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When a patient comes in with back pain, examinations are done to figure out the cause, severity, and whether it’s coming from muscles, joints, nerves, or internal organs.
A proper assessment usually has three main parts:

1. History Taking (Interview)

The clinician asks about:

• Onset – When did the pain start? Sudden or gradual?

• Location – Is it in the lower back, upper back, or radiating to the legs/arms?

• Character – Sharp, dull, burning, throbbing?

• Aggravating & relieving factors – Does it worsen with movement, rest, bending?

• Duration & pattern – Constant or intermittent? Morning stiffness?

• Associated symptoms – Numbness, tingling, weakness, fever, bladder/bowel changes.

• Past history – Injuries, surgeries, chronic diseases, osteoporosis risk.

• Lifestyle – Occupation, physical activity, posture habits.

2. Physical Examination

a. Observation

• Posture, spinal alignment, gait (walking pattern)

• Any visible swelling, muscle spasm, scars, deformities.

b. Palpation

• Feeling for tenderness, warmth, muscle tightness, or step-offs in vertebrae.

c. Range of Motion (ROM) Tests

• Forward bending, backward bending, side bending, rotation — checking for restrictions or pain.

d. Neurological Examination

• Reflexes – Knee jerk, ankle jerk, etc.

• Strength testing – To detect muscle weakness.

• Sensation testing – Checking for numbness or tingling areas.

• Special nerve tests – e.g., Straight Leg Raise (SLR) for sciatica, Slump test.

e. Special Orthopedic Tests

• Schober test – Measures lumbar spine flexibility (for ankylosing spondylitis).

• Facet joint loading test – Tilting and twisting to check facet joint pain.

• SI joint stress tests – For sacroiliac joint issues.

3. Imaging & Laboratory Tests (if needed)

• X-ray – Checks bones, alignment, fractures, arthritis.

• MRI – Detects herniated discs, nerve compression, soft tissue injuries.

• CT scan – Detailed bone and joint structures.

• Bone scan – For fractures, tumors, infections.

• Blood tests – For infection, inflammation (ESR, CRP), autoimmune markers.

Flow acupuncture clinic is a English-friendly clinic in Tokyo. Please feel free to contact us.

03-6453-6376