Spine examination:

Look – Feel – Move – Measure

Ask patient to stand, clothed only in underpants.

1. Look

 Start when the patient is in the room, look at how patient move and walk, sit, open the
shoes, clothes, etc.
 Look for deformity, inspect from back and side. (Note for loss of normal thoracic kyphosis
and lumbar lordosis – Ankylosing spondylitis)
 Look for scoliosis (lateral curvature of spine, C-shaped or S-shaped)
 Look for muscle wasting, surgical scar(scoliosis)
 Look for hemangioma, midline moles, tuft of hair – spina bifida occulta

2. Feel – To detect level of pain.

 Stand at the side of patient and look at the face while palpating.
 Feel each vertebral body for tenderness and palpate muscle spasm. (start at L1-L5 and then
sacrum and coccyx)
 Feel/palpate at 3 main sites: centrally (spinous process to coccyx, unilateral right and left
sides – 1.5 cm from midlines, transverse pressure to the sides of spinous process)

3. Movement – To reproduce the pain.

 Cervical movements: cervical flexion, extension, rotation, lateral flexion.

 Assess actively. 3 main movements of lumbar spine:
- Extension (20 – 30 degree) – Ask patient to lean backward
- Lateral flexion left and right (30 degree)
- Flexion (75 – 90 degrees: Average of 80 degree) – Ask patient to touch toes with
knee straight. Assess lumbar flexion with schober’s test – a mark made at the
posterior iliac spine at the vertebral body level approx. L5, mark 5 cm below the
line and another 10 cm above. Patient is asked to touch toe. An increase less
than 5 cm indicate limitation of lumbar flexion.
- Rotation – Ask patient to sit on a stool (to fix the pelvis) and ask him to rotate
head and shoulder as far as possible.

4. Straight leg raising test (SLR test)

 Patient lie supine, knee extend, ankle dorsiflexion.

 Slowly raised the leg, keep knee extended.
 Normally can raised up to 80 – 90 degrees, but if sciatica, 20 – 60 degree of elevation cause
pain.

5. Slump Test

 For lumbosacral pain. Screening test for disc lesion and dural tethering. Performed in patient
who have low back pain with pain extend into the leg esp. for post. Thigh pain.
 Positive if back or leg pain reproduced.
  Patient sits on couch in relaxed manner. Patient slumps forward, chin on chest. Unaffected
leg first straightened. Then affected leg straightened together. Foot of affected leg
dorsiflexed. *Deflexing the neck relieve pain of spinal origin not hamstring pain.

Complete examination with:

 Lower limb neurological examination.

 Rectal examination
 Testing of related joints (Hip and sacroiliac)