Lumbar Spine Examination

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Inspection

  • Gait
  • Stature
  • Build
  • Transitioning movements
  • Lumbar alignment coronal plane
  • Lumbar alignment sagittal plane
  • Pelvic alignment
  • Thoracolumbar alignment coronal plane
  • Thoracolumbar alignment sagittal plane

Palpation

  • Skin drag
  • Skin rolling
  • Vertebral springing tenderness
  • Rotation testing
  • Iliac crest palpation
  • PSIS palpation
  • Long dorsal sacroiliac and sacrotuberous ligament palpation
  • Iliopsoas palpation
  • Gluteus medius, minimus, and piriformis palpation

Movement

  • Forward flexion
  • Extension
  • Side flexion
  • Rotation
  • Extension/Rotation test

Special Tests

  • Slump test
  • Straight leg raise
  • Femoral stretch test
  • Sacroiliac joint provocation testing
  • Iliopsoas length test
  • Provocation test

Neurological Exam

  • 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) [1]
  • Sensation
  • Plantar reflexes

References

  1. Esene et al. Diagnostic performance of the medial hamstring reflex in L5 radiculopathy. Surgical neurology international 2012. 3:104. PMID: 23087820. DOI. Full Text.