ABSTRACT
KEY Assess the neck by asking your patient to perform forward flexion, extension and lateral flexion. Next assess the lumbar spine. To do this, ask your patient to touch his/her toes, lean back, and run a hand alongside the lateral aspect of each leg. Pain on flexion is suggestive of a prolapsed disc and one side should be affected more than the other, unless a very large disc has prolapsed. You will need to ask your patient to sit in order to assess the rotation movements of the thoracic spine, and, once sitting, to rotate his/her upper body to each side. Next ask your patient to lie prone, palpate the sacroiliac joint lines for tenderness and press on the midline of the sacrum to establish whether movement of the sacroiliac joints is painful. A painful femoral stretch test suggests irritation of nerve roots L2, L3 and L4, and a painful straight-leg raising test is suggestive of sciatica with nerve roots L5 and S1 being affected. Whilst performing these two tests you are also assessing hip flexion and extension, and the other hip movements should be assessed passively.
