What can a movement-based examination tell us about lower back pain?

X-rays and MRIs show the structure of the spine. However, it is difficult to determine from photographs alone how the patient bends and straightens their back, at which movements pain occurs, or the extent of movement in the pelvis and hip joints.

Physical examination is an assessment in which the medical team directly observes the patient's posture and movement, range of motion of joints, muscle tension, and strength.

In many cases of general lower back pain, the current condition and initial treatment direction can be determined through history taking and physical examination.

Important information can also be obtained during the process of entering the examination room and sitting down or standing up.

• Is your walking speed slower than usual?
• Can you bear weight on one leg?
• Is it comfortable to walk with your back bent?
• Do you use your hands to support yourself when standing up from a chair?
• Does your leg drag or is your gait unstable?
• Are you tilting your body to one side to avoid pain?

We do not judge the illness based solely on outward appearance. We examine which movements cause pain, along with the findings from the medical interview.

Bending forward

We check where it hurts when you bend forward, how far your hand can reach down, and how the symptoms in your lower back and legs change.

Straightening the lower back

We check whether back pain and leg numbness worsen when standing up or leaning backward.

Bending to the side and rotating

We check how left-right movements differ and in which direction familiar pain appears.

Limited movement does not necessarily mean that the spine is misaligned. Protective responses to avoid pain, muscle tension, and fear may also lead to reduced movement.

Lower back pain is more likely to occur during specific movements than when at rest.

• Sitting to standing
• lifting objects
• Wearing shoes and socks
• Turning over in bed
• Standing on one leg
• Climbing stairs
• Walking a certain distance

During the consultation, we assess the movements that the patient actually finds difficult within a safe range.

Even after treatment, you can observe whether the movement and pain have changed by performing the same motion again.

The lower back, pelvis, and hip joint are interconnected and move together.

If hip movement decreases, the lumbar spine may compensate by moving excessively, or if gluteal muscles cannot generate proper force, surrounding back muscles may become overly tense.

You can check the following content.

• Hip flexion and rotation
• Presence or absence of groin pain
• Pelvic movement
• Strength of the buttock muscles
• Standing on one leg
• Stairs and sitting to standing

We should not definitively conclude that 'the pelvis is misaligned' based on a single test alone; rather, we must examine multiple movements and the patient's symptoms together.

If you have lower back pain, the surrounding muscles may tense up strongly to protect the painful area.

The medical team will check the following.

• Which muscle is excessively stiff?
• Does familiar pain appear when pressed?
• Whether the torso and buttock muscles are using their strength properly
• Does the difference in strength between left and right sides affect actual movement?
• Are you unable to exert strength due to pain, or is there actual weakness?

A spot that hurts when pressed is not necessarily the only cause of pain. Palpation findings are interpreted together with movement and neurological examination findings.

You can check whether the usual leg pain reappears when you lift your leg or change your posture.

At this time, we examine separately the sensation of pulling in the back of the thigh and the familiar pain extending from the lower back down to the foot.

A single positive test result does not immediately confirm a herniated disc. Muscle strength and sensation, reflexes, and any MRI performed when necessary should be evaluated together.

We may observe shoulder and pelvic height, the curve of the lower back, and how you bear weight.

However, the human body is not perfectly symmetrical left and right. Even in people without pain, differences in pelvic height and muscle development may be observed.

BONEDOCTOR does not attribute all pain to a single visible asymmetry.

The important points are as follows.

• Whether the asymmetry is currently related to the actual pain
• Does it restrict movement and function?
• Whether the movement becomes more comfortable, not just the appearance, after treatment

In the following cases, imaging studies and evaluations at other medical institutions may be necessary.

• Severe trauma and possibility of fracture
• When leg muscle strength progressively declines
• Changes in bowel or bladder control and perineal sensation
• High fever and suspected infection
• History of cancer and unexplained pain
• If symptoms continue that are difficult to explain based on physical examination alone
• When it is necessary to decide whether an injection or surgery is needed

Physical examination is not a test that unconditionally replaces imaging studies; it is also an important process for determining who needs imaging.

Determine the area and direction to be treated.

We check which joint's movement is restricted and which muscle is excessively tense.

Determine the treatment intensity.

Depending on acute pain, osteoporosis, and surgical history, a gentle technique may be selected or Chuna manual therapy withheld.

Compare before and after treatment.

After treatment, we verify whether the range of motion in the lower back, the ability to sit and stand, and gait have actually changed.

We will plan other treatments together.

If muscle tension is prominent, acupuncture and pharmacopuncture may be considered; if recovery of strength and movement is needed, exercise and lifestyle management may also be considered.