Physical and neurologic examination of the lumbar spine

A. External manifestations of pain, including an abnormal stance, should be noted. The patient's posture and gait should be examined for sciatic list, which is indicative of disc herniation. The spinous processes and interspinous ligaments should be palpated for tenderness.

B. Range of motion should be evaluated. Pain during lumbar flexion suggests discogenic pain, while pain on lumbar extension suggests facet disease. Ligamentous or muscular strain can cause pain when the patient bends contralaterally.

C. Motor, sensory and reflex function should be assessed to determine the affected nerve root level. Muscle strength is graded from zero (no evidence of contractility) to 5 (complete range of motion against gravity, with full resistance).

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