Before a health care professional can diagnose your condition and design a treatment plan, a complete history and physical examination are necessary. There are so many possible internal causes of pain; it is important to determine what is and is not the root of the problem.

History

First, you will be asked for a complete physical history of your condition. This may begin by filling out a written form that asks you a number of questions relating to your pain. The more information you share with your provider, the easier your problem will be to diagnose. Your physical history is important because it helps your doctor understand: when the pain began, anything that could have caused an injury, your lifestyle, physical factors that might be causing the pain, and any family history of similar problems. After reading through your written history, your physician will ask more questions that relate to the information you have given. Some typical questions include:

When did the pain begin?

Was there an injury that could be related to the pain?

Where do you feel the pain? What is the intensity?

Does the pain radiate to other parts of the body?

What factors make the pain feel better or worse?

Have you had problems with your bladder or bowels?

Is there a history of osteoporosis in your family?

Physical Examination

After taking your history, the doctor will give you a physical examination. This allows the doctor to rule out possible causes of pain and try to determine the source of your problem. The areas of your body that will be examined depend upon where you are experiencing pain - neck, lower back, arms, legs, etc. The following are some of the things that are checked in a typical exam:

Motion of Spine and Neck - Is there pain when you twist, bend, or move? If so, where? Have you lost some flexibility?

Weakness - Your muscles will be tested for strength. You might be asked to try to push or lift your arm, hand, or leg when light resistance is put against them.

Pain - The doctor may try to determine if you have tenderness of certain areas.

Sensory Changes - Can you feel certain sensations in specific areas of the feet or hands?

Reflex Changes - Your tendon reflexes might be tested, such as under the kneecap and under the Achilles tendon on your ankle.

Motor Skills - You might be asked to do a toe or heel walk.

Special Signs - The physician will also check for any "red flags" that could indicate something other than spinal/vertebrae problems. Some signs of other problems include: tenderness in certain areas, a fever, an abnormal pulse, chronic steroid use (leads to loss of bone mass), or rapid weight loss.

Diagnostic Tests

You may be asked to take a variety of diagnostic tests. The tests are chosen based upon what your physician suspects is the cause of your pain. The most common diagnostic tests used to diagnose degenerative disc disease are probably ordinary X-rays, CT scan and MRI scan.

X-rays

An X-ray is a painless process that uses radioactive materials to take pictures of bone. If your doctor suspects vertebral degeneration, X-rays can be used to verify: a decrease in the height of space between discs, bone spurs, nerve bundle sclerosis (hardening), facet hypertrophy (enlargement), and instability during flexion or extension of limbs. X-rays show bones, but not much soft tissue, so they will definitely be used if fractures, infections, or tumors are suspected.

During X-rays, you will be asked to lie very still on a table and hold certain positions while pictures are taken of your spine.

CT-scan

CT scan of the cervical spine is valuable in assessing bone injury, such as fracture and/or dislocation. Bulging or herniated discs may or may not be visible on CT scan, and may or may not be related to the patient's symptoms. CT scan is most useful in showing bone structures, and is not as good as MRI in showing spinal cord, nerve roots or discs. CT scan does not show torn ligaments or minor tears of discs.

MRI Scan (Magnetic Resonance Imaging)

The MRI scan is a fairly new test that does not use radiation. By using magnetic and radio waves, the MRI creates computer-generated images. The MRI is able to cut through multiple layers of the spine and show any abnormality of soft tissues, such as nerves and ligaments. The test also can be used to verify: loss of water in a disc, facet joint hypertrophy (enlargement), stenosis (narrowing of spinal canal), or a herniated disc (protrusion or rupture of the intervertebral disc).

During an MRI test, you lie on a table that slides into a machine with a large, round tunnel. The machine's scanner then takes many pictures that are watched and monitored by a technician. Some newer MRI machines, called Open MRIs, are likely to be more comfortable for patients who experience claustrophobia. The procedure takes 30-60 minutes.