Hx==>Directed Hx==>Directed Physical Examination

Examination based on position of patient rather than a general survey of the spine.

Exmaination is directed by History
Increase sensitivity, red flags, efficient
Rule out malingering.

Gait on entering room - foot drop sign? (If foot drop not like a disc problem)

Walk on heels and tip toes for gross screening

Tip toes x 10 to determine plantar flexion weekness.g

Flexion vs Extension and how to measure flexion

Palpation of paraspinal muscle spasm.  (Demonstrate how to simulate)

Percussion of spinous processes and level of iliac crest as L4-L5 level

Rotation of pelvis to r/o malingerer

Kneel on chair for achilles tendon reflex

Sit on chair for:
  Testing ankle dorsiflexion and great toe extension
  Distracted indirect SLR
  Knee jerk

Supine on examining table:
  Test for sensation
  Bowstring Sign
  Test for SLR, to point of maximum pain (positive SLR) then slightly flex the patient’s knee approximately 20 degrees thereby reducing the pain.
Apply thumb pressure in the popliteal fossa to aggravate pain compared to pressure over the hamstrings to rule out  malingering and as a control.
  Lesaque Sign
   SLR, to point of maximum pain (positive SLR) then plantar flex foot (control) and compared with dorsiflex foot.