Acute lower back pain assessment

Look

• Look for abnormalities, including the posterior, anterior, and lateral aspects.
• Consider posture, curvature and distribution of mass.
• Note any significant lower limb rotation or limb length asymmetry.
• Look for peripheral oedema to lower limbs.
• Reassess for saddle paraesthesia or bladder and/or bowel dysfunction.

Feel

• Assess for altered lower limb sensation and strength.
• Assess L4/L5/S1 dermatome regions.
• Palpate the spinous processes for localised pain.
• Palpate the paraspinal areas for muscular pain.

Move

• Look at the patient’s movement and mobility. Note any acute limitations or pain.
• Straight leg raise: compare passive and active leg raise. Look for the reproduction of pain and the angle.
• Watch the patient walk.
• Assess ability to heel raise, toe stand, stand on one leg and bilateral squat.
• Assess spinal range of motion as tolerated, including flexion, extension and lateral flexion.