Thoracolumbar spine examination

ASK
Ask for consent
Ask if they have any pain at present
Ask them to tell you if they feel pain at any time during the examination
Ask them to undress

LOOK
Look at their posture
Look for deformities, from both back and side view
Look for normal thoracic kyphosis and lumbar lordosis
Look for scoliosis (C shaped or S shaped curvature laterally)

FEEL
Feel each vertebral body for tenderness and muscle spasm (start at the top and work downwards)

MOVEMENT
Flexion: ask the patient to touch their toes with their knees straight
Extension: ask the patient to lean backwards
This is usually less painful than bending forwards for patients with back pain
Lateral bending: ask the patient to slide the right hand down the right leg, then same for left
Rotation: have the patient sitting and ask them to rotate to each side (NB this is thoracic not lumbar spine)

MEASURE
Schober's test: Find the posterior iliac spine (around L5) and mark points 5cm below and 10cm above it. Then ask patient to touch their toes. The distance should increase at to at least 20cm, any less indications limitation on lumbar flexion
Straight Leg Raising test: With the patient lying down, lift the straightened leg. Normal is 80-90 degrees, a disc prolapse will limit this to less than 60 degrees.