Family Medicine Physical Exam Competencies: The Back Exam

Learning Objectives:

  1. Provide a structured approach to the lumbar back examination (Inspection, palpation, range of motion, strength and neurologic testing of L4, L5, & S1, and special tests)
  2. Demonstrate the straight leg raise test what constitutes a positive test versus a negative test.
  3. Demonstrate the five Waddell's tests and explain their significance if two or more are positive.

Teaching Points:

  1. The lower back exam will frequently not provide a specific diagnosis, but will help rule out a neurosurgical emergency such as cauda equina syndrome.
  2. The majority of low back pain patients will get better: 75% in 6 weeks and 90% in 6 months.
  3. One of the main goals of evaluating low back pain is to rule out a serious underlying condition such as pyelonephritis, renal stone, tumor, or metastatic disease. The history and exam will help to clarify this.

Module 6 : Teaching the "Family Medicine Clinical Competencies"