Back Exam

Prepare patient

  1. Introduction
  2. Position: standing in underwear


General inspection

  1. Obvious other joint disease
  2. Deformity – scoliosis, loss of normal lumbar lordosis/thoracic kyphosis (ank. spondylosis)


  1. Each vertebrae, SIJs, and para-spinal muscle bulks


  1. Lumbar movements
    1. Forward flexion – touch toes.
      1. Schrober’s test: mark level of L5 (or dimples of Venus). Place one finger ~5 cm below this mark, and a second ~10 cm above this mark. When patient tries to touch toes distance should increase 5cm.
    2. Lateral flexion – slide hand down to touch knees
    3. Extension
    4. Rotation (fix pelvis – e.g. by sitting)


  1. Straight leg raising (>60º)
  2. Test for radicular pain on dorsiflexing foot at limit of SLR


  1. Full neurological examination of lower limb
  2. Anal tone
  3. Test for saddle anaesthesia
  4. Ask about bladder & bowel problems