Inspection begins from the moment the patient is sighted in the waiting room. A patient who is noted to be standing is likely to have a significant disc lesion. Considerable information can be obtained from the manner in which the patient arises from a chair, moves to the consulting room, removes the shoes and clothes, gets onto the examination couch and moves when unaware of being watched. The spine must be adequately exposed and inspected in good light. Patients should undress to their underpants; women may retain their brassiere and it is proper to provide them with a gown that opens down the back. Note the general contour and symmetry of the back and legs, including the buttock folds, and look for muscle wasting. Note the lumbar lordosis and any abnormalities such as lateral deviation. If lateral deviation (scoliosis) is present it is usually away from the painful side. Note the presence of midline moles, tufts of hair or haemangioma that might indicate an underlying congenital anomaly such as spina bifida occulta.

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