We do back pain examination every day, but it is worth remembering how to do it properly.
- Introduction, Consent, Handwashing, Chaparone. Exposure from the waist up
Inspection from the back and side for:
Cervical lordosis, thoracic kyphosis and lumbar lordosis (lost with age, ank spond, acute disc prolapse).
Cafe au lait spots (neurofibromatosis), hairy patch (spinal dysraphism)
Palpate each spinous process
Palpate sacroiliac joints
Palpate paraspinal muscles
Percuss with a fist or tendon hammer (infection, fracture or tumour)
Lumbar: Lumbar flexion, extension and lateral flexion.
run hands down side (lateral flexion)
touch their toes with knees straight (flexion)
lean backwards with knes straight (extension) - no extension in facet disease.
Can do a modified Schobers Test - place index and middle fingers 5 centimeters apart and noting how close and far apart they move on the movements.
Lateral flexion: place your ear on your shoulder;
rotation: look over your shoulder;
flexion: put your chin on your chest;
extension: put your head back to look at the ceiling.
Fix pelvis and turn
- Special Tests
Straight leg raise - to look for sciatica
Sciatic nerve test - do SLR. When pain brought on, dorsiflex the foot = positive = sciatic!
Bowstring test - SLR. Then lower. Apply popliteal compression = symptoms.
Femoral nerve stretch test - lie prone, passively flex knee - severe = positive.
Tiptoe test - tests S1
Duck walk (on heels) - for L4 power