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
http://bestpractice.bmj.com/best-practice/monograph/772/overview/aetiology.html
http://bestpractice.bmj.com/best-practice/monograph/772/overview/aetiology.html
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.
http://www.sciencedirect.com/science/article/pii/B9781416037798100272
http://www.neuroanatomy.wisc.edu/SClinic/Radiculo/Radiculopathy.htm
http://www.neuroanatomy.wisc.edu/SClinic/Radiculo/Radiculopathy.htm

2) Strength

  • Hip flexors L2/3
  • Knee extension L3/4
  • Ankle flexion/big toe extension L5
  • Ankle extension S1
https://www.glowm.com/section_view/heading/Neurophysiologic%20Testing%20of%20the%20Pelvic%20Floor/item/57
https://www.glowm.com/section_view/heading/Neurophysiologic%20Testing%20of%20the%20Pelvic%20Floor/item/57

3) Reflexes

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

4) Gait

References1

  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.