Exam - Back

From CambridgeNotes

Preparation and planning

  • Expose patient completely except for boxer shorts or equivalent (i.e. to see back and legs)


  • Ask patient to walk
  • Look from side and then back


  • Feel spine and paraspinal areas; feel for sacro-iliac tenderness (ankylosing spondylitis)


  • Lumbar: assess flexion (Schober’s test: mark 5cm below and 10cm above L4 → increases 5cm on flexion); assess extension; assess lateral flexion
  • Consider thoracic rotation; Cervical neck flexion, extension, lateral flexion, and rotation


  • Sciatic: Straight leg raise to elicit pain (then flex ankle to make worse! flex knee to make better (bow-string test); if both legs raised pain shouldn’t be elicited
  • Femoral: Hip extension elicits pain (then knee flexion)


  • Test tone, power, reflexes, co-ordination and sensation of lower limbs (best test of power is standing on tip-toes or balls-of-feet); offer to test perineum including perianal sensation, anal sphincter tone
  • Assess lower limb circulation


  • Offer abdominal exam (abdominal aortic aneurysm) and digital rectal exam (prostate)