Physical examination

The basic objectives of the physical examination are to reproduce the patient's symptoms, detect the level of the lesion and determine the cause (if possible) by provocation of the affected joints or tissues. This is done using the time-honoured method of joint examination—look, feel, move and test function. The patient should be stripped to a minimum of clothing so that careful examination of the back can be made. A neurological examination of the lower limb should be performed if symptoms extend below the buttocks.

A useful screening test for a disc lesion and dural tethering is the slump test. 6 The main components of the physical examination are:

1. Inspection

2. Active movements o forward flexion (to reproduce the patient's symptoms) o extension (to reproduce the patient's symptoms) o lateral flexion (R & L) (to reproduce the patient's symptoms)

3. Provocative tests (to reproduce the patient's symptoms)

4. Palpation (to detect level of pain)

5. Neurological testing of lower limbs (if appropriate)

6. Testing of related joints (hip, sacroiliac)

7. Assessment of pelvis and lower limbs for any deformity, e.g. leg shortening

8. General medical examination including rectal examination

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