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Lumbar Spine Exam:
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INSPECTION:
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Inspection Normal
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Inspection Abnormal
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Inspection comments
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MUSCLE PALPATION:
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Musculature Normal
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Musculature Right
• • •
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Musculature Rt Location
• • •
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Musculature Left
• • •
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Musculature Lt Location
• • •
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Comments on musculature:
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BONY PALPATION:
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Bony Palpation Normal
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There is ____ tenderness at
• • •
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Bony Palpation Location
• • •
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RANGE OF MOTION:
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ROM FOR COMMERCIAL INSURANCE
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RANGE OF MOTION (NON NO FAULT/WC PATIENTS)
• • •
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ROM Comments
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ROM IF NO FAULT OR WC CASE PLEASE ROM USE BELOW
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ROM Flexion Normal N=60
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ROM Flexion Abn N=60
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ROM Extension Normal N=25
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ROM Extension Abn N=25
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ROM Rotation Normal N=18
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ROM Rotation Right
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ROM Rotation Left N=18
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ROM Sidebending Normal N=35
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ROM Sidebending Right N= 35
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ROM Sidebending Left N=35
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REFLEXES:
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Knee Reflex Normal (L4)
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Knee Reflex Right (L4)
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Knee Reflex Left (L4)
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Ankle Reflex Normal (S1)
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Ankle Reflex Right (S1)
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Ankle Reflex Left
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MUSCLE/STRENGTH EXAM:
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Hip Flexor Strength Normal (L1/L2)
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Hip Flexor Strength Right (L1/L2)
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Hip Flexor Strength Left (L1/L2)
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Quadriceps Strength Normal (L3)
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Quadriceps Strength Right (L3)
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Quadriceps Strength Left (L3)
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Anterior Tibialis Normal (L4)
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Anterior Tibialis Right (L4)
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Anterior Tibialis Left (L4)
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EHL Strength Normal (L5)
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EHL Strength Right (L5)
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EHL Strength Left (L5)
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Gastroc-Soleus Normal (S1)
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Gastroc-Soleus Right (S1)
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Gastroc-Soleus Left (S1)
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SENSATION EXAM:
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Dermatomes Normal
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Dermatomes/Sensation Comment
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Dermatomes Right
• • •
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Dermatomes Left
• • •
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Sensation Right
• • •
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Sensation Left
• • •
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PROVOCATIVE EXAMS:
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SLR/Sitting Root Normal
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SLR/Sitting Root Right
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SLR/Sitting Root Rt Degrees
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SLR/Sitting Root Left
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SLR/Sitting Root Lt Degrees
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Facet Loading Norm
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Lumbar Facet Loading Right
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Lumbar Facet Loading Left
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Ober's Test For ITB
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[+] Ober's Right Test (for ITB)
• • •
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[+] Ober's Left Test (for ITB)
• • •
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Sacroiliac Joint Normal
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Sacroiliac Joint Right
• • •
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Sacroiliac Joint Left
• • •
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Gaenslen's Test
• • •
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Gaenslen's Test Definition
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Patrick Test (FABER's)
• • •
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Patrick Test (FABER's)Definition
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Sacral Thrust/Compression Test
• • •
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Sacral thrust test,Definition
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GAIT:
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Gait Normal
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Gait Right
• • •
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Gait Left
• • •
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Assistive device
• • •
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Gait Comments:
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UPPER MOTOR NEURON (UMN) SIGNS:
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Long Tract/Clonus Normal
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Ankle Clonus
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lumbar diagram
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