Tests For Examination of the Lower Back - Everything You Need To Know - Dr. Nabil Ebraheim
Dr. Ebraheim's animated educational video describing testing for lower back pain - clinical evaluation tests.
Low back pain is common. There are several clinical evaluation tests used to assess patients with low back pain.
1-Straight leg raising test: elevation of a painful limb causes sciatica and radicular pain. The test is positive when the pain occurs with less than 60 degrees of hip flexion. The test stretches the sciatic nerve. When the sciatic nerve itself or one of the nerve roots irritated, the patient will experience pain that travels to the leg. The test can be modified by bending the knee. When the knee is bent, the pain gets better due to relaxing of the sciatic nerve. Once the patient feels the pain, lower the leg slightly and dorsiflex the foot.
2-Contralateral straight leg raising test: elevation of the non-involved leg, which is the contralateral leg, causes back pain and leg pain on the involved side.
3-Femoral nerve stretch test: this test is rarely done. The hip extension will stretch the femoral nerve. A positive test means the L3, L4 nerve roots are involved. The test will stretch the femoral nerve and is positive when pain Is felt on the ipsilateral anterior thigh.
4-Faber test: helpful in determining the presence of SI joint problems. With the patient lying supine on the examination table, the leg of the affected side should be placed into external rotation and with the foot onto the opposite knee. The examiner will press down gently but firmly on the flexed knee and the opposite anterior superior iliac crest. The position of the left will be flexion, abduction and external rotation of the hip. The Faber test is suggestive, but not a confirmatory test, because any condition in the lower back will be painful when you perform this maneuver. SI joint injection is confirmatory for SI joint problems. Some physicians believe in this and some do not. If you inject the SI joint with numbing medicine and some steroids and the patient gets better temporarily, then the problem is in the SI joint. The symptoms of SI joint and other back problems can overlap and everything can hurt:
•Nerves •Tendons •Intervertebral discs •Facet joints •Ligaments •Muscles •Nerve irritation
The examiner has to have a detailed plan and work through algorithms. If the patient points towards one side of the lower back and the Faber test is positive, then it is probably a good idea to inject the SI joint and see the response of the patient in addition to other methods of treatment. It is up to you if or when you give the injection. It is your clinical judgment that decides the treatment.
5-Movement of the spine tests:
•flexion: pain in the lower back with lumbar flexion suggests a disc related disorder. •Extension: patient with spinal stenosis, spondylolysis, spondylolisthesis or facet disease will demonstrate pain with extension of the lower back. Because of the pain experienced with extension of the spine, people suffering from spinal stenosis gain relief from leaning forward.
6-Myelopathic signs: a positive clonus sign or Babinski's sign indicated an upper motor neuron lesion that will not occur from a lumbar spine pathology.
•Gait disturbance: means there is myelopathy. Need to check the thoracic and cervical spine for spinal cord involvement even if they have a huge disc in the lumbosacral MRI. The lower lumbar spine deals with nerve roots and not the spinal cord itself.
•Clonus sign: nonvoluntary sustained movement of the ankle muscles with frim passive continuous stretch.
•Babinski’s sign: the test is performed by stimulating the outside portion of the sole of the foot. The test is positive when running a sharp instrument along the lateral border of the forefoot from the calcaneus produces extension of the big toe and fanning of the other toes. The test is negative if no reaction occurs or if the toes all bunched up.
7-Wadell’s signs (nonorganic findings): extremely controversial. Wadell’s sign is a set of physical signs used to indicate if chronic low back pain is due to non-organic or psychological components. There are five categories of tests included in the Wadell’s sign:
•Simulation tests •Tenderness tests •Flip test •Nonanatomic weakness and sensory findings. •Overreaction
Nonorganic physical exam findings determine if the patient is over exaggerating with nonanatomic findings. The clinician should be alert to the possibility that the patient may be exaggerating the symptoms possibly for a secondary gain. The clinicians should not be accusatory. Different patients may perceive their pain differently. We don’t understand how pain is produced, so we can’t simply accuse the patients of over exaggerating their symptoms.
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Пікірлер: 81
Sincere respect to u sir....ur videos are invaluable! I hope this never stops...
Thank you, Dr. Ebraheim for another excellent and educational video!
All of your videos are so informative and very helpful. Deepest gratitude and thanks!
You are a very good teacher. You are very patient. Thank you.
It was good to hear that patients should always be treated in a non-accusatory manner when no organic cause can be elicited Sir. Thank you for your video
Fantastic! Thank you.
Great explanation. My doctors have missed a few of these test on me in the last 20 years of back pain.
The most professional way to present the topic. Greatly appreciated.
@yawe2born101
Жыл бұрын
His illustrations and explanation are so understandable. He's one of the best.
BEST INFORMATION .GOD BLESS
Very informative, useful, to a layman Thanks Dr.
Thanks !!!
THANKS for all..knowledge 's..
perfect Dr jzak Allah khair
Thank you so much 🙂
Love your videos sir. Also I'd like to also Thankyou for writing the explanation in the description as well. It's helpful. Thankyou!
Thanks
Many thanks to you Prof. Ebraheim forthese enlightening educatoonal material.Well structured delivery to assist comprehension. Julius Babalola.
Thank you, I'm a PT from taiwan, this really helps me a lot.
Great video.
Thanks very much
Great sir
Super Videos by him/He Has Other Videos As Well. Excellent. Very Informative. Thank You & Thanks To All Who Involved. God Bless.
U r the best doc
God bless you
Very informative..Need you in my country... Blessings to you..
Thank you Sir, your videos are best and useful
Thank you for saying what you said at the end about pain perception. I have A.S., gouty arthritis, and Osteoarthritis. My Dr. Said my pain is fibromyalgia and pain medication are therefore not helpful and in fact make the pain worse. I have been given 5 days of pain management in12 months. 5 days out of 365. I am beside myself. I almost have Osteoporosis and nearing prediabetic from over prescribing steroids. This world is upside down.
It was so good to me and explain very clear easy to understand. Thank so much
U r the boss sir. Cheers
I need to see this doctor and have this test done
Amazing information ...very good
Thanks a million Dr. Nabil all the way from Republic of Ireland filipino
the doc said hope this helps. yes it does doc thank you
Thanks Sir
nice video
Dr. MAY ALLAH BLESS YOU. You are spreading knowledge and your life expetience.
so helpful and amazing presentation. thanks deeply Dr. N.E.
@faridahassanzai1304
5 жыл бұрын
?
@serrielu8025
4 жыл бұрын
Farida Hassanzai ?
Thank you very much for all your videos. They are extremely useful in diagnosing our back pain symptoms . They are very professional and well explained so that we can understand the causes of our pain . I would really like and appreciate you to have a video about Tarlov cysts simtoms and how do we know that these cysts are the cause of our lumbar pain if we have several diagnoses and if there is some conservative treatment such as physical therapy. Thanks a lot and best wishes!
Thank you very much! These orthopedic details you don't learn in med school in Austria.
Always best
Thank you doctor. But how to diagnose Lower Back Pain not associated with spinal problem?.
thank you so much for this extremly usefull and hard to find material
I’d like to know more about the tests you mention at the very end please.
Thank you for sharing pro god bless and best wishes
@abhilashgowda7572
5 жыл бұрын
des goulding .
Do one about the coracobrachialis musle. I have a popping sensation in my biceps/coracobrachialis musle and sometimes pain when my arm is forcefully adbucted. When I do cable flyes for example on the eccentric movment something popps. I feel it like a tightness when I do flexion of the arm. I can't figure out whats wrong :/
Mashallah sir
Dr how abaut if I can’t lift up the leg I have sciatica pain when I sleep on my back. Does it means I have herniated disck.
Do you cure back pain?
Di doctor what do you mean when you say the test is positive?
If there is a pain in right leg calf thigh and right hip. Is it sciatica? or is it disc issue. The patient also had an injury while using broken toilet in the right thigh area. It caused inflammation and severe pain. The patient can stand and walk yet patient can't sit. The patient cannot stand for longer time and walking causes pain in right hip area. What do you think it would be? Please suggest.
Does anyone know why he says that the femoral nerve stretch test is rarely done? Thanks!
Doc, when i raise my left foot inn60 degrees, my left area in mg lower back is paining and cracking, what signs it is?
What could it be if your in a sitting up position and you began having severe pain in neck, shoulders to mid shoulders with inflammation as well as lower back pain and stiffness? What could it be if you stand/walking pushing a grocery basket for a certain period of time or moving around the kitchen and your back stiffens and pain to the point you have to bend and lean on grocery basket for a little relief? What is it if your lying on your left side and you have shoulder and back pain as well as if you make a slight or try to roll over to turn to the right and the pain radiates down into your hips/ butt cheek down your leg to feet with tingling as well as slightly putting pressure with your hand on the mid back side right above the beginning of your bottom or even raising your arm in a saluting position? What is it if you lay on your back or stomach you have lots of pain as well as stiffness as if you move from that position something will snap and break. It seems like maybe a little W-D 40 may help too loosen something up because the meds don't work. Is this normal for a 44 year old who has worked a total of 28yrs as a CNA/Home Health Aide, Customer Service Rep in a call center as well as worked in the usps warehouse and a few car accidents. PLEASE HELP WITH ANY SUGGESTIONS!!! I'm not yelling at you just looking for relief due to over the years this has just progressed and not getting better with meds nor PT more than once over the years? I have had a nerve conductor test states normal,MRI shows a little arthritis per the doc, MRI nothing. Signed miserable and depressed.
@jenniferindy6628
6 жыл бұрын
Angela White arachnoiditis? ankylosing spondylitis? fibromyalgia?
@sunnypreet378
6 жыл бұрын
A lot of ur symptoms match with that of mine. Though I have disk prolapse and doctors say that I hve sciatica because of spinal Stenosis. But I somehow feel my pains are linked to Sacroiliac Joint dysfunction, not sure just suggesting and please excuse for my lack of knowledge.
ارجو الترجمة للعربي وشكرا لكم
Dr Nabil is your office in Ny
queria entender ,mas não sei inglês 😢
Setfness in hole body after surgery cervical spondylitis l5 s1
Faber test my right leg Very difficult To do , but Another Excercei all I can do übt only darüber test only right leg.I ask my Doctor he said from Gold but not real answers because my sister She never got Anything.
Toledo.... Any chance we can barrow you in Southern California? It's very warm here! Wink 😉 wink. I could really use some help in a big way.
Babinski, not babiniski
👋👋👋👋👋
Sadly the injections do not work and even sadder is even when you can prove you issues most Dr's will not even help you with pain meds and then you get labeled drug seeking.
@markj850
5 жыл бұрын
The injection is not supposed to work. The aim is, just to decipher the source . if the numbing injection subdues the pain - they know the source. If it doesn't, they need to look at other adjacents.
@pelipequi1493
4 жыл бұрын
I can't take most pain medicine b/my blood pressure drops below 60, and still I don't get answers from doctors, after 8 months of specialty doc rounds. The US health system is terrible unless you live near a major university hospital.
@corniss
3 жыл бұрын
@@pelipequi1493 yes. It is terrible. Especially in west virginia where wvu has taken over and destroyed a lot of hospitals and ran all the decent docs away.
Your are wrong, dorsiflexion of great toe is right
The clowns in the area where i live barely touch you. They probably dont even know about these tests.
@hornyval82
Жыл бұрын
Hahahaha 😆 😂
தமிழ் மொழி தமிழ்ல பேசு 👨⚕️✍️
We still in the Stone Age. Poor medical evaluations . Maybe good in 1800 year, more cartoons and promises please
Thank you for saying what you said at the end about pain perception. I have A.S., gouty arthritis, and Osteoarthritis. My Dr. Said my pain is fibromyalgia and pain medication are therefore not helpful and in fact make the pain worse. I have been given 5 days of pain management in12 months. 5 days out of 365. I am beside myself. I almost have Osteoporosis and nearing prediabetic from over prescribing steroids. This world is upside down.