Location of pain
Onset of pain
Mechanism of injury
Consistency of the pain
Constant pain; chemically induced pain (relating to inflammation of the dural sheath)
Intermittent pain; mechanical origin
Paresthesia
Activities or positions that alter the level of symptoms
Bowel or bladder signs
Incontinence or urinary retention may indicate lower nerve root lesions (cauda equina syndrome)
Prior history of spinal injury
Inspection
General Inspection
Frontal curvature
Test for scoliosis
Sagittal curvature
Lordotic and kyphotic curves
Observation of gait
Skin markings
Café-au-lait spots may be normally occurring skin discolorations or may preset collagen disease or neurofibromatosis.
Cervical Spine
Forward head posture
Position of head on the shoulders
Bilateral soft tissue comparison
Level of the shoulders
Thoracic Spine
Breathing patterns
Pressure on thoracic nerve roots, or trauma to ribs or costal cartilage may result in pain during respiration, resulting in
irregular or shallow breathing patterns.
Bilateral comparison of skin folds
Caused by bilateral muscle imbalance, increased or decreased kyphosis, scoliosis, or disease.
Lumbar Spine
General movement and posture
Lordotic curve
Standing posture
Erector muscle tone
Faud’s beard (Sacrum and lower lumbar spine for tuft of hear, indicating spina bifida occulta)
Palpation
Cervical Spine
Anterior Cervical Structures
Hyoid bone
Thyoid cartilage
Cricoid cartilage
SCM (Sternocleidomastoid)
Scalenes
Sarotid artery
Lymph nodes
Posterior cervical spine
Occiput/superior nuchal line
Transverse processes
Spinous processes
Trapezius
Thoracic Spine
Spinous processes
Supraspinous ligaments
Costovertebral junction
Trapezius
Scapular muscles
Paravertebral muscles
Lumbar Spine
Spinous processes
Step-off deformity
Paravertebral muscles
Sacrum and Pelvis
Median sacral crests
Iliac crests
PSIS (Posterior superior iliac spine)
Gluteals
Ischial tuberosity
Greater trochanter
Sacral nerve
Pubic symphysis
Range of Motion Tests
Cervical Spine (AROM, PROM, RROM)
Thoracic and Lumbar Spine (AROM, PROM, RROM)
Ligamentous Tests
Spring test for facet joint mobility (hypomobility of vertebrae)
Neurological Tests
Upper motor neuron lesions
Babinski test
Oppenheim test
Lower motor neuron lesions
Upper quarter screen
Lower quarter screen
Beevor’s sign-thoracic nerve inhibition (T5 through T12)
Sciatic nerve compression
Special Tests
Herniated disc
Valsalva test (effect of increased intrathecal pressure)
Milgram test (effect of increased intrathecal pressure)
Kernig’s test/Brudzinski test
Well straight leg raising test
Quadrant test
Nerve Root Impingement
Quadrant test
Femoral nerve stretch test
Sciatic Nerve Involvement
Straight leg raise
Slump test
Tension sign/Bowstring test