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.