Pre-Procedure Planning

Prior to patient contact, the physician should properly wash his or her hands. To complete a proper lumbar spine examination, the physician should be prepared to examine not only the low back but also bilateral hips and both lower extremities.

Equipment

The examination room needs to be spacious to allow for the patient to move freely. It should also contain a full-length sturdy examination table that will allow the patient to sit comfortably and to lie prone and supine. In addition, a stool on wheels will allow the physician to move easily around the room. The physician should be equipped with a measuring tape, goniometer, and reflex hammer.

Patient Preparation

Proper patient exposure is critical to any musculoskeletal examination, including evaluation of the spine. Shoes, socks, shirt, and pants need to be replaced with examination shorts and t-shirt or an examination gown. The patient should be given an additional sheet for leg coverage.

Technique

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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 Periprocedural Care

Pre-Procedure Planning

Equipment

Patient Preparation

References

Tables

Contributor Information and Disclosures

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