What is included in the physical exam for low back pain (LBP)?

Updated: Aug 22, 2018
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
  • Print
Answer

Answer

The patient is asked to drop his or her head and shoulders forward and then move slowly into forward bending. Normal forward bending is revealed when the patient recruits from each cephalic segment to the level below, and so on, progressing from the cervical spine through the thoracic and lumbar region, where flexion of the hips completes the excursion into full flexion. Patients with clinically significant mechanical back pain or lumbar segmental instability usually stop cephalic-to-caudal segmental recruitment on reaching the thoracolumbar junction, or sometimes the involved lumbar level. To continue forward bending, they then contract their lumbar muscles to brace the mechanically compromised segment and then continue recruitment in a reverse direction, beginning with motion through the hips, then proceeding cephalad, level to level, completing the excursion of the spine to the erect posture.

In cases of severe mechanical back pain and segmental instability with regional muscular spasm, the patient often reports an inability to perform any flexion below a thoracic spinal level. Any soft-tissue abnormalities and tenderness to palpation should be recorded. Palpation of lumbar paraspinal, buttock, and other regional muscles should be performed early in the examination. The examiner should palpate and note areas with superficial and deep-muscle spasm, and he or she should identify TrPs and small, tender nodules in a muscle that elicit characteristic regional referred pain.


Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!