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The regional musculoskeletal examination (RMSE) of the low back is designed to build on the sequences and techniques taught in the SMSE and GMSE. It is intended to provide a comprehensive assessment of structure and function combined with special testing to permit you to evaluate common important musculoskeletal problems of the low back seen in an ambulatory setting. The skills involved require practice and careful attention to technique. However, they can be learned and mastered on normal individuals.

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The RMSE of the low back is clinically useful as the initial examination in individuals whose history clearly suggests an acute or chronic low back problem: back-predominant spinal pain or lower extremity–predominant pain (possible lumbosacral nerve root irritation) or associated systemic or visceral disease. With practice, a systematic, efficient RMSE of the low back can be performed in ∼4 to 5 minutes.

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Furthermore, the RMSE of the low back provides the foundation for learning additional, more refined diagnostic techniques through your later exposure to orthopedic surgeons, rheumatologists, physiatrists, physical therapists, and others specifically involved in the diagnosis and treatment of back problems.

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This instructional program will enable you to identify essential anatomical features, functional relationships, and common pathologic conditions involving the low back. Essential content includes

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  • Observation of posture, gait, and movement
  • Inspection, palpation, and range of motion of the lumbosacral spine
  • Examination of the hip
  • Evaluation for possible nerve root irritation
  • Evaluation for important signs of psychological distress
  • Evaluation for sacroiliitis/spondylarthritis
  • Consideration of systemic or visceral disease.

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Most importantly, this program will prepare you to perform an organized, integrated, and clinically useful regional examination of the low back.

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Structural and Functional Anatomy

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The spinal column is composed of four balanced curves: the cervical lordosis, thoracic kyphosis, lumbar lordosis, and coccygeal kyphosis (Fig. 7–1). The compensatory nature of these balanced curves allows the normal resting erect posture to be maintained with minimal muscular effort.

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Fig. 7–1.
Graphic Jump Location

(Modified with permission from Lawry GV, Kreder HJ, Hawker G, Jerome D. Fam's Musculoskeletal Examination and Joint Injection Techniques, 2nd ed. Mosby/Elsevier, 2010, p. 104.)

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The vertebrae have important common features: an anterior element, the weight-bearing vertebral body; and posterior elements, the neural arch and facet joints (Fig. 7–2A, B).

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Fig. 7–2.
Graphic Jump LocationGraphic Jump Location

(Modified with permission from Lawry GV, Kreder HJ, Hawker G, Jerome D. Fam's Musculoskeletal Examination and Joint Injection Techniques, 2nd ed. Mosby/Elsevier, 2010, p. 104.)

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The intervertebral disks are shock-absorbing cushions between vertebral bodies which distribute weight over the surface of the vertebral end plates. They convert vertical loads into horizontal thrusts which are absorbed by ...

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