Lower Back Exam

Overview

Source: Robert E. Sallis, MD. Kaiser Permanente, Fontana, California, USA

The back is the most common source of pain in the body. Examination of the back can be a challenge due to its numerous structures, including the bones, discs, ligaments, nerves, and muscles-all of which can generate pain. Sometimes, the location of the pain can be suggestive of etiology. The essential components of the lower back exam include inspection and palpation for signs of deformity and inflammation, evaluation of the range of motion (ROM) of the back, testing the strength of the muscles innervated by the nerves exiting in the lumbar-sacral spine, neurological evaluation, and special tests (including the Stork test and Patrick's test).

Procedure

1. Inspection

Inspection should be done with the patient standing, while observing from behind. Have the patient remove enough clothing so the entire back and sacral area can be properly inspected.

Inspect the entire back for redness, asymmetry, deformity, scoliosis, or abnormal hair growth.
From the side, observe lumbar lordosis, which normally appears as a gentle, reverse C-shaped curve of the spine.

2. Palpation

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Application and Summary

Low back pain is very common, and occasionally can be a manifestation of a serious underlying condition, such as cancer, infection, or a surgical emergency. Systematic physical examination supplements the information obtained in the history by helping to identify serious problems that require earlier clinical actions or neurological dysfunction. Examination of the lower back is best done with the patient in both sitting and standing positions, following a step-by-step approach. It is important to have the patient remove

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