Low Back Pain

HPI:

• Ask about trauma
• Ask about precipitants
• Ask about radiation, numbness, tingling, weakness, etc.
• Ask about possible motivations - worker's comp, etc.
• Ask about bladder or bowel changes

SITTING:

• Observe the back
• Palpate the spine for tenderness
• Palpate the paraspinous muscles for spasm or tenderness
• Palpate the sacroiliac (SI) joint
• Check sensation of the medial calf [sensory L4]
• Check sensation of the dorsal foot [sensory L5]
• Check sensation of the lateral foot [sensory S1]
• Test the patellar reflex [reflex L4]
• Test the Achilles reflex [reflex S1]
• Test hip, knee, and ankles for flexion and extension strength
• While examining feet, note that knee extension is equivalent motion to leg raises - useful for detecting malingering

SUPINE:

• Passive leg raises

STANDING:

• Observe the back
• Feel the iliac crests for equal height
• Palpate the course of the iliac nerve (mid-buttock, posterior thigh, etc.)
• Squat on one leg at a time [motor L4]
• Walk on your heels [motor L5]
• Walk on your toes [motor S1]
• Touch your toes
• Lean back
• Lean right
• Lean left
• Twist right
• Twist left