What Happens During a Back Pain Evaluation?

Many people delay getting their back checked because they are unsure what to expect. Knowing what happens can make the first visit easier.

At Innovative Nerve & Joint Centers, Dr. Paul Fisher holds advanced certification in Selective Functional Movement Assessment and completed Department of Defense hospital rotations in orthopedic surgery, radiology, pain management, and physical medicine and rehabilitation.

What Happens at My First Visit?

Your visit starts with your story. We ask when the pain began, what triggered it, where you feel it, and what makes it better or worse. We also ask about leg symptoms, sleep, work, past injuries, and your goals.

Next comes the exam. We check posture, spinal motion, tenderness, and strength. A neurological screen tests reflexes, sensation, and muscle strength in the legs to see whether a nerve is involved.

One of the most important parts of this visit is understanding your goals. For some patients, it’s being able to sleep through the night, while others want to be able to run 5 miles. This also matters because in cases of chronic pain, your function may improve faster than your pain decreases. While this can be frustrating, it’s important to understand that you are still improving.

What Is a Movement Assessment (SFMA)?

The Selective Functional Movement Assessment is a structured series of movements, such as bending, squatting, rotating, and balancing on one leg. It shows which movements are painful and which are limited without pain.

That distinction matters. A stiff hip or weak core can overload the low back, even when the pain is felt in the spine. The SFMA helps us find those links so treatment addresses the cause, not just the sore spot. Understanding how your body is moving (and not moving) shows us where to test further and how to tailor therapy to your specific needs.

When Are X-Rays or an MRI Needed?

Most new back pain without trauma or severe pain does not need imaging, though these are cases we rarely see in the office. Clinical guidelines from groups such as the American College of Physicians recommend against routine imaging for low back pain without warning signs.

Imaging may be recommended when there are signs of a serious problem, significant or worsening nerve symptoms, a history of trauma, or pain that is not improving with good care. When imaging is used, results are always read alongside your exam.

If X-rays are performed, they are evaluated using CRMA (computerized radiographic mensuration analysis) with a program called PostureRay, which compares them to normal spinal alignment.

What Questions Should I Ask at My Evaluation?

• What do you think is causing my pain?
• Is a nerve involved?
• Do I need imaging, and why or why not?
• What should I avoid, and what should I keep doing?
• How will we measure progress?
• What would make you refer me to another specialist?

Frequently Asked Questions About Back Pain Evaluations