Video of patient examination


Discussion about examination 



Examination lying down



Neurological examination



The physical examination

The physical examination provides information about much more than just the back. 

The way in which patients approach movement demonstrates how protective they are of their back, and their beliefs about pain.

  • Muscle guarding indicates a fear of movement
  • An abrupt end to movement as soon as pain is felt indicates a belief that pain represents further damage

The examination can be a powerful therapeutic experience.

Explaining the information being taken from different tests, and highlighting normal or encouraging findings, can reassure patients. This also demonstrates that information is not being withheld, and that something useful is being found. 

The examination also provides an opportunity to demonstrate your belief that movement is a safe and useful thing, and that it is okay to experience some pain while doing this. This tests the patient’s assumption that moving into pain will create more damage.

Repeating examination movements while confidently encouraging movement into pain or stiffness can have a very positive influence. These movements can be trialled in standing, lying, or sitting. When a movement is found which seems to help, the person can be encouraged to continue doing this at home or work. All movement is good, but some may be particularly therapeutic.

Patients can approach other movements and activities in their life with the same rationale. Pain will always protect them from injury. By moving into the pain, and finding out they do not get worse (and even improve), they teach their brain that it does not need to be so protective.

“that’s probably the most important thing, if you don’t constantly challenge the boundaries, how ever will you know if you can go further? So you have to go up and bat them all the time, and when you bat them, you can do too much, but then you know ‘okay, so that was too much, so I, I hit that one a little more gently, and I go beyond it and push,’ you’ve got to keep pushing that barrier out, whether it’s the pain barrier, or your activity barrier, they’ve both got to keep on being pushed out”