Low Back Pain Physical Exam

Open Handout

 


 


STANDING
:

Inspection

    • Spine
    • Leg length discrepancy/pelvic tilt
    • Scoliosis
    • Postural dysfunction
    • Muscle asymmetry
    • Skin lesions, incisions

Gait

    • Velocity, symmetry
    • Heel and toe walking

Balance

  • Romberg

Range of Motion

    • Flexion (cephalad to caudal progression reversed at the L spine? Disc pain?)
    • Extension (facet pain?)
    • Rotation
    • Lateral flexion
    • Facet loading maneuver

Palpation

    • Spinous processes, interspinous ligaments
    • Lumbar paraspinal
    • Buttock
    • Other areas

Waddell Signs – Pain caused by:

    • Rotating hips WITH spine
    • Light pressure on the head
    • Gentle effleurage of superficial tissues
    • Non-physiologic pain/sensory patterns (e.g. non-dermatomal leg pain, sensory deficits from waist down)


SITTING
:

Extremity Strength

    • Flexion of thigh at the hip against resistance (iliopsoas – L1, 2, 3)
    • Extension of leg at the knee against resistance (quadriceps – L2, 3, 4)
    • Heel walking (tibialis anterior – L4)
    • Dorsiflexion of great toes (extensor hallucis longus – L5)
    • Plantar flexion

Reflexes

    • Patellar
    • Achilles
    • Babinski

Sensory exam

    • Light touch
    • Sharp stimulus (toothpick)
    • Consider temperature (ice) if exam is difficult to evaluate
    • Straight Leg Raise (Waddell’s if different seated vs. supine)


SUPINE:

Straight Leg Raise (pain at 30-60 degrees is positive – L5, S1)

    • Ipsilateral
    • Contralateral

FABER Test (sacroiliac dysfunction)

Gaenslen’s (SI dysfunction)

Decubitus position

    • Palpation of trochanteric bursa, gluteal muscles
    • Passive external rotation of the hip
    • External rotation of hip against resistance, repeat while palpating piriformis


PRONE
:

Femoral Stretch (L2, 3, 4)

Watch for fluidity of exam, ease of changing position, which leg used to get up on table, etc. Look for consistency (inconsistency) between complaints, studies and behaviors.