Lumbar Spine Examination

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Standing

• Gait
• Stature
• Build
• Romberg
• Transitioning movements
• Posture and alignment
  • Thoracolumbar alignment coronal and sagittal plane
  • Lumbar alignment coronal and sagittal plane
  • Pelvic alignment
  • Foot alignment
• Movement
  • Forward flexion
  • Extension
  • Side flexion
  • Compound extension and rotation
• Trendelenburg

Sitting

• Breathing
• Pelvic alignment
• Slump test

Lying

• Skin drag and rolling
• Allodynia to cold and pin prick
• Palpation
  • Vertebral springing tenderness
  • Rotation testing
  • Bony landmarks: Iliac crest, PSIS, LPSL, sacroiliac joint
  • Soft tissue: sacrotuberous and sacrospinous ligaments, gluteus medius and gluteus minimus, piriformis, iliopsoas, quaratus lumborum, hamstring origin
• SIJ provocation testing: distraction, thigh thrust, sacral thrust, compression
• Hip joint range of motion
• Special tests
  • Straight leg raise
  • Femoral stretch test
  • Iliopsoas length test and tenderness
  • Direction preference
  • Centralisation phenomenon
• Neurological examination
  • Tone
  • Power: hip flexion (L2), hip adduction (L3), ankle dorsiflexion (L4), great toe extension (L5), knee flexion (S1)
  • Reflexes: knee (L3, L4), medial hamstring (L5), achilles (S1)
  • Sensation: L2, L3, L4, L5, S1, S2, S3
  • Plantar reflexes