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The lower back contains multiple pain-generating structures including bones, discs, ligaments, nerves, and muscles. Because the back is the most common source of pain in the body, understanding these anatomical components is essential for accurate diagnosis. Pain location often suggests the underlying cause, making careful examination critical for identifying which structure is responsible.

A comprehensive lower back exam includes inspection and palpation to assess for deformity and inflammation, evaluation of range of motion, testing muscle strength innervated by lumbar-sacral nerves, neurological evaluation, and special tests like the Stork test and Patrick's test. These components work together to identify structural and functional abnormalities.

Palpation allows clinicians to detect signs of deformity and inflammation by direct physical examination of back structures. Combined with inspection, palpation provides tactile feedback about tissue quality, tenderness, and abnormal findings that guide diagnosis. This hands-on assessment is fundamental to identifying the source of lower back pain.

Testing muscle strength in the lower back evaluates the function of muscles innervated by nerves exiting the lumbar-sacral spine. Weakness or asymmetry in strength can indicate nerve compression, muscle injury, or neurological dysfunction. This assessment helps localize pathology and determine whether nerve involvement is present.

Range of motion testing measures the back's flexibility and identifies restrictions that may indicate pain, muscle tightness, or structural limitations. Decreased motion in specific directions can suggest disc pathology, facet joint involvement, or muscle guarding. ROM assessment helps characterize the functional impact of lower back conditions.

Special tests such as the Stork test and Patrick's test are targeted maneuvers designed to reproduce or elicit specific lower back pain patterns. These tests help differentiate between various causes of pain by stressing particular structures or nerve pathways. Positive findings guide clinicians toward specific diagnoses and treatment approaches.

Neurological evaluation assesses nerve function and detects signs of nerve compression or damage in the lumbar-sacral region. This includes testing reflexes, sensation, and motor function to identify pathways and peripheral nerve distribution abnormalities. Neurological findings help determine whether nerve involvement is contributing to the patient's symptoms.