DDx

• Types of Organic Back Pain
• R/O Red Flag

History

• Back Pain Hx

Exam Checklist

Observation (Stand)

• General activity and behaviour
• Back-specific:
  • Gait and Posture
  • Contour – subtle mal-alignments are not relevant
    • PSIS
    • Scoliosis
    • Atrophy
  • Colour – areas of obvious inflammation
  • Scars

Palpation (Prone)

• Vertebral and paravertebral tenderness
  • Of limited value – briefly palpate for tenderness and gross deformity

Movement

• Flexion – “Bend forward and try to touch your toes”
  • Reproduction of the typical back pain and rhythm of movement
  • Uniformed curve = normal
  • Prone Passive Extension – up to 10 when the history or physical suggests pain on flexion
• Extension - “Arch your back”
  • Reproduction of the typical back pain and rhythm of movement
    • Stabilize the patient by placing one of your hands on the small of their back and the other hand on their shoulder
    • A normal spine can extend 30° from the upright position
  • Uniformed curve = normal
• Rotation* - ****“Twist towards each side”
  • Stabilize the patient’s pelvis by placing your hands on their hips
  • Compare side to side

Mandatory tests

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UMN signs → Spinal Cord Compression

Plantar Response, Ankle clonus

• Any UMN finding negates a low back mechanical diagnosis, think spinal cord and brain

Saddle Sensation Test → !CES - Cauda Equina Syndrome

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Special Test

1. Nerve Root Irritation Tests
   • SLR (L4 - S1) → MAKE SURE to ask for location of Pain
   • FST (L2-L4)