Approximately 80% of the population is plagued by back pain at one time or another. Associated leg pain occurs less frequently. Pain can be bothersome and debilitating, limiting daily activities. Leg and back pain, including sciatica, can be caused by a variety of reasons, not all of which originate from your spine.

Physical Examination to Diagnose Low Back Pain

During the physical and neurological examination, the physician observes your ability to move (range of motion) and movements that are difficult and/or that cause symptoms. Your reflexes are also tested and may reveal important findings about which nerve root(s) may be compressed.

In the table below, "L" means lumbar (low back) and "S" means sacral (back of the pelvis). The number that follows denotes the level in the particular region of the spine.

The table (below) shows what findings your physician may find during his/her examination.

Nerve Root Involved Possible Exam Findings with Nerve Root Compression L2

• Decreased hip flexor strength (hip flexor muscles allow you to lift your knee toward your chest)

L3

• Decreased patellar reflex (knee jerk response)
• Sensation loss of the anterior thigh (front of one or both thighs)
• Weakness in quadriceps muscle (a large muscle group at the front of each thigh)
• Pain in the area of the anterior thigh (front of a thigh)

L4

• Sensory loss of the anterior, lateral or medial foot (front, side or inside of a foot)
• Possible decreased patellar tendon reflex (knee jerk response)
• Weakness of the quadriceps muscle
• Pain in the area of the anterior leg (front of a leg)

L5

• Sensory loss in the dorsum (top) of the foot and great toe
• Weakness of the anterior tibialis (front of a shinbone) , great toe (extensor hallicus longus), and hip abductors (moves a leg outward from the hip)
• Pain down the side of the leg

S1

• Decreased Achilles reflex (heel)
• Sensory loss of the lateral (side) foot and the small toe
• Weakness of the gastrocnemius (calf muscle), gluteus maximus (buttock muscle), plantar flexor (enables you to point your foot), and great toe
• Pain down the back of the leg into the bottom or side of the foot

Imaging Tests Help Confirm the Diagnosis
To further determine the source of your symptoms, and to confirm your diagnosis, your physician may request other tests such as an X-ray or MRI (magnetic resonance imaging).

• An x-ray is used to show the bony anatomy of the spine. In an x-ray, the physician is looking for the alignment and integrity of the bony structures. Integrity in this sense means no degeneration in the bone structures.

• An MRI produces images of the soft tissues of the spine. Using an MRI, the physician looks at the soft tissue structures such as the discs, ligaments, spinal cord, and spinal nerves. The physician looks at the integrity of the discs themselves for degeneration (dark in color because of loss of hydration), bulging or herniation (where the disc contents protrude into the spinal canal and compress the nerves or spinal cord). If there is a herniation present, the MRI helps the physician determine if the nerves are being pinched or smashed by the herniated disc.

Low Back and Leg Pain (Sciatica) Treatments
Low back pain with lumbar radiculopathy is often treated conservatively. These non-surgical treatments may include a combination of:

• Rest
• Medication
• Spinal injections are dual purpose; may manage pain and provide diagnostic information
• Home exercise or structured physical therapy program

Spine surgery may be recommended if symptoms persist after a period of conservative treatment. These symptoms may include severe pain, increasing numbness, or weakness of the legs. The decision for surgical intervention is often made when conservative treatment has failed and the symptoms are interfering with your daily function causing lifestyle changes such as an inability to work or participate in the activities you enjoy.