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Spine Examination

A 10-step examination covering inspection, spinal movement and palpation, nerve stretch, straight leg raise and sacroiliac testing.

Musculoskeletal · Self-paced

Step 1. Introduction

  1. Hand hygiene

    Hand wash/rub

  2. Introduce yourself

    Introduce self

  3. Explain the purpose

    Explain purpose

  4. Consent

    Obtain consent

  5. Ask about back pain

    Ask if patient has any back pain

Step 2. Inspection (Look)

  1. Exposure and stance

    Adequate exposure, shoes removed; inspect in stance

  2. Balance

    Balance:

  3. Coronal balance

    Coronal: head centred over middle of natal cleft (from behind)

  4. Sagittal balance

    Sagittal: ear centred over greater trochanter, knee and foot (from side)

  5. Shoulder height

    Shoulder height symmetry / elevated shoulder (scoliosis)

  6. Spinal curves

    Cervical lordosis, dorsal kyphosis, lumbar lordosis

  7. Trunk symmetry

    Trunk symmetry

  8. Iliac crest symmetry

    Iliac crest symmetry (short leg?)

  9. Lateral curvature

    Lateral curvature (concave or convex) – scoliosis

  10. Scars and bruising

    Scars (surgical or otherwise), bruising

  11. Other visible features

    Skin changes, muscle wasting, spasms, swellings, deformity, posture, symmetry

  12. Gait

    Gait: smoothness, uninterrupted motion, antalgic gait

  13. Function

    Function: toe walking, heel walking

  14. Report findings

    Report findings correctly

Step 3. Feel – Superficial Neck

  1. Instructions

    Clear instructions to patient

  2. Position and commentary

    Stand behind patient; commentary during palpation

  3. Triangles

    Palpate anterior and posterior triangles (briefly)

  4. Muscles

    Palpate muscles: sternocleidomastoid, scalenes, superior trapezius

  5. Tenderness

    Ask about tenderness

  6. Report findings

    Report findings correctly

Step 4. Move – Cervical Spine

  1. Instructions and position

    Clear instructions; patient standing

  2. Flexion and extension

    Flexion and extension

  3. Lateral flexion

    Left and right lateral flexion

  4. Rotation

    Left and right rotation

  5. Symmetry, range and pain

    Note symmetry and range; ask about pain

  6. Report findings

    Report findings correctly

Step 5. Move – Thoracic and Lumbar Spine

  1. Standing movements

    Standing: flexion (touch toes), inspect for scoliosis, extension (bend backwards ± support patient), left and right lateral flexion

  2. Sitting movements

    Sitting: left and right rotation

  3. Instructions, symmetry, range and pain

    Clear instructions; note symmetry and ROM; ask about pain

  4. Report findings

    Report findings correctly

Step 6. Feel – Cervical, Thoracic and Lumbar Spine

  1. Instructions and tenderness

    Clear instructions; encourage patient to report tenderness

  2. Position

    Patient prone, C-spine flexed (± pillow under chest)

  3. Cervical landmarks

    Cervical: stand at head of bed; apply pressure at appropriate landmarks (C2–C7)

  4. Thoracolumbar palpation

    Thoracolumbar: position self appropriately; palpate paraspinal muscles and landmarks (T1–sacrum)

  5. Report findings

    Report findings correctly

Step 7. Femoral Nerve Stretch Test (Prone)

  1. Instructions and symptoms

    Clear instructions; encourage patient to report symptoms

  2. Perform test

    Perform test appropriately

  3. Repeat on opposite leg

    Repeat on opposite leg

  4. Report findings

    Report findings correctly

Step 8. Straight Leg Raise (SLR) Test

  1. Instructions and affected side

    Clear instructions; ask about affected side

  2. Unaffected side first

    Perform on unaffected side first (where appropriate)

  3. Repeat on opposite leg

    Repeat on opposite leg

  4. Report findings

    Report findings correctly

Step 9. Sacroiliac Joint Testing

  1. FABER test

    FABER test (Patrick's test)

  2. Leg length discrepancy

    Leg length discrepancy

  3. Instructions, symptoms, performance and reporting

    For each test: clear instructions, encourage patient to report symptoms, perform appropriately, report findings correctly

Step 10. Conclusion

  1. Conclude and redress

    Conclude examination; indicate patient may redress

  2. Neurological testing

    Comment on neurological testing appropriate to the levels affected

  3. Hand hygiene

    Hand rub/hand wash

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