots each supply different muscle groups. Pressure on a nerve root will often cause weakness in the muscle supplied by that root. For example, the S1 root supplies the gastrocnemius muscle (calf muscle), and injury to or pressure upon the root may cause the patient to have difficulty walking on the toes. Pressure or injury to the L5 root may cause difficulty picking up the big toe, and can result in foot drop.

4.Signs of “straight leg raising” or “crossed straight leg raising”: a straight leg raise is a test in which the leg is raised straight up in the air, extending the knee. If pain shoots down the leg being raised, this is a positive indication that there is likely to be something (quite possibly a herniated disk) pushing on the nerve root. A crossed straight leg raise test is a test where, when one leg is raised, the pain travels down the opposite leg. This sign often has a 96% accuracy in predicting the presence of a herniated disk.

5.Tenderness to palpation over the lumbar spine

Tests: In many cases, testing is not needed for simple low back pain. When testing is required, the type and amount are determined by the severity of the pain, whether it is chronic, and the individual’s history of trauma or signs or symptoms (frequently called “red flags”) suggesting the possibility of serious disease like spinal infection or tumor. In order to be considered diagnostic, test results must closely correlate with symptoms.

Physical exam: Individuals are examined in three positions: lying flat (supine), sitting, and standing. The exam includes visual inspection for obvious asymmetry, deformities, or accentuated spinal curves. Posture, gait, and range of motion are evaluated. Neurological examination assesses reflexes, muscle strength, sensation, and gait. Palpation along the spine, muscles, and tendon insertions can reveal areas of localized tenderness. Examination of the circulation in the lower extremities is important to exclude vascular causes of leg pain.