Physical examination

General: Overweight middle-aged man with stiff gait.

Examination of lumbar spine

Gait and movement—stiff, cautious. Posture—normal, no muscle spasm.

Tender over spinous process L4, over the L4-L5 interspinous space, and unilaterally to left between L4 and L5.

Restricted left lateral flexion and forward flexion ( Fig 11.1 ).

Lower limbs normal. No neurological abnormalities. Urine analysis: NAD


Palpation: Movement:


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