Lumbar Spine Examination
Prior to the physical examination the doctor will perform on you, he or she will want as much medical information as possible that might be relevant to your back condition. blood testing may be performed to look for evidence of inflammatory arthritis, such as rheumatoid arthritis, and ankylosing spondylitis. You may be asked to fill out forms on when the pain started, where it hurts, and if you have any associated pain and weakness in your arms or legs. You will be asked if your pain was caused by a known injury, and if you have had similar symptoms in the past. When you get to your appointment, your doctor will take the information that they already had available in your medical record, as well as the new information that you provided them, and use it all as part of the process of coming up your diagnosis. In addition, your doctor will perform a lumbar spine examination to get a complete picture to aid the diagnostic process. Here is a brief overview of the hands on examination that you may receive.
Lumbar Spine Examination: Before your doctor puts his hands on you, he is going to look for any spinal abnormalities by asking you assume various postures and various movements. The way you move your body and spine, with or without limitation, will tell you doctors a lot about whether or not you have any spinal abnormalities or injuries. Let's take a look at what you may expect to hear and do during your examination.br>
To confirm or rule out any spinal abnormalities, your physician will examine your spine while you are standing, sitting, and supine (lying on your stomach).br>
You will be asked to stand in front of the doctor with your back turned to him. Differences in the elevations of the shoulders may indicate lateral scoliosis. The doctor may also observe if the pelvis is tilted or not. Tilting of the pelvis may indicate one leg being longer than the other.br>
You may be asked to stand sideways in front of the doctor. This may also be described as standing in profile. The doctor may look for the presence of kyphosis near the base of the neck, or hyperlordosis in the small of the back (lumbar spine).
Signs of kyphosis may be a bump or hump at the base of the neck and the forward position of the head and neck.br>
Signs of hyperlordosis may be a protruding abdomen. The abdomen may be positioned forward due to abdominal weakness causing an increased forward lumbar curve.br>
Range of Motion and Rhythm: Your doctor will also want to look at the way your muscles and spine is affected by certain movements. Your doctor will ask you to stand in place and move your body in several directions. He or she will ask you to bend forwards, backwards, sideways, and to perform hip rotations. The way your spine moves while you turn from the erect position will provide to clues as to which parts of the spine are affected. Let's take a look at some examples.br>
If you have increased back pain when bending backward (extension) it may indicate irritation or arthritis of the lumbar facet joints.br>
Your doctor will look at the shape of your spine and the movements of your hips as you flex your spine forward and bring yourself back up to the standing position. In a normal spine, this upright motion will involve the hips being rotated first, and the lower spine going from bending forward to bending backward. Normally, your spine will remain in the bent forward position until reach the upright position. With an injured lumbar spine, your knees will bend during flexion, and your spine will bend backward before you go into the upright position. In addition, the lumbar curve will not have the normal curve in the standing position.br>
Sideways bending may tell doctors a lot about possible muscle injuries or possible facet inflammation. During this portion of the lumbar spine examination, your doctor will ask the patient to provide feedback about changes in their pain levels as they turn from side to side. When you turn on your right side, the facet joints on your right side are compressed, while the back muscles on the opposite side are stretched. Vice versa bending to the opposite side. Pain just to the side of the midline on the same side of the motion indicates irritation of the facet joints at that level of the spine. The doctor will ask the patient if side bending produces pain on that side as well as any referred pain that radiates down the leg to the foot.br>