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Examination of Low Back Pain

  • Author: Bradley J Sandella, DO, ATC; Chief Editor: Vinod K Panchbhavi, MD, FACS  more...
 
Updated: Apr 05, 2016
 

Background

A standardized clinical examination of the lumbar spine is critical in the evaluation of patients with low back pain. Progressing in an orderly fashion through the different components of the examination ensures accuracy and repeatability.

Every examination should include inspection of the spine followed by active and passive range-of-motion testing, as well as manual muscle testing at the hip and spine. Finally, special testing and palpation are used to confirm findings appreciated earlier in the examination.

See Back Pain: Find the Cause, Watch for the Comeback, a Critical Images slideshow, to help diagnose and manage this common problem.

 
 
Contributor Information and Disclosures
Author

Bradley J Sandella, DO, ATC Assistant Professor, Assistant Program Director, Sports Medicine Fellowship Program, Physician in Sports Medicine/Family Medicine, Drexel University College of Medicine

Bradley J Sandella, DO, ATC is a member of the following medical societies: American Academy of Family Physicians, American Medical Society for Sports Medicine, American Osteopathic Association, National Athletic Trainers' Association, American College of Osteopathic Family Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Christof J Daetwyler, MD Associate Professor of Family, Community, and Preventive Medicine, Office of Educational Affairs, Drexel University College of Medicine

Disclosure: Nothing to disclose.

Steven Peitzman 

Disclosure: Nothing to disclose.

Chief Editor

Vinod K Panchbhavi, MD, FACS Professor of Orthopedic Surgery, Chief, Division of Foot and Ankle Surgery, Director, Foot and Ankle Fellowship Program, Department of Orthopedics, University of Texas Medical Branch School of Medicine

Vinod K Panchbhavi, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Orthopaedic Trauma Association, Texas Orthopaedic Association

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Styker.

Acknowledgements

Videos are courtesy of Drexel University College of Medicine; Christof J Daetwyler, MD, Associate Professor of Family Medicine, Drexel University College of Medicine; and Steven J Peitzman, MD, Professor, General Internal Medicine, Drexel University College of Medicine.

References
  1. Casazza BA. Diagnosis and treatment of acute low back pain. Am Fam Physician. 2012 Feb 15. 85(4):343-50. [Medline].

  2. Chou R, Qaseem A, Snow V, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007 Oct 2. 147(7):478-91. [Medline].

  3. Last AR, Hulbert K. Chronic low back pain: evaluation and management. Am Fam Physician. 2009 Jun 15. 79(12):1067-74. [Medline].

  4. Bruno PA, Millar DP, Goertzen DA. Inter-rater agreement, sensitivity, and specificity of the prone hip extension test and active straight leg raise test. Chiropr Man Therap. 2014. 22:23. [Medline]. [Full Text].

  5. van der Windt DA, Simons E, Riphagen II, et al. Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain. Cochrane Database Syst Rev. 2010 Feb 17. CD007431. [Medline].

  6. Joshi KC, Eapen C, Kumar SP. Normal sensory and range of motion (ROM) responses during Thoracic Slump Test (ST) in asymptomatic subjects. J Man Manip Ther. 2013 Feb. 21(1):24-32. [Medline]. [Full Text].

  7. Nadler SF, Malanga GA, Stitik TP, Keswani R, Foye PM. The crossed femoral nerve stretch test to improve diagnostic sensitivity for the high lumbar radiculopathy: 2 case reports. Arch Phys Med Rehabil. 2001 Apr. 82(4):522-3. [Medline].

  8. Masci L, Pike J, Malara F, Phillips B, Bennell K, Brukner P. Use of the one-legged hyperextension test and magnetic resonance imaging in the diagnosis of active spondylolysis. Br J Sports Med. 2006 Nov. 40(11):940-6; discussion 946. [Medline]. [Full Text].

  9. Ozgocmen S, Bozgeyik Z, Kalcik M, Yildirim A. The value of sacroiliac pain provocation tests in early active sacroiliitis. Clin Rheumatol. 2008 Oct. 27(10):1275-82. [Medline].

  10. Magee DJ. Orthopedic Physical Assessment. 2nd Edition. WB Saunders Company: Philadelphia; 1992. 247-307.

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Introductory discussion on the examination of low back pain.
A discussion on the initial approach to the patient with acute low back pain.
A discussion on visual inspection of the patient with acute low back pain.
Overview of palpation in the examination of a patient with acute low back pain.
A discussion of the role of range-of-motion testing in the evaluation of low back pain.
A discussion of potential causes and symptoms based on patients' descriptions of low back pain.
An introduction to and explanation of the straight leg raise test as part of an examination for low back pain.
Demonstration of the straight leg raise technique.
Explanation of the crossed straight leg raise in the evaluation of low back pain.
Demonstration of dorsiflexion of the big toe as part of the evaluation of low back pain.
Demonstration of Achilles reflex evaluation as part of the examination of low back pain.
Demonstration of plantarflexion evaluation as part of the low back pain examination.
Evaluation of dermatome sensation as part of the low back pain examination.
Evaluation of the patella tendon reflex as part of the low back pain examination.
A discussion of lumbar spinal stenosis as a cause of low back pain.
Demonstration of the Romberg test to evaluate for proprioception in the examination of low back pain.
Table 1. Myotome Testing
Nerve Root Myotome Dermatome Reflex
L1Hip flexionAnterior lateral thighNone
L2Hip flexion and adductionAnterior medial thighNone
L3Knee extensionDistal medial thigh and kneeNone
L4Ankle dorsiflexionMedial malleolusPatella tendon
L5Toe extension (great toe)Dorsum of the footNone
S1Ankle plantar flexion and eversionLateral calcaneus and footAchilles tendon
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