====== Low back pain physical examination ======

Less helpful than the history in identifying patients who may be harboring conditions such as cancer, but may be more helpful in detecting spinal infections.

1. spinal infection: findings that suggest this as a possibility (but are also common in
patients without infection)

a) fever:common in epidural abscess and vertebral osteomyelitis,less common in discitis b) vertebral tenderness

c) very limited range of spinal motion

2. findings of possible neurologic compromise: the following physical findings will identify most cases of clinically significant nerve root compromise due to L4–5 or L5–1 HLD, which comprise > 90% of cases of radiculopathy due to HLD; limiting the exam to the following might not detect the much less common upper [[lumbar disc herniation]]s, which may be difficult to detect on PE 

a) dorsiflexion strength of ankle and great toe: weakness suggests L5 and some L4 dysfunction

b) Achilles reflex:diminished reflex suggests S1 root dysfunction

c) light touch sensation of the foot:

● diminished over medial malleolus and medial foot: suggests L4 nerve root involvement

● diminished over dorsum of foot: suggests L5

● diminished over lateral malleolus and lateral foot: suggests S1

d) straight leg raising (SLR);also check for crossed SLR.