Which tests are performed in the evaluation of mechanical low back pain?

Updated: Mar 06, 2018
  • Author: Everett C Hills, MD, MS; Chief Editor: Stephen Kishner, MD, MHA  more...
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Answer

The following tests are used when evaluating low back pain.

  • Observe the patient walking into the office or examining room

  • Observe the patient during the history-gathering portion of the visit for development, nutrition, deformities, and attention to grooming

  • Measure blood pressure, pulse, respirations, temperature, height, and weight

  • Inspect the back for signs of asymmetry, lesions, scars, trauma, or previous surgery

  • Note chest expansion: If < 2.5 cm, this finding can be specific, but not sensitive, for ankylosing spondylitis

  • Take measurements of the calf circumferences (at midcalf). Differences of less than 2 cm are considered normal variation

  • Measure lumbar range of motion (ROM) in forward bending while standing (Schober test)

  • Neurologic examination should test 2 muscles and 1 reflex representing each lumbar root to distinguish between focal neuropathy and root problems

  • Measure leg lengths (anterior superior iliac spine to medial malleolus) if side-to-side discrepancy is suspected

  • Use the inclinometer to measure forward, backward, and lateral bending. With the goniometer positioned over the head, measure trunk rotation

  • Palpate the entire spine to identify vertebral tenderness that may be a nonspecific finding of fracture or other cause of low back pain

  • Test for manual muscle strength in both lower extremities.

  • Test for sensation and reflexes

  • Imaging studies: Persistent pain may require CT scanning, diskography, and 3-phase bone scanning; electromyography and nerve conduction studies can help in the evaluation of neurologic symptoms or deficits

See Workup for more detail.


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