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Adapted from Cameron 20091.
Ask the patient to remove enough clothing to allow full inspection of the back and legs.
With the patient standing
- Inspect the spine for any developmental or traumatic deformities. Assess the lumbar lordosis; loss of curvature may
indicate ankylosing spondylitis. Look for any muscle wasting (buttock, thigh, calf). Check for any discrepancy in leg
length by comparing the levels of the iliac crests.
- Movement: Ask the patient to extend the spine, flex forward and then flex laterally by sliding their palm down their
outer thigh. Most patients with non-specific back pain will be slightly stiff in extension, have pain on flexion, and
asymmetric limitation and pain on lateral flexion.
With the patient lying prone
- Femoral nerve stretch test (nerve roots L2, L3 and L4): With the patient lying prone, flex the knee towards ninety
degrees (Figure 3). Burning discomfort in the groin or anterior thigh will occur if there is femoral nerve involvement.
|Figure 3: Femoral nerve stretch test
- Palpate the spine for tenderness and for muscle spasm
With the patient on their side
In patients who describe loss of sphincter control, or with serious or progressive neurological findings, test for impaired
sensation in the saddle area (checking pin-prick sensation around the anus) and assess anal sphincter tone by digital
examination while the patient tries to “squeeze” your examining finger.
- Cameron G. The assessment of lower back pain in primary care or family practice. Available from:
- Bernstein R, Cozen H. Evaluation of back pain in children and adolescents. AAFP 2007;76(11):1669-76.