Spine – History and Exam

History

1. Pain: location (leg versus back), radiation, timing, duration, quality, aggravating, relieving, change with cough/sneeze
2. Other: stiffness, deformity, numbness, weakness, bladder problems, bowel problems, scoliosis (duration, progress, pain, neurologic signs, growth, menarche, family history, treatment, previous XR)
3. Function: walking, limp, supports, distance, stairs, socks, toes, transportation
4. Past history: treatment, injury, surgery, similar episodes

Exam (Standing)

1. Look: shoes, sticks, spine, scars, waist, hair, deformity (scoliosis, kyphosis, lordosis), scoliosis (balance, shoulders, rib prominence, loin creases)
2. Feel: LLD, Trendelenburg sign, pelvic obliquity, steps
3. Movement:
   1. Spine flexion: 2 points 10 cm apart move 5 cm
   2. Spine extension: including wall test           
   3. Lateral flexion
   4. Rotation 
   5. Rib excursion

Exam (Supine)

1. Look: asymmetry, wasting, deformity, scars, atrophy
2. Feel: pulses
3. Movement: crossed SLR, SLR, Lasaugue, bowstring
4. Neurovascular sensation, power, tone, coordination, abdominal reflex, tendon reflex, anal reflex
5. Sacroiliac joint, hip & knee

Exam (Side)

1. Femoral stretch
2. Gluteus mediustest

Exam (Prone)

1. Look: bony tenderness, steps, soft tissue
2. Feel: glutei
3. Movement: hip internal and external rotation and extension
4. Power

Waddel (3/5)

1. Tenderness: superficial or non anatomic
2. Simulation tests: axial load & pelvic rotation
3. Distraction tests: SLR seated
4. Regional disturbance
5. Over reaction

Any individual sign counts as a positive sign for that category. 3 or more of the 5 categories is clinically significant