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Specific movements and positions that reproduce the symptoms should be documented. The upper lumbar region (L1, L2 and L3) controls the iliopsoas muscles, which can be evaluated by testing resistance to hip flexion. While seated, the patient should attempt to raise each thigh while the physician's hands are placed on the leg to create resistance. Pain and weakness are indicative of upper lumbar nerve root involvement. The L2, L3 and L4 nerve roots control the quadriceps muscle, which can be evaluated by manually trying to flex the actively extended knee. The L4 nerve root also controls the tibialis anterior muscle, which can be tested by heel walking.

The L5 nerve root controls the extensor hallucis longus, which can be tested with the patient seated and moving both great toes in a dorsiflexed position against resistance. The L5 nerve root also innervates the hip abductors, which are evaluated by the Trendelenburg test. This test requires the

Cauda equina syndrome can be identified by unexpected laxity of the anal sphincter, perianal or

Nerve root tension signs are evaluated with the straight-leg raising test in the supine position. The physician raises the patient's legs to 90 degrees. Normally, this position results in

The most common sites for a herniated lumbar disc are L4-5 and L5-S1, resulting in back pain and pain radiating down the posterior and lateral leg, to below the knee.

A crossed straight-leg raising test may suggest nerve root compression. In this test, straight-leg raising of the contralateral limb reproduces more specific but less intense pain on the affected side. In

Nonorganic physical signs (Waddell signs) may identify patients with pain of a psychologic or socioeconomic basis. These signs include superficial tenderness, positive results on simulation tests (ie, maneuvers that appear to the patient to be a test but actually are not), distraction tests that