Exam

Low Back Exam

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Low Back Exam, Low Back Assessment, Low Back Pain Exam

  • See Also
  1. Low Back Pain
  2. Lumbar Spine Anatomy
  3. Low Back Pain History
  4. Low Back Pain Red Flags
  5. Low Back Exam
  6. Differential Diagnosis of Low Back Pain
  7. Rheumatologic Conditions affecting the Low Back
  8. Low Back Pain in Children
  9. Low Back Pain in Teen Athletes
  • Precautions
  1. Back should be exposed (e.g. in gown) to allow for adequate palpation and visualization
  • Exam
  • Approach
  1. See links for each summarized section below
  2. Standing Low Back Exam
    1. Observation and Palpation
      1. Assess Curvature (Kyphosis, Lordosis)
      2. Chest Expansion with inspiration and expiration
      3. Iliac crests (palpate for equal level)
      4. Shoulders (assess symmetry of Shoulder levels, dominant Shoulder is often lower)
      5. Spine and Sacroiliac joints (palpate and percuss for spasm and tenderness)
    2. Range of Motion
      1. Flexion on forward bending
        1. Measure as distance between fingertips and floor (Lumbar Spine mobility, Hamstring flexibility)
      2. Back Extension
        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 (Lumbar Disc Disease)
        2. Pain bending away from affected side (low back Muscle spasm or strain)
    3. 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)
  3. Sitting Low Back Exam
    1. Complete lower extremity Neurologic Exam
    2. Consider measuring thighs and calves for discrepancy between sides (signs of Muscle atrophy)
    3. Sitting root test (Sitting Straight Leg Raise)
      1. Lower Test Sensitivity as standard supine Straight Leg Raise
      2. Observe discrepancy between supine and sitting SLR
        1. Consider Malingering if significant discrepancy
  4. Supine Low Back Exam
    1. Hip Range of Motion
      1. Assess for primary hip disorder
    2. Assess Leg lengths
    3. Supine Straight Leg Raise
    4. Pelvic Compression Test
    5. Pedal Pulses (Dorsalis Pedis Pulse, Posterior Tibial Pulse)
  5. Neurologic Exam
    1. Sensory Exam
    2. Reflex Exam
    3. Motor Exam
    4. Clonus (suggests Upper Motor Neuron involvement)
  6. Images
    1. BackExamNomenclature.gif
  • Exam
  • Other findings
  1. Gastrointestinal findings
    1. Epigastric or right upper quadrant tenderness
      1. Peptic Ulcer Disease
      2. Pancreatitis
      3. Cholecystitis
    2. Flank Pain
      1. Nephrolithiasis
    3. Midline pulsatile mass
      1. Abdominal Aortic Aneurysm
    4. Decreased Rectal Tone or decreased perineal Sensation
      1. Cauda Equina Syndrome
  2. Genitourinary findings
    1. Adnexal tenderness or cervical motion tenderness
      1. Pelvic Inflammatory Disease
    2. Prostate tenderness and swelling
      1. Prostatitis
    3. Urinary Retention (with significant post-void residual)
      1. Cauda Equina Syndrome
  3. Vascular findings
    1. Varicosities of lower extremities
    2. Diminished Peripheral Pulses
      1. Peripheral Arterial Disease (Claudication)
  4. Skin Findings
    1. Cafe-Au-Lait Spots
    2. Cutaneous Signs of Dysraphism (e.g. midline hairy patches)
    3. Lipomata
    4. Pilonidal Cyst
    5. Perirectal Abscess
  • Diagnostics
  1. See Low Back Imaging
  • References
  1. Earwood (2025) Am Fam Physician 112(5): 526-36 [PubMed]