BACK EXAMINATION:

Good Day. I’m Dr.________, I’m the HMO in this hospital. How do you want me to address you?
Today I’m gonna do a physical examination of your back, I’m gonna have a look, feel and I’ll ask you to do some
movements. I will also tell the examiner my findings while I’m doing my examination.
Is that alright with you?

Can you expose your back while I wash my hand.

Before I start. Are you in pain? Where exactly is the pain? Do you need any painkillers? During the examination if
I hurt you or you feel uncomfortable, just let me know so that I could stop

 WIPE + PE + TSDR
 PE
1. Gait: Can you take few steps for me? Can you walk on your heels and then with your toes? Can you squat for me?
The gait is normal and not antalgic with good range of motion of the lower extremities.

2. Back: On inspection of the back, the posture is normal, the back is symmetrical. There were no scars, no swelling on
articular joints. No muscle wasting of the paravertebral muscle. No visible deformity or lateral deviation of the
spine. There is a normal lordosis of the spine.
LOOK:
a. Normal Posture, Symmetrical
b. No scars, Swellings, Muscle wasting
c. No deformity or Lateral deviation
On palpation, the temperature is normal; there were no tenderness on spinous process from L1 to sacrum
and coccyx. No tenderness on paraspinal line and sacroiliac joint.
FEEL: landmark: L4: down and then up,
a. L1 spinous process to sacrum and coccyx
b. Paraspinal line
c. Sacroiliac joint
I will be testing your back movement. Can you follow after me? There were no pain on movement of the
spine and the ranges of motions are good.
MOVE:
a. Flexion
b. Extension
c. Left Lateral Flexion
d. Right Lateral Flexion
e. Left Rotation
f. Right Rotation
I’ll be measuring your spine on flexion. Is that alright with you? From the dimples of venus, I will measure
and mark 10cm above and 5 cm below. Can you bend forward and try to touch your toes? The Schober’s test is
normal with <20cm measurement of the spine.
MEASURE:
a. Schober’s test: central of Dimples of Venus (between sacroiliac joints), measure 10 cm
above, 5 cm below
b. If <20cm: Ankylosing spondylitis
Can you sit on the edge of the bed for me? Put your chin to your chest, straighten your leg. while I dorsiflex
the affected foot. The patient is negative for slump test.
Can you lie down for me please? Raise your leg. The straight leg raising test is normal.
SPECIAL TESTS:
a. Straight leg raising test: if <60: passive dorsiflexion
b. Slump test: sit, slump forward, chin to chest, straightened leg, normal first then affected leg,
both legs straightened together then dorsiflexion of affected leg
3. Neuro:
Can you push away my hands? The power are good on knee flexion and extension and ankle plantar flexion
and dorsiflexion.
a. Power:
1) L3: extension of knee
2) L4: flexion of knee
3) L5: dorsiflexion of ankle
4) S1: plantar flexion of ankle
This is a neuro hammer, I’m gonna test your knee and ankle reflex. The reflexes were normal.
b. Reflex:
1) L3- L4: Knee jerk
2) S1 : Ankle jerk
This is a neuro pin, this is how what it feels like. Can you close your eyes and let me know if you can feel it?
The sensations from L2-S1 were all normal.
c. Sensation:
1) L2: lateral thigh
2) L3: knee
3) L4: lateral leg
4) L5: dorsum of foot (great toe, 2-4 toes)
5) S1: lateral aspect of ankle (4-5th toes)
4. Rectal examination if Cauda Equina Syndrome suspect