Background

A review and analysis of data from two US national surveys in 2002 found that 26.4% of respondents reported low back pain lasting at least a whole day in the past 3 months.^[1]Lower back pain causes more global disability than any other condition.^[2]

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.

Periprocedure

Deyo RA, Mirza SK, Martin BI. Back pain prevalence and visit rates: estimates from U.S. national surveys, 2002. Spine (Phila Pa 1976). 2006 Nov 1. 31 (23):2724-7. [QxMD MEDLINE Link].
Hoy D, March L, Brooks P, Blyth F, Woolf A, Bain C, et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014 Jun. 73 (6):968-74. [QxMD MEDLINE Link].
Casazza BA. Diagnosis and treatment of acute low back pain. Am Fam Physician. 2012 Feb 15. 85(4):343-50. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Last AR, Hulbert K. Chronic low back pain: evaluation and management. Am Fam Physician. 2009 Jun 15. 79(12):1067-74. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link]. [Full Text].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link]. [Full Text].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link]. [Full Text].
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. [QxMD MEDLINE Link].
Magee DJ. Orthopedic Physical Assessment. 2nd Edition. WB Saunders Company: Philadelphia; 1992. 247-307.

Media Gallery

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.

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Nerve Root	Myotome	Dermatome	Reflex
L1	Hip flexion	Anterior lateral thigh	None
L2	Hip flexion and adduction	Anterior medial thigh	None
L3	Knee extension	Distal medial thigh and knee	None
L4	Ankle dorsiflexion	Medial malleolus	Patella tendon
L5	Toe extension (great toe)	Dorsum of the foot	None
S1	Ankle plantar flexion and eversion	Lateral calcaneus and foot	Achilles tendon

Examination of Low Back Pain

Background

References

Tables

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