What questions are asked during treatment for lower back pain?

It is easy to think that one must take an X-ray or MRI first to understand the condition if the lower back hurts.

However, many common cases of lower back pain can be evaluated for initial treatment direction simply by examining the onset process of the pain, changes with movement, and carefully assessing strength and sensation in the legs.

This process is called history taking.

Taking a medical history involves more than simply asking, “Where does it hurt?” This is an important examination to distinguish whether the pain is related to muscle and joint issues or requires evaluation of the lumbar nerves, and whether imaging studies or visits to other medical institutions are needed first.

Even for the same lower back pain, the content to be examined differs depending on how it started.

• Pain that suddenly occurs when lifting a heavy object
• Did it start after twisting your back or exercising?
• Have you fallen or been in a traffic accident?
• Did it gradually worsen without any specific trigger?
• Has similar pain occurred repeatedly in the past?
• Whether it is improving compared to the initial state, remaining unchanged, or worsening

If your back feels stiff after lifting a heavy object, you can first examine for sprain and muscle tension. Conversely, if pain and difficulty moving occur after a severe trauma, it may be necessary to first check for a fracture.

The location and nature of the pain are also important information.

• Does the middle of your lower back hurt?
• Is only one side of the lower back painful?
• Does the heaviness extend down to the buttocks?
• Does it extend down to the thigh, calf, and foot?
• Does it feel sore, sharp/stinging, or like an electric current?
• Is there also numbness or decreased sensation?

Depending on whether the pain is confined to the lower back or extends down into the legs, the need for neurological examination may vary.

Lower back pain often varies with movement.

• Is it severe when sitting?
• Does it hurt when you sit down and stand up?
• Does it hurt when you bend forward?
• Does it hurt when you straighten your back or lean backward?
• Is it severe when walking or standing for a long time?
• Is it comfortable when lying down?
• Is it difficult to turn over in bed?
• Does leg pain worsen with coughing or sneezing?

Confirming which movements reproduce pain and which postures relieve it helps determine the direction of the physical examination.

If you experience the following symptoms along with lower back pain, you must inform us.

• Pain radiating from the buttock down to the leg
• Numbness in the legs and feet
• Diminished skin sensation or a feeling that the left and right sides feel different.
• Weakness in the ankle or toes
• Dragging the foot along the ground
• Difficulty climbing stairs
• Walking distance has decreased.
• Both legs are painful or numb at the same time.

Changes in actual muscle strength and sensation may be more important signals than severe pain.

In the treatment of lower back pain, the following items must be confirmed before performing Chuna manual therapy.

• Has control over urination and defecation changed suddenly?
• Has the sensation in the perineum or inner buttocks become dull?
• Is your leg strength decreasing rapidly?
• Have you had a severe fall or been in a traffic accident?
• Do you have high fever or chills?
• Do you have a history of cancer, infection, or osteoporosis?
• Did you lose weight without any reason?
• Does the pain continue to worsen even at rest?

Having these symptoms does not necessarily mean you have a serious condition. However, if missed, it can be dangerous; therefore, imaging or evaluation at another medical institution may be necessary first.

Even medical history that appears unrelated to the lower back can affect treatment safety.

• Osteoporosis and Fracture
• Lumbar surgery and procedures
• Cancer and Infection
• Diabetes and Peripheral Neuropathy
• Cardiovascular and vascular diseases
• Rheumatic and inflammatory diseases
• Possibility of pregnancy
• Risk of bleeding and use of anticoagulants
• Long-term use of steroid medication
• Recent injection therapy
• Medications currently being taken

Especially osteoporosis history, surgical history, and the timing and location of recent injections are important information for determining the method and intensity of Chuna manual therapy.

The treatment goal is not merely to reduce the pain score.

• How long can you sit?
• How far can you walk?
• Is it difficult to wear shoes and socks?
• Is it difficult to sleep or turn over in bed?
• Whether one can continue working
• To what extent are exercise, household chores, and childcare restricted?

These functions serve as criteria for confirming changes before and after treatment.

Briefly noting the following content can help with your consultation.

1. Date when pain began
2. The occasion when pain occurred
3. How far does the pain extend?
4. Positions that worsen the condition and positions that relieve it
5. Whether there is leg numbness and weakness
6. Whether there are changes in urination, defecation, and sensation in the perineum
7. Response to previous examinations and treatments
8. Currently prescribed medications and major conditions

If you have existing X-ray or MRI images, please prepare the imaging studies and their interpretation reports together.

A medical history alone cannot confirm every condition.

However, through a detailed history taking, it is possible to determine which physical and neurological examinations are needed, whether there are warning signs, and whether imaging studies will change the treatment direction.

In many cases of general musculoskeletal pain, the clinical interview and physical examination form the core of the consultation, with imaging studies or referrals added only when necessary.

• If there is a risk of severe trauma or fracture, we perform an examination before Chuna manual therapy.
• If progressive muscle weakness is present, neurological evaluation and consultation are prioritized.
• If it is judged to be a common muscle or joint problem, we directly examine the movement.
• If pain persists and recurs over time, we also examine sleep patterns, activity levels, and work-related movements.
• If there is a history of surgery or osteoporosis, we adjust the treatment technique and intensity.
• After treatment, we check whether the movement that was initially uncomfortable has actually changed.