History

Offending events?
Personal History Periods of remission?
Alleviated by posture , medication or rest?
Chief Compliant Worsenend by posture , coughing or straining ?

History or Presenting Complaint

Constiutional Symptoms

Medical History

Surgical History

Drug History and Allergies

Family History

Social History

Systemic Review

DONT FORGET FIFE: (FEELINGS , IDEAS, FUNCTION AND EXPECTATIONS

 Physical
Examination

Palpate spinous processes for

Posture , gait, skin , tenderness , steps or gaps
muscle bulk , spinal paraspinal muscles and sacroiliac
alignment joints
INSPECTION
PALPATION

Active and passive

range of motion.
Flexion , extension , Power in key muscle groups.
lateral bending , Dermatomal sensation
rotation Reflexes

NEUROLOGICAL
RANGE OF EXAMINATION
MOTION
Lumbrosacral Strains Clinical Presentation

S: Lumbar and sacral regions of back

A lumbosacral strain refers to an
O: Sudden following a specific activity , may
injury to the muscles, ligaments, or
worsen over time
tendons in the lumbosacral region
of the spine, usually due to C: Aching or dull
overstretching , tearing or overuse. R: Typically localised
A: muscle spasms , stifness , bruising and swelling
T: Intermittent
E: Aggravated by movement and prologned
standing , Relieved by rest , heat or ice therapy
and gentle stretching
S: Varies

Observation: Slightly flexed/protective posture ,

swelling or bruising over affected area
Palpation: Tenderness over the paraspinal
Diagnosis muscles, visible muscle spasms
1.Focused history and examination Movement: Reduced lumbar externsion and
2.Imaging not usually required for acute flexion and lateral flexion and rotation
presentations.
Neurological: Usually normal
Ankylosing Spondylitis (Radiographic Clinical Presentation
axial spondyloathritis )
S: Lumbar and sacral region of back
O: Insidious onset progresses slowly (age at onset <45)
Ankylosing spondylitis is a chronic C: Dull
inflammatory disease primarily affecting R: Radiation to gluteal region
the spine and sacroiliac joints causing A: Morning stiffness >30 mins , extraspinal joint pain ,
pain, stiffness, and eventually leading to extrarticular manifestations eg. uveitis
the fusion of the spine. T: Persists with rest and occurs at night
E: Aggravated by prolonged inactivity relieved by movement
S: Varies
Observation: Kyphosis of spine in severe cases
Palpation: Tenderness over the sacroiliac joints
Diagnosis FABER test positive : Pain in ipsilateral SIJ on Flexion ,
1.Focused history and examination ABduction and External Rotation
2.Suspected AS in patients <45 y : SIJ X-ray Mendell sign: Tenderness and pain to percussion on
3.If SIJ X-ray inconclusive obatin CRP/ESR and
displacement of SIJ
HLA-B27
Movement: Reduced spinal motility
Schober test: Limited lumbar flexion (<5 cm increase in
Schober test distance
FABERwhen bending forward).
Mendell Sign
test
 Degenerative Disc Disease:
Herniated Disc Clinical Presentation
A herniated disc occurs when
the soft center of an S: Lumbar region of back
intervertebral disc (nucleus O: Acute and sudden often following heavy lifitng
pulposus) pushes through a tear C: Stabbing , shocking or burning
in its outer layer (annulus R: Radicular, radiating to the legs
A: Radiculopathy, bowel and bladder dysfunction
fibrosus), potentially
T: Persistent or intermittent
compressing nearby nerves and
E: Aggravated by ↑ pressure reliieved by ↓ pressure
causing pain, numbness, or
S: Varies , usually high on pain scale
weakness.
Observation: guarded or tilted posture , antalgic gait
Palpation: Tenderness over affected spinal level .
Movement: Increased pain in foward flexion and lateral
bending
Neurological: Muscle weakness in muscles innervated
Diagnosis by compressed nerve root. Sensory changes in areas
1.Focused history and examination
corresponding to affected nerve root
2.Imaging required if suspected urgent
compressive radiculopathy eg. cauda
equina syndrome. MRI without contrast

In lumbar disk herniation, the nerve root that leaves the intervertebral foramen one segment
below the level of herniation is impaired, rather than the nerve root that exits the intervertebral
Sciatica Clinical Presentation

S: lumbosacral region
Sciatica is pain along the sciatic nerve, O: Sudden or gradual
running from the lower back through the C: Shooting , burning or sharp
buttocks and legs, commonly caused by R: Radiating down the leg
spinal issues like herniated discs or spinal A: Paresthesias, numbness or weakaness
stenosis. Extraspinal causes, such as T: Intermittent or Persistent
piriformis syndrome, pelvic masses,
trauma, or pregnancy, can also compress
E: Aggravated by prologned siting , coughing or
or irritate the nerve, mimicking or causing sneexing , Relieved by lying down or gentle stretching
sciatic pain. S: Varies

Neurological: Muscle weakness in muscles innervated by

Straight Leg compressed nerve root. Sensory changes in areas
Raise Test corresponsding to affected nerve root

Straight Leg Raise Test: Pain is elicited when the leg is

raised between 30-70 degrees.

Other provocative maunvers : Bragard sign , crossed

Diagnosis
straight leg test and reverse straight leg test
1.Focused history and examination
2.Provocative manuvers of lumbar
radiculopathy
3.Imaging only required for patients with
 Lumbar Spinal Clinical Presentation
Stenosis S: Load dependent back pain in lumbar region
O: Usually gradual , can be subacute or chronic depending
on etiology
Spinal stenosis is the narrowing of the spinal
C: Aching , dull , burning or tingling
canal which can compress the spinal cord or
nerve roots. R: Radiating unilaterally or bilaterall to buttocks , thighs
and calves
A: Neuropathic claudication , myeloradiculopathy
T: Intermittent or Persistent (activity dependent)
E: Aggravated by walking and prolonged standing ,
Relieved by siting or laying down , “shoping cart sign”
(lateral flexion)
S: Varies
Observation: wide-based gait
Movement: Pain worsened on lumbar extension
Neurological: Reduced lower extremity reflexes , mild
motor weakness and sensory changes and abnoraml
Romberg’s test
Diagnosis
1.Focused history and examination
2.MRI spine without contrast is the preferred
modality
3.CT myelogram if MRI spine is C/I or inconclusice