Lumbar Disc Herniation

Look

1. General screening:
   • Check for scars post-discectomy, which may indicate previous surgery.

Feel

1. Pain in back:
   • Palpate the lumbar spine for tenderness and trigger points.

Move

1. Range of Motion (ROM) examination:
   • Assess for restricted movements, especially in flexion, extension, and lateral bending.
2. Walk:
   • Observe gait for any limp, altered stride, or compensation (e.g., limp on the affected side).

Lie Down

1. Full Neurologic Examination:
   • Perform a detailed sensory, motor, and reflex assessment.
2. Include sciatic stretch tests:
   • SLR (Straight Leg Raise):
     • Positive if pain radiates down the leg below the knee.
   • Lesague’s test:
     • Extension of the knee with hip flexion increases radicular pain.
   • Cross over test:
     • Positive if pain radiates on crossing the unaffected leg over the affected one.
   • Bowstring test:
     • Relief of pain when the leg is lowered after a positive SLR.
   • Femoral Stretch test:
     • Pain in the anterior thigh when extending the knee from a flexed position at the hip.

Finishing

1. PR (Per Rectum) and perianal sensation:
   • Check for sacral root involvement and bowel function.
2. Vascular:
   • Assess pulses, color, and temperature in the legs.
3. MRI:
   • Recommended for visualization of the herniated disc and surrounding structures.