Lumbar

Question 1

What is the very first thing you should do before performing a physical exam?

Answer 1

Sanitize your hands

Question 2

What is the first step of the lumbar physical exam?

Answer 2

Inspection of lumbar region. You must verbalize findings

Question 3

What are you looking for in the inspection phase of the lumbar physical exam?

Answer 3

Posture

• Are they slumped over?
• Are they erect?

Asymmetry

• Evaluate iliac crest heights
• Evaluate greater trochanter heights

Lumbar Lordosis

• Is lordosis increased?
• Is lordosis decreased?

Gait

• Is there “listing” of trunk to one side
• Antalgic or limping gait
• Foot Drop, hiking up hip, rotating of lower extremity
• Shuffling or fenestrated gait

Question 4

What is the second step of the lumbar physical exam?

Answer 4

Palpation of lumbar region

Question 5

What are you looking for when palpating the lumbar region?

Answer 5

• Skin
• Spinous Processes
• Transverse Processes
• Sacroiliac Joint
• Paravertebral Muscles

Question 6

What is the third step of the lumbar physical exam?

Answer 6

Test range of motion of lumbar spine

Question 7

What are looking for in range of motion of the lumbar spine?

Answer 7

Flexion: 40-90
Extension: 20-45
Rotation: 3-18
Sidebending: 15-30

Question 8

What is the normal range of motion for lumbar flexion?

Answer 8

40-90

Question 9

What is the normal range of motion for lumbar extension?

Answer 9

20-45

Question 10

What is the normal range of motion for lumbar rotation?

Answer 10

3-18

Question 11

What is the normal range of lumbar sidebending?

Answer 11

15-30

Question 12

What is the fourth step of the lumbar physical exam?

Answer 12

Perform lower extremity strength testing. Remember to verbalize results

Question 13

What are you looking for in lower extremity strength testing?

Answer 13

Strength is scored on a scale out of 5
- 5/5 is normal

Must be done bilaterally

• Hip Flexors
• Hip Extensors
• Knee Flexors
• Knee Extensors
• Ankle Flexors
• Ankle Extensors

Question 14

What is the fifth step of the lumbar physical exam?

Answer 14

Sensory testing on lower extremity

Question 15

What are you looking for when conducting sensory testing on the lower extremities?

Answer 15

• Have patient close their eyes
• Touch the medial top surface of one foot (L5 dermatome)
• Have patient indicate whether they feel any sensation from your touch
• Touch medial top surface of the other foot (L5 dermatome)
• Again have patient indicate whether they feel any sensation from your touch

Question 16

What is the sixth step of the lumbar physical exam?

Answer 16

Perform deep tendon reflex test (just one)

Question 17

What are you looking for in deep tendon reflex test?

Answer 17

Scaled out of 4

• Normal is +2/4
• 0 is no reflex
• +1/4 is weak reflex
• +3/4 is a brisk reflex
• +4/4 is an abnormal clonus (repetitive reflex)

Calcaneal Reflex (S1 nerve root)
Patellar Reflex (L4 nerve root)

Question 18

What is the seventh step of the lumbar physical exam?

Answer 18

Specialty Test

Question 19

What are you looking for with the Thomas Test?

Answer 19

• Patient is supine with butt at end of table
• Patient flexes both hips, bringing both knees to their chest
• Patient extends affected leg toward table, while keeping the other leg at their chest

(+) Test: lower extremity unable to fully extend at the hip

• Indicates iliopsoas tension, shortening or contracture
• This is common finding in acute and chronic lower back pain