Lumbar Exam Flow

Question 1

Patient position order

Answer 1

Standing, supine, side, prone, seated, straddle

Question 2

What to perform while patient is standing?

Answer 2

Posture
AROM
Toe raises/heel walk
Squat and rise
Standing crest height
Standing trochanteric crest height 
Single leg stand

lateral pelvic shift

Question 3

What should be performed while patient is supine while doctor is at the table’s side?

Answer 3

High index neuro
Low back/pelvic orthopedics
SI distraction
Pubic symphysis
Aorta exam
Abdominal exam
Inspect feet and palpate pulse

Question 4

Components of Lumbar High Index Neuro

Answer 4

Light touch
Sharp/dull
DTR: 
Vibration
Babinski
LE girth measurements
Muscle tests: Hip flexor muscle test, Quadriceps test, Tibialis anterior, Extensor hallucis longus, Peroneus longus, Flexor hallucis brevis

Question 5

Low back or pelvis orthopedics to be assessed while patient is supine

Answer 5

Active SLR 
Bilateral active SLR
SLR (braggard, bowstring, max SLR)
Kernig
Fabere
Modified Laguerre
Hip circumduction
Thigh thrust
Thomas
Knees to chest

Question 6

What to perform while patient is supine

Answer 6

LLI
Allis
Hip internal rotation and external rotation
Anvil

Question 7

What to perform while patient is side-lying

Answer 7

Active abduction
Gluteus medius muscle test
Modified Ober's
SI compression
Side posture motion palpation (joint dysfunction)

Question 8

What to assess while patient is prone

Answer 8

Prone low back/pelvic orthopedic

Soft tissue - hamstrings, ischial tuberosity, TFL, greater trochanter, piriformis, gluteus maximus/medius, lumbar paraspinals, quadratus lumborum
Bony and ligament - PSIS, long dorsal ligament, sacrotuberous ligament, SI joint provocation, iliolumbar ligament, lumbar and thoracic spine and ribs
Sciatic nerve

Question 9

Low back and pelvis orthopedics to assess while prone

Answer 9

Gluteus maximus muscle test (L5, S1; sciatic n)
Hamstring muscle test (L5, S1; sciatic nerve)
Nachlas (quad/fem N stretch)
Hibb’s test (palpate piriformis) (hip)
Yeoman’s (SI/femoral nerve stretch test)
Sacral thrust (SI)
Farfan torsion (Lx facet/disc)
Prone extension (active, resisted, passive) (St/Sp)

Question 10

What perform while patient is seated

Answer 10

Bechterew’s (Deyerlie, Slump)
Quadrant test
Kemp’s
Lumbar and thoracic motion palpation