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Physical Exam Back

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Other Names

  • Low Back Exam
  • Back Exam

Introduction

  • Follows the IP-PASS examination methodology
    • Inspection
    • Palpation
    • Passive Range of Motion
    • Active Range of Motion
    • Strength & Neurovascular
    • Special Tests

Inspection

  • Skin
    • Color: erythema, ecchymosis, white, black
    • Trophic changes (altered hair growth, sweat production)
    • Scars
  • Swelling
  • Muscle tone: atrophy, hypertrophy
  • Deformity: asymmetry, rotation, amputation
  • Areas of emphasis for back exam
    • Evaluate for lordosis, kyphosis, scoliosis
    • Leg length discrepancy
    • Overall posture

Palpation

  • Palpate for
    • Effusion
    • Clicking
    • Snapping
    • Crepitus
    • Tenderness
    • Temperature
    • Masses
  • Areas of Emphasis
    • Midline tenderness
    • Stepoffs
    • Sacroiliac joint

Range of Motion

  • Thoracic
    • Flexion: 80 from neutral
    • Extension: 30 from neutral
  • Lumbar
    • Flexion: 40-60 from neutral
    • Extension: 20-35 from neutral
    • Rotation: 45 from neutral
    • Lateral Flexion (sidebending): 25 degree from neutral

Strength


Neurovascular

Dermatomes of the lower extremity[1]
  • Sensory Nerves
    • L1: Iliac crest, groin
    • L2, L3: Anterior and inner thigh
    • L4: Lateral thigh, anterior knee, medial leg
    • L5: Lateral leg, dorsal foot
    • S1: Posterior Leg
    • S2: Plantar foot
    • S3, S4: Perianal
  • Dermatomes (see image)
  • Reflexes
    • Commonly Used
      • Patellar (L3, L4)
      • Achilles (S1, S2)
    • Uncommonly Used
      • Medial Hamstring (L5, S1)
      • Lateral Hamstring (S1, S2)
      • Posterior Tibial (L4, L5)
      • Cremasteric (L1, L2)
      • Anal wink/ bulbocavernous (S2)
  • Myotomes
    • L2: Hip Adduction, Hip Flexion
    • L3: Knee Extension, Hip Adduction, Hip Flexion
    • L4: Knee Extension, Dorsiflexion
    • L5: Hip Abduction, Hip Extension, Toe Dorsiflexion, Foot Inversion, Dorsiflexion
    • S1 Foot Version, Plantarflexion
    • S2: Toe Plantar Flexion
    • S3: Bowel, bladder function
    • S4: Bowel, bladder function
  • Vascular

Special Tests


See Also


  1. Ostelo, Raymond WJG. "Physiotherapy management of sciatica." Journal of physiotherapy 66.2 (2020): 83-88.
Created by:
John Kiel on 25 May 2020 23:48:23
Authors:
Last edited:
19 August 2021 14:48:38
Category: