Lumbar (standard tests)

Case 3

You have a rotation at a general practitioner's office. Your supervisor has scheduled a healthy 30-year-old woman for you for a clinical examination due to low back pain.

The patient reports that she works as a hairdresser. Over the past year, she has experienced pain in her lower back, worsening as the workday progresses. The pain is central, but over the past month mostly on the left side.

Back examination (lumbar)

• Perform a standard examination of the lumbar spine
  • Inspection
  • Active movement
  • Passive movement
  • Isometric movement
  • Palpation

1. You perform an inspection, what are you looking for?
2. You ask the patient to perform active movements, what do you expect to find?
3. You perform passive movements, what do you expect to find?
4. Perform isometric movements.
5. Finally, palpate the muscles in the lumbar spine, locate and name the muscles.

Back inspection

Active movement of the back

Passive movement of the back

Isometric movement of the back

Palpation of the back

Clinical findings

• Upon inspection, you see increased lumbar lordosis.
• There is normal range of motion in the lower back.
• When bending sideways to the right, she reports pain on the left side.
• Normal strength for walking on toes, walking on heels, and squatting.
• Tenderness on palpation in the left m. quadratus lumborum.

Cases