Low Back Pain Exam


    Low Back Pain Exam

    Clinical Scenario:

    A 28-year-old male with no significant past medical history presents with low back pain for 6 days. His pain started after playing soccer. The pain is severe, sharp, and radiates down the left leg. The pain limits his ability to walk. He has been taking ibuprofen every 6 hours without relief. Today he has been having difficult urinating. He also has some numbness down the left leg. He denies trauma, fall, IV drug use, fevers, dysuria, hematuria, abdominal pain, bowel incontinence, steroid use, or history of malignancy.

    slide1What is your low back pain examination?

    Along with your standard exam you should look for:

    • Abdominal masses/tenderness, costovertebral angle tenderness
    • Peripheral pulses for symmetry/quality
    • Palpate the spine for tenderness

    Lower Extremity Exam

    1) Sensation

    • Rectal exam for sphincter tone or anal wink


    Yi Zhang, in Pain Procedures in Clinical Practice (Third Edition), 2011. http://www.sciencedirect.com/science/article/pii/B9781416037798100272

    Yi Zhang, in Pain Procedures in Clinical Practice (Third Edition), 2011.



    2) Strength

    • Hip flexors L2/3
    • Knee extension L3/4
    • Ankle flexion/big toe extension L5
    • Ankle extension S1


    3) Reflexes

    • Patellar L3/L4
    • Achilles S1/S2
    • Babinski

    4) Gait


    1. Della-Giustina D, Kilcline BA, Denny M. Back Pain: Cost-Effective Strategies For Distinguishing Between Benign And Life-Threatening Causes. Emergency Medicine Practice. 2000;2(2):1-24.
    • Welcome! This is the website for the Mount Sinai Emergency Ultrasound Division. It serves as an information resource for residents, fellows, medical students and others seeking information about point-of-care ultrasound. There is a lot ofRead more

    • renal handling of water

      If you were on a tea & toast diet, how much water would you need to drink before you develop hyponatremia? I haven’t seen anyone work out the numbers before so here are my calculations. AndRead more

    • acute acidemia physiology

      As alluded to in the first post, don’t be fooled by a “normal” potassium in the setting of DKA because osmotic diuresis and H+/K+ exchange means that total body potassium is actually LOW. You all knowRead more

    • renal handling of potassium

      the first symptom of hyperkalemia is death Earlier post covered temporizing measures to counter hyperkalemia — namely, intracellular shift, increasing cardiac myocyte threshold potential. Give furosemide if the patient still urinates and consider dialysis, but then askRead more

    • bicarbonate revisited

      Previous post reviewed the safety of balanced crystalloids in hyper K. But what was up with serum bicarbonate decreasing with saline administration? This post introduces a new way of looking at the anion gap to possiblyRead more

    • hyperkalemia and balanced crystalloids

      Is it safe to give LR or plasmalyte to a hyperkalemic patient (these balanced crystalloids have 4-5 mEq/L K as opposed to 0 mEq/L K in normal saline)? Postponing the discussion of renal handling of potassium toRead more

    • hyperkalemia physiology

      You’ll likely encounter hyperkalemia on your next Resus / Cardiac shift, and you’ll instinctively treat it. But take a moment to review the fascinating physiology behind the “cocktail”! First, consider how K+ is buffered byRead more

    • Slow down your tachycardia (but not really)

      You’re sitting in resus bemoaning the departure of your most beloved attending when suddenly a patient wheels in without warning. The patient looks relatively stable but the triage RN tells you her heart rate wasRead more

    • Otitis externa: use the ear wick!

      Acute otitis externa (AOE) is a common complaint seen in pediatric as well as adult emergency departments. AOE is typically not accompanied by acute otitis media, although concurrent cases are possible. Also called “swimmer’s ear”Read more