Physical Exam Back

Other Names

• Low Back Exam
• Back Exam

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Introduction

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

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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

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Palpation

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

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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

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Strength

• Motor examination
  • Should include examination of intrinsic back muscles and lower extremities
• Back
  • Extension: Erector Spinae Muscles, Multifidus
  • Lateral Flexion (sidebending): Erector Spinae Muscles, Quadratus Lumborum
  • Rotation: Multifidus
  • Flexion: Rectus Abdominis, Internal obliques, External Obliques
• Hip
  • Hip Flexion (L2, L3): Iliopsoas
  • Hip Adduction (L2, L3): Gracilis, Obturator Externus, Adductor Brevis, Adductor Longus and Adductor Magnus
  • Hip Extension (L5): Gluteus Maximus, Biceps Femoris, Semitendinosus, Semimembranosus, Adductor Magnus
  • Hip Abduction (L5): Gluteus Medius, Gluteus Minimus, Tensor Fasciae Latae
• Knee
  • Knee Extension (L3, L4): Rectus Femoris, Vastus Lateralis, Vastus Medius, Vastus Intermedius
  • Knee Flexion: Biceps Femoris, Semitendinosus, Semimembranosus, Gracilis, Sartorius, Gastrocnemius, Popliteus
• Ankle
  • Dorsiflexion (L4, L5): Tibialis Anterior
  • Plantarflexion (S1): Gastrocnemius, Soleus, Peroneal Muscles
  • Eversion (S1): Peroneal Muscles
  • Inversion (L5): Tibialis Posterior
• Foot
  • Toe Dorsiflexion (L5): Extensor Hallucis Longus, Extensor Digitorum Longus
  • Toe Plantarflexion (S2): Flexor Hallucis Longus, Flexor Digitorum Longus

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Neurovascular

Dermatomes of the lower extremity

• 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)
  • Knee: L3/L4
  • Achilles Tendon: S1/S2
• 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
  • Femoral Artery
  • Popliteal Artery
  • Dorsalis Pedis Artery
  • Posterior Tibial Artery

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Special Tests

• Lumbar Radiculopathy (Sciatica)
  • Straight Leg Raise Test
  • Kemp Test
• Herniated Nucleus Pulposus
  • Femoral Nerve Tension Test
  • Straight Leg Raise Test
  • Slump Test
• Facet Joint Pain
  • Kemp Test
• Spinal Stenosis
  • Kemp Test
  • Straight Leg Raise Test
• Sacroiliac Joint Pain
  • Stork Test
  • Standing Flexion Test
  • One Legged Hyperextension
  • FABER Test
  • Posterior Shear Test
  • Resisted Abduction Test
  • Sacroiliac Distraction Test
  • Sacroiliac Compression Test
  • Gaenslens Test
  • Fortins Sign
  • Cranial Shear Test
  • Sacral Thrust Test
  • Active Straight Leg Raise Test
• Spondylolysis
  • One Legged Hyperextension
• Spondylolisthesis
  • One Legged Hyperextension
  • Provocative Walking Test
• Ankylosing Spondylitis
  • Schobers Test
  • FABER Test
• Sacral Stress Fracture
  • FABER Test
  • Flamingo Test
  • Gaenslens Test
  • Squish Test
• Cauda Equina Syndrome
  • Bulbocavernous Reflex
• Scoliosis
  • Adams Forward Bend Test
• Upper Motor Neuron Lesion
  • Babinski Test
• Spinal Cord Injury, Spinal Shock
  • Bulbocavernous Reflex

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See Also

• Internal
  • Clinical Exam (Main)
  • Back Pain (Main)
  • Back Anatomy (Main)
• External
  • Sports Medicine Review Back Pain: https://www.sportsmedreview.com/by-joint/back/

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