Lumbar Spine Rubric

(1 pt.) Student sanitized hands before performing physical exam

(1 pt.) Inspection of lumbar spine and verbalize finding

 Expose the skin of the lumbar area
 Patients appearance and posture while seated
o Posture white standing
 Are they slumped over or standing straight?
 Do they have an exaggerated lumbar lordosis?
 Assess symmetry of the height of the ilac crests, medial malleoli. Comparing the heights
and looking for any asymmetry.
o Visual on skin, white seated
 Are there any scars of bruises?
o Gait

(1 pt.) Palpation of lumbar spine on skin (skin, Spinous and transverse processes, Sacroiliac joint, Paravertebral
muscles)
 Spinous process
 Paravertebral tissues
 Quadratus lumborum
 Bogginess/hypertonicity
 SI joints tenderness

(1 pt.) Perform range of motion of lumbar spine (include all Flexion/Extension, Sidebending, Rotation)
 Have the patient stand
 Block linkage at hips!
 Have the pt flex forward (40-90) and extend (20-45)
 Have the pt side bend (15-30)
 Have the pt cross their arms across their chest, then look to the right and left (rotation) (3-18)

(1 pt.) Perform lower extremity strength testing and verbalize finding i.e. 4/5 lower extremity strength
bilaterally for the following: Hip flexors, knee flexors/exstensors, ankle flexors/extensors
 Hand on thigh, ask pt to push up (hip flexion)
 Hand on front of leg, ask pt to push against you (knee extension)
 Hand on back of leg, ask pt to push against you (knee flexion)
 Hand on top of foot, ask bend their foot up against you (ankle flexion)
 Hand on bottom of foot, ask them to push their foot down against you (ankle extension)

(1 pt.) Perform Sensory testing on lower extremity

 Check the dermatomes bilaterally
 Medial thigh
 Back of thigh
 Patella
 Side of Knee
 Lateral foot

(1 pt.) Perform lower extremity DTR (at least one)

 Achilles is the easisest (S1)
o Make sure its relaxed
(1 pt.) Perform one specialty test for lumbar spine (performed at least 1 test)
Straight leg raise test – positive for lumbosacral radiculopathy
o Lateral back pain at >15 = IT band contracture
o Low back pain at > 70 = muscle strain or joint disease
Contralateral Leg Raise test – positive for lumbosacral radiculopathy in opposite leg
o Pain in the other leg @ 30-60 degrees
Hoover’s sign + = malingering (functional weakness)
o Positive if no downward force on contralateral leg
o Pt is making no effort to lift affected leg
Thomas test = Iliopsoas contracture
o At end of table,
o One leg over
o One leg flex and held up
o Did the one over the table lie flat?
Gaenslen test
o + = SI joint dysfunction