← Full lesson and references Paired practice cardsSt Emlyn’s · MLA

One learner performs. One learner checks the key steps and gives feedback. Then swap roles. This is a practice aid, not an official mark scheme.

Examiner / observer

Back examination

Tick the actions you observe. Discuss any step that was not needed for this examination; unchecked boxes are not a score.

Examiner / observer · 1 of 4

Back examination

Preparation · History and urgent concerns

Agree supervision and any communication or chaperone support before starting. Provide a couch, tape measure and neurological equipment. Practise only comfortable movements on a consenting partner. Discuss intimate examination indications; do not perform rectal examination in peer practice. Bowstring and other uncomfortable adjuncts should be described or supervised on a suitable model.

St Emlyn’s · MLA · Practice aid, not an official mark schemeObserver 1 of 4

Examiner / observer · 2 of 4

Back examination

Regional examination · Lumbar mobility

Regional examination

Inspects posture, curves, scars, skin and gait only when safe; avoids forced single-leg standing.

Gently palpates the spine and paraspinal muscles, noting tenderness, warmth, swelling or deformity.

Assesses comfortable flexion, extension, rotation and lateral flexion only when safe.

Lumbar mobility

If measuring Schober, marks the PSIS level, 5 cm below and 10 cm above; records the change with flexion and the technique.

St Emlyn’s · MLA · Practice aid, not an official mark schemeObserver 2 of 4

Examiner / observer · 3 of 4

Back examination

Examination continued

Straight-leg and nerve-tension tests

With the patient supine, passively raises the straight leg and distinguishes familiar radiating pain from back pain or hamstring tightness.

For crossed straight-leg raise, lifts the unaffected leg and asks whether this reproduces familiar radicular pain in the affected leg.

Treats bowstring as an optional trained-examiner adjunct; avoids forceful pressure and stand-alone diagnosis.

Hip and upper lumbar assessment

If FABER is appropriate, flexes, abducts and externally rotates the hip, with the ankle above the opposite knee; stabilises the opposite pelvis, lowers gently and records the pain site.

If femoral nerve stretch is appropriate, uses gentle prone knee flexion with hip extension only if needed.

Distinguishes familiar anterior-thigh radicular pain from quadriceps stretch discomfort.

St Emlyn’s · MLA · Practice aid, not an official mark schemeObserver 3 of 4

Examiner / observer · 4 of 4

Back examination

Neurological completion · Close

Neurological completion

Completes lower-limb neurological assessment and examines other possible sources as indicated.

Does not infer deliberate deception from inconsistent or non-anatomical responses. Key step

Does not make rectal examination a routine completion step or prerequisite for cauda equina referral. Key step

Close

Restores comfort and privacy, thanks the patient and discusses the findings with the responsible clinician.

Explains the agreed plan to the patient.

Ask the candidate

How would you present your findings and their significance? Describe posture, movement, neurological findings and relevant red flags. Connect an inflammatory pattern to the history; routine imaging is not needed for every back pain. A normal limb examination does not dismiss cauda equina symptoms; discuss urgent concerns immediately.

What would you do next, and why? Explain the important uncertainty, a relevant next assessment and when help is needed. State what you could not assess.

Feedback

What went well:

One thing to improve:

Try again focusing on:

St Emlyn’s · MLA · Practice aid, not an official mark schemeObserver 4 of 4

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Return to the examination notes and references

Back examination

Your task

Starting information

Back examination

Back examination

Preparation

History and urgent concerns

Back examination

Regional examination

Lumbar mobility

Back examination

Straight-leg and nerve-tension tests

Hip and upper lumbar assessment

Back examination

Neurological completion

Close

Ask the candidate

Feedback