At a first visit, one of the first things a clinician asks is where it hurts. Most people reach around, wave a hand somewhere below the ribs, and say "my lower back." That is true, and it is nearly useless. The back is a big place, and "sore" covers a dozen different complaints. The words you walk in with shape the questions the exam asks next, so it is worth spending ten minutes the night before finding better ones.
This is not about learning medical vocabulary or guessing at a diagnosis. It is about reporting what you feel the way a good witness reports what they saw: specific, in order, and without dressing it up or playing it down.
Where, exactly
Use one finger, not a whole hand. Then answer these:
- Center or one side? Right on the spine, or off to the left or right of it.
- How high? At the belt line, just above the tailbone, up near the bottom of the ribs, or across the top of the hip bone.
- Does it stay put? A spot you could cover with a coin, a band across the whole low back, or something that spreads into a buttock or the side of the hip.
- Has it moved since the crash? Pain that started on one side and now sits in the middle is worth mentioning.
If pointing is awkward, sketch a rough outline of a back on a sheet of paper and shade where it hurts. Bring it. A drawing made at home on a bad evening is often more accurate than one made on an exam table while you are nervous.
What it feels like
People tend to reach for "sore" or "tight" because they are safe words. Try to be more exact. You do not need to know what a word means clinically. You only need to pick the one that fits.
| Word | What people usually mean by it |
|---|---|
| Ache, dull | Constant, low-level, hard to point at, there in the background all day |
| Sharp, stabbing | Sudden, sits in one place, often tied to a particular movement |
| Tight, cramping | A pulling or clenching feeling, like a muscle that will not let go |
| Stiff | Less pain than resistance: it does not want to bend or twist |
| Burning | Hot, surface-level or deep, sometimes worse at rest |
| Electric, shooting | A jolt that travels, rather than staying in one spot |
More than one can be true. "A dull ache all day, and a sharp catch when I stand up from the couch" is a very good sentence to say at an exam.
What changes it
This is the part people skip, and it is often the most useful. Before the visit, notice what makes the back worse and what makes it better. Common ones to check:
- Sitting for a long time, and the first few steps after you stand up
- Bending forward to put on socks or load the dishwasher
- Coughing, sneezing or laughing
- Rolling over in bed, or getting out of bed in the morning
- Walking, and whether it eases or builds the longer you walk
- Driving, especially the moment you get out of the car
Note the time of day, too. A back that is stiff first thing and loosens up by lunch is a different report from a back that is fine in the morning and worst by 6 p.m.
A 0 to 10 scale that means something
You will almost certainly be asked to rate the pain from 0 to 10. The trouble is that one person's 7 is another person's 3. You can make your number mean more by tying it to what you could and could not do:
- 2: I notice it if I think about it.
- 4: It changes how I sit, stand or lift.
- 6: It stops me from doing something ordinary, like carrying laundry up from the basement.
- 8: I cannot sleep through it or think about much else.
Give three numbers, not one: your usual level, the worst it has been in the past day, and the best. Then name the task. "Usually a 4, it hit 7 when I tried to pick up my daughter, and it drops to 2 lying on my back" gives an examiner far more to work with than "about a 6."
Before the crash and after
Plenty of St. Louisans had a cranky back long before anyone rear-ended them. Say so. Then say what is different now: a new location, a new kind of pain, a higher number, a task you could do last month and cannot do this week. An honest before and after is part of the history, and the history is the first page of the dated exam record.
If it travels
If the pain runs into a buttock or down a leg, say how far it goes and whether there is numbness or tingling with it. New numbness in the groin or inner thighs, loss of bowel or bladder control, or a leg that is getting weaker is an emergency room trip right now, not a clinic call. The ER or clinic chapter covers the full list.
Put it on a card
Write five lines on an index card or in your phone and read from it at the visit:
Rear-ended on I-55 northbound, Tuesday. Stopped, not braced.
Right side of the low back, belt line. Dull ache, sharp catch when I stand.
Worse after sitting and first thing in the morning. Better walking.
Usually 4, worst 7 lifting a laundry basket, best 2 lying down.
Had some back stiffness before. Never on the right side, never this sharp.
That card takes two minutes to write and saves ten minutes of trying to remember while someone waits. The first visit chapter covers what else to bring.
Have the words ready, then book a back exam this week at Missouri Injury Clinic. Tesson Ferry, (314) 530-5480, is the near office for most of the city. Hazelwood is (314) 627-1411 and O'Fallon is (636) 280-0990. Every office is closed from 12 to 2.