Once the doctor has received and developed a complete family and social history, and recorded all the relevant medical history to your case, he or she will usually move on to your physical examination. Your physical examination will be a hands on back test to look for asymmetries in the muscles, test for muscle spasm, and range of motion injuries in your spine related to specific spinal injuries. During your back test, your doctor will put his hands on you to feel for obvious abnormalities, and he or she will also learn a lot about the health of your back by looking at the way your body moves when it is asked to bend in certain positions. Following this hands on examination, your doctors may have the information they need to make a diagnosis, or more technical tests may be performed to look at the anatomy of your spine or to measure the functioning of the nerves that come off of it. Let's take a look first at the lumbar spine examination.
Lumbar Spine Examination: Your doctor will want to look for abnormalities in your spine by asking you to move into all positions, and to rotate your spine in all positions while in the standing position.
Your doctor will examine the form of your spine while you are standing, sitting, and lying on your stomach. When standing, your doctor will observe any obvious physical asymmetries in your body, such as scoliosis, tilt of the pelvis, or differences in shoulder height. Shoulder height differences may indicate scoliosis. Tilting the pelvis may indicate one leg being longer than the other.
The doctor may then ask the patient to turn in profile, so that the doctor can see the patient from a side view. One spine condition that may be noticeable from this view, if present, is kyphosis (Dowager's Hump). With Kyphosis, the doctor may notice a forward position of the head and a hump at the top of the back, at the level of the top of the shoulder blades.
From the side view, the doctor may look for signs of hyperlordosis in the lumbar spine. The lumbar spine has a normal lumbar curve of 40-60 degrees, in which it arches towards the back of the spine. An excessive bend of the spine beyond this angle of curvature is known as hyperlordosis. Signs of this condition are a protruding abdominal muscles, caused by obesity or weak abdominal muscles. Hyperlordosis is also described as an increased forward lumbar curve.
Testing Your Back Muscles At Rest: You may or may not be aware of muscle tension in your back that is either causing your back pain or affected by injuries to your spine. To look for muscle spasms, muscle tension, or tension of the fascia, your doctor will put his or her hands on you to look for any pathology contributing to your symptoms. Your doctor will touch your back with varying degrees of pressure to detect for muscle spasms or areas of tightness. When your back muscles are at rest, they are soft and movable, and may be compressed with light pressure. Muscles that are spasm are firm to the touch and may be tender with direct palpation.
The doctor will check for muscle spasm on both sides of the spine when the patient is upright, and note any differences. Muscle tension or spasm on one side of the spine may indicate an injury to that side of the spine. This may indicate an injury because when a spinal structure, such as a spinal nerve, becomes injured, the protective response by the body is for the muscles to tense up to limit movement to that part of the body, in an attempt to protect the injury from becoming any worse. Or the muscle spasm could indicate an injury to the affected muscle or fascia.
Range of Motion and Rhythm: at this point in the examination, the physician will ask the patient to stand, and move in all directions while bending and rotating from the waist. The physician will ask the patient to flex their spine (bend forward), extend their spine (bend backward), tilt sideways in both directions, and rotate their hips. Difficulty bending backwards may indicate facet joint arthritis in the lumbar spine or the thoracic spine. When there is an injury in the lumbar spine, it may look abnormal when the patient is standing still and bending it. Remember above that we wrote that the protective response of the body to a spinal injury is for the muscles moving that part of the spine to tense up of spasm in order to limit its movement. This muscle response to injury will severely limit forward motion of the lumbar spine.