What is included in the physical exam to evaluate 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

Equipment often used for the examination includes a stethoscope, goniometer, inclinometer, pinwheel or safety pin, tape measure, and reflex hammer.

Testing

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 it is less than 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).

The neurologic examination should test 2 muscles and 1 reflex representing each lumbar root to accurately distinguish between focal neuropathy and root problems.

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

Using the inclinometer, measure forward, backward, and lateral bending. With the goniometer positioned in a horizontal plane over the axial skeleton (ie, over the head), measure trunk rotation.


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