Orthopedics Book

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Low Back Standing Exam

Aka: Low Back Standing Exam, Standing Low Back Exam
  1. See Also
    1. Low Back Pain
    2. Low Back Exam
    3. Sitting Low Back Exam
    4. Supine Low Back Exam
  2. Exam: Observation and Palpation
    1. Images
      1. BackExamNomenclature.gif
    2. Assess Curvature
      1. Kyphosis
      2. Lordosis
    3. Chest Expansion with inspiration and expiration
      1. Normal expansion: 5 cm
      2. Ankylosing Spondylitis: < 2.5 cm
    4. Iliac crests
      1. Palpate for equal level
      2. If not level, use footboards to raise shorter leg
        1. Assess amount of shoe lift to level Pelvis
    5. Shoulders
      1. Assess symmetry of Shoulder levels
      2. Dominant Shoulder is often lower in normal people
    6. Spine and Sacroiliac joints
      1. Palpate and percuss for spasm and tenderness
      2. Spinous process tenderness suggests Vertebral Fracture
      3. Step-off at L5 suggests Spondylolisthesis
  3. Exam: Range of Motion
    1. Flexion on forward bending
      1. Measure as distance between fingertips and floor
        1. Lumbar Spine mobility
        2. Hamstring flexibility
      2. While bending assess Scoliosis (Shoulders even?)
      3. While bending observe from side
        1. Persistence of lumbar lordosis due to muscle spasm
      4. Limited in Spondylolisthesis (due to hamstring spasm)
    2. Extension of back
      1. Pain on extension seen in spinal stenosis
      2. One Legged Hyperextension (for SI Joint Dysfunction)
    3. Right and Left lateral Bending
      1. Pain bending toward affected side
        1. Lumbar Disc Disease
      2. Pain bending away from affected side
        1. Tendon Strain
  4. Exam: Gait
    1. Walk on heels (L5 root)
    2. Walk on toes (S1 root)
    3. Tandem Walk
      1. Incoordination may suggest cerebellar disorder(e.g. Multiple Sclerosis)

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