A Scale That Can Be Used To Discriminate Patients With Low Back Pain From Normal Subjects

False positive rate of 14% in normals (86% specificity)

False negative rate of 24% in patients (76% sensitivity)

Procedure (equipment required - inclinometer, pen)

1. Identify anatomic landmarks
1. prone lying
2. horizontal marks S2 and T12-L1
3. vertical marks T12 and T9



2. Warm-up exercises
1. flexion/extension (twice)
2. left/right rotation (twice)
3. left/right lateral flexion (twice)
4. flexion/extension (once)



3. Standard standing position
1. barefoot, heels together
2. knees straight, weight evenly borne on both legs
3. looking straight ahead
4. arms relaxed at sides



4. Measure total flexion
1. erect position
1. inclinometer measurement at T12-L1
2. forward bent position
1. "reach finger tips toward toes"
2. keep knees straight
3. inclinometer measurement at T12-L1
3. subtract measures
Measure Total Flexion

5. Measure total extension
1. erect position
1. inclinometer measurement at T12-L1
2. backward bent position
1. examiner supports shoulder for balance
2. inclinometer measurement at T12-L1
3. subtract measures
Measure Total Extension




6. Measure lateral flexion
1. erect position
1. align straight edge and inclinometer with spinous processes of T9 and T12 and take measurement
2. sidebent position
1. lean to side, finger tips down side of thigh
2. examiner supports shoulder for balance
3. align straight edge and inclinometer with spinous processes of T9 and T12 and take measurement
3. subtract measures
Measure Lateral Flexion

7. Tenderness
1. prone, muscles relaxed
2. firm pressure with ball of thumb
1. spinous processes T12 to S2
2. "Is that painful?"
3. any response other than specific "no" is positive
3. behavioral (invalid) responses
1. superficial tenderness to light skin pinch
2. widespread, non-anatomic tenderness



8. Straight leg raise (SLR)
1. supine (neck relaxed, head on table)
2. inclinometer on tibial crest just below tibial tuberosity
3. hip neutral rotation
4. raise leg with hand at heel, maintain knee in extension
5. record maximum tolerable (not onset of pain) SLR
6. check limited SLR with distraction (e.g. sitting SLR), discount limited SLR as behavioral if distraction test does not show limitation
Measure Straight Leg Raise

9. Bilateral active SLR
1. supine
2. ask patient to lift both legs 6" and hold 5 seconds
1. both heels and calves must clear table
2. do not count or give verbal encouragement
3. anything other than the ability to hold both legs clear of table for 5 seconds is recorded as a "0"



10. Active sit-up
1. supine, knees flexed and feet flat on table
2. examiner holds down feet with one hand
3. ask patient to sit-up and touch (not hold) knees with fingertips for 5 seconds
1. do not count or give verbal encouragement
4. anything other than the ability to touch the knees for 5 seconds is recorded as a "0"