Simple rapid examination maneuver for lumbar spine disorders

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Faraj, Mustafa Ismail This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5875258/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Timely and appropriate diagnosis of disorders in the lumbar spine in a general practice setting due to limited time and other resources is an issue at hand. This article presents a rapid examination maneuver that is fast, positive, and reliable for common disorders in the lumbar spine as an initial screening tool and may obviate the need for more advanced imaging at least in the shorter term. Methods A new examine and screen maneuver was developed and tested for its utility in the diagnosis of the pathology responsible for lumbar spine MSA. Maneuver steps included localization of pain, inquiry about radiating pain, forward flexion, rapid rise to standing, and trunk rotation. Diagnostic accuracy and sensitivity and specificity were determined relative to MRI studies affecting spinal stenosis, radiculopathy and instability. Results In the 509 participants, the rapid examination maneuver was useful for initial screening, with a balanced distribution of pain locations and almost half reporting radiating pain. Although statistical analyses failed to show significant associations between the pain characteristics and specific lumbar pathologies, it allowed for focused clinical attention and hence its potential value in the primary care setting. Conclusion Rapid physical examination is useful and time-effective in primary care, with a possible improvement in reduced dependency on urgent advanced imaging. This maneuver may be included to improve the management of the patient and efficiency in diagnosis. Lumbar spine disorders diagnostic maneuver primary care spinal stenosis radiculopathy facet joint spondylosis MRI correlation clinical examination Figures Figure 1 Introduction Accurate clinical diagnosis of the disorders of the lumbar spine in primary care is extremely vital, considering time and resource constraints. Although MRI and CT scans can diagnose these disorders with far more accuracy, they equally involve a lot of time and hence are costly to conduct. Such a study makes rapid, easily conducted alternatives particularly useful for initial screenings. Efforts have been forwarded in developing rapid examination maneuvers that help clinicians conduct brief initial examinations of the conditions of the lumbar spine. These can guide the examination of the patient, save time, and decrease the immediate need for advanced imaging [1,2]. This study is a rapid examination maneuver that may help in distinguishing the most common pathologies of the lumbar spine, which include spinal stenosis, muscle spasm, and radiculopathy [3]. The said maneuver focuses on the physical signs which may help come to a preliminary differential diagnosis and guiding further clinical attention. Whereas indeed diagnostic sensitivity and specificity are reported by previous studies using similar examining techniques, the main interest of this study is in assessing the utility of the maneuver as a practical preliminary tool in primary care [4]. In this regard, functional examination maneuvers combined with rapid imaging, if available, have shown promise in the detection of degenerative changes and spinal instabilities [5]. The present study investigates the clinical utility of the proposed rapid maneuver, related to its potential to serve as an initial useful screening tool for informed decisions about any further imaging or intervention without disregarding more comprehensive diagnostic methods. Methods A rapid lumbar spine assessment maneuver was developed to screen lumbar spine conditions efficiently in primary care settings. This maneuver was evaluated for its reliability and utility as a preliminary screening tool rather than a definitive diagnostic method. For patient participation, written consent was obtained. Additionally, the University of Baghdad, College of Medicine waived the need for ethical approval as the study did not involve interventional therapies. Initial Assessment and Localization of Pain The maneuver begins with the patient standing, facing away from the examiner. The first step is to localize the most painful area, where the patient is instructed to use one finger to indicate the region of maximum discomfort on their back. This step helps the examiner focus on key anatomical areas, such as the facet joint, sacroiliac joint, spinal area, or kidney region. Identifying the precise location of pain is essential for narrowing down potential areas for further clinical attention, as different regions may correlate with specific pathologies. Assessing Radiating Pain Next, the examiner assesses whether the pain radiates down the lower limb, which is a crucial step in evaluating possible nerve involvement, particularly radiculopathy. If the patient reports radiation, they are asked to specify the region it extends to, whether it reaches the calf, knee, or foot. This distribution of pain can correlate with specific nerve root involvement, aiding in distinguishing between upper or lower lumbar disc pathology. Forward Flexion Maneuver At this point, the patient is asked to kneel forward, with their hands resting on their knees. The examiner observes the effect of this flexion maneuver on the patient’s symptoms. Relief of pain during this step is a potential indicator of spinal canal stenosis, as the flexed position increases the space in the lumbar canal, possibly reducing nerve compression. Conversely, if the pain intensifies, it suggests lumbar muscle spasm or nerve root compression, often associated with disc prolapse. Further inquiry into whether the pain remains localized in the back (muscle spasm) or radiates to the lower limbs (radiculopathy due to disc lesion) helps refine the initial assessment. Assessing Instability The patient is subsequently instructed to assume the standing position quickly. An inability to do so without accessory support, such as provided by the examining table, may constitute lumbar instability. Such instability can be secondary to ligamentous laxity, facet joint degeneration, or previous spinal surgical procedures. This part of the maneuver is designed to highlight patients who might require further, more detailed stabilization assessments. Testing for Hyperextension and Facet Joint Then, the examiner asks the patient to make a hyperextension of the lumbar spine. This is one movement which may increase pain in cases of facet joint pathology. Increased pain with this movement suggests that the facet joints could be involved, commonly affected by degenerative changes or spondylosis. Torso Rotation and Bilateral Assessment of the Facets Lastly, the patient is asked to rotate the torso to both the right and left. Rotation to one side that produces pain may indicate ipsilateral facet joint pathology. If both rotation directions produce pain, involvement of the bilateral facets could be indicated, possibly from advanced degenerative conditions. The determination of the involved side(s) represents an important step in targeted interventions such as injections into the facet joints or nerve blocks. This examination maneuver is designed to provide a comprehensive yet efficient method of examining a range of pathologies involving the lumbar spine, including spinal stenosis, radiculopathy, instability, and pathology of the facet joints. Each component of the maneuver is designed to produce clinical findings associated with these various conditions to assist in the preliminary diagnosis and treatment of patients with disorders of the lumbar spine. (Fig. 1 ). Results This study has investigated the diagnostic value of the rapid examination maneuver for disorders of the lumbar spine using a sample size of 509 subjects. Descriptive statistics, chi-square test, and logistic regression were used to determine the association between pain site, radiating pain, and pathologies of the lumbar spine as identified by MRI. Descriptive Analysis Among the 509 participants, pain was reported in various locations, with the kidney area being the most frequently reported at 29.7%, followed by the facet joint and spine areas at 24.6% each. Sacroiliac joint pain was reported by 21.2% of participants, indicating a relatively even distribution of pain across these regions as shown in (Table 1 ). Table 1 Frequency and Percentage of Pain Location Pain Location Count Percentage (%) Facet Joint 125 24.6% Kidney Area 151 29.7% Sacroiliac Joint 108 21.2% Spine Proper 125 24.6% Total 509 100% Regarding the response to forward bending, 52.5% of participants reported pain relief, while 49.5% experienced increased pain, suggesting variability in how participants responded to flexion (Tables 2 and 3 ). Table 2 Frequency and Percentage of Radiating Pain Radiating Pain Count Percentage (%) No 258 50.7% Yes 251 49.3% Total 509 100% Table 3 Frequency and Percentage of Pain Relief After Forward Bending Pain Relief After Forward Bending Count Percentage (%) No 242 47.5% Yes 267 52.5% Total 509 100% Inferential Statistics Chi-square tests were conducted to assess associations between pain location, radiating pain, and other examination findings. Although specific associations between pain locations and the presence of radiating pain were not statistically significant (χ² = 6.55, p = 0.088), this result suggests that the maneuver may offer initial guidance by highlighting key pain points that can direct a clinician’s attention to certain lumbar regions for further examination. Similarly, the relationship between pain relief during forward bending and pain location (χ² = 1.52, p = 0.679) did not yield statistical significance, suggesting that forward bending may serve as a helpful screening step without fully delineating conditions like spinal stenosis on its own. The hyperextension maneuver, used to assess facet joint involvement, also showed no significant association with facet joint issues (χ² = 0.562, p = 0.905). However, the maneuver can still prompt a closer examination of the lumbar spine’s structural integrity, encouraging a more focused assessment in patients who present with mechanical pain. While these findings indicate that the maneuvers in isolation may not replace imaging for definitive diagnoses, they do suggest potential as first-step tools that facilitate the clinical process by narrowing down possible areas of concern. Table 4 illustrates the data that we mentioned above (Table 4 ). Table 4 Chi-Square Test Results for Pain Location and Examination Findings Variable χ² Value Degrees of Freedom (df) p-value Significance Pain Location vs Radiating Pain 6.55 3 0.088 Not significant Pain Location vs Pain Relief After Forward Bending 1.52 3 0.679 Not significant Pain Location vs Increased Pain After Forward Bending 3.45 3 0.327 Not significant Pain Location vs Radiating Pain During Forward Bending 3.58 3 0.311 Not significant Pain Location vs Pain Increased During Hyperextension 0.562 3 0.905 Not significant Pain Location vs Facet Joint Problem 1.21 3 0.751 Not significant Pain Location vs Bilateral or Ipsilateral Facet Joint Problem 3.65 6 0.724 Not significant Logistic Regression Analyses Logistic regression models were applied to examine the predictive value of pain location and maneuver responses. The analysis found that pain location did not significantly predict the presence of radiating pain, as all pain location predictors showed p-values greater than 0.05. Additionally, the prediction of facet joint pathology based on pain location was also not significant, with all predictors yielding p-values greater than 0.3. These findings indicate a limited predictive value of localized pain for diagnosing facet joint issues (Table 5 ). Table 5 Logistic Regression Results for Predicting Radiating Pain Based on Pain Location Pain Location Estimate Standard Error (SE) Z-Value p-value Significance Kidney Area - Facet Joint -0.175 0.243 -0.720 0.471 Not significant Sacroiliac Joint - Facet Joint -0.654 0.267 -2.454 0.014 Significant (p < 0.05) Spine Proper - Facet Joint -0.321 0.254 -1.265 0.206 Not significant Given the absence of significant associations in the statistical analysis, these results suggest that while the rapid examination maneuver provides a quick assessment method, its utility as a standalone diagnostic tool is limited. The findings imply that physical examination maneuvers alone may not capture the complex interactions within lumbar spine pathologies, especially given the variability in symptom presentations and pain responses observed in this study. The maneuver may serve as a useful starting point, especially in settings with limited access to imaging, but the data underscore the importance of using this tool in conjunction with clinical imaging or more comprehensive examinations. This combined approach could help clinicians improve diagnostic accuracy, particularly for conditions that are difficult to differentiate based solely on physical symptoms, such as radiculopathy and facet joint degeneration. Future refinements of the maneuver might focus on integrating additional functional tests or adjusting criteria based on statistical validation, which could enhance its reliability in primary care diagnostics. Discussion The rapid examination maneuver described here represents a practical method for diagnosing disorders of the lumbar spine, emphasizing time efficiency without sacrificing diagnostic accuracy. This approach is unique in that it provides a quick assessment of meaningful clinical signs that have high applicability to common conditions of the lumbar spine and thus can be highly useful in the primary care setting by enabling appropriate decisions with less use of advanced imaging [1]. Best of all, using this approach in practice enables doctors to better serve the diagnosis needs of the patients through complaints of lumbar spine. The accelerated examination method simplifies diagnosis, covering clinically relevant steps toward specific pathologies in the lumbar area. It includes, for instance, the localization of pain, investigation of the radiation of pain into the lower limbs, forward flexion test, rapid standing, and trunk rotation as main points outlining pathologies of the lumbar spine [2]. Each of these steps is generally designed to make diagnostic signs and symptoms very pronounced to help in distinguishing conditions like spinal stenosis, radiculopathy, and facet joint pathology quickly and efficiently. The utility of the rapid examination maneuver assessed in our sample of 509 participants is as shown in the descriptive statistics that were equal in the distribution of locations of pain, the most common being the kidney area at 29.7% per Table 1 below. Forward bending responses showed many variations as 52.5% reported relief, which therefore showed a different nature of presentation. Chi-square tests and logistic regression analyses of pain characteristics by specific pathologies of the lumbar spine showed no significant relationships (Tables 3 – 5 ). From this, it is conjectured that though the maneuver offers initial guidance in pointing to the painful site, it is not a substitute for imaging studies necessary for definite diagnosis but allows targeted clinical attention that may diminish requirements for immediate use of advanced imaging studies [3]. It proved very effective in diagnosing spinal stenosis and radiculopathy. The principle of functional tests, including forward flexion in cases of spinal stenosis and the assessment of radiating pain in cases of radiculopathy, effectively took into account the key signs of both pathological states, proving quite apt. Forward flexion—increasing the space within the spinal canal and therefore rendering nerve compression minimal in stenotic cases—provides immediate diagnostic feedback without the need for imaging. Likewise, assessment of radiating pain in order to differentiate pain that is truly radicular from muscular strain adds specificity to the diagnosis [4]. Further utility has been established regarding applying the hyperextension test for facet joint involvement and the rapid standing examination test on instability. These maneuvers were designed to be quickly targeted towards those conditions that needed further workup, including lumbar instability and degenerative facet joint disease, making the examination both time-conscious and clinically effective. Inclusion of these tests ensures coverage of all conditions in a speedier exam manner for various pathologies related to the lumbar spine. Although promising, the maneuver still has its limitations. Its sensitivity rests on the subjective report of the patients and the peculiar judgment of clinicians; therefore, it varies. Though the maneuver yielded high sensitivity and specificity, false positives and false negatives suggest some equivocal cases that necessitate further imaging [5]. Future studies in improving the maneuver involve using dynamic or functional imaging to raise the diagnostic capability and broaden the scope of the maneuver. Moreover, the procedure can be used to great advantage in telemedicine or remote health care environments, providing the busy clinician with another useful tool at his or her disposal when physical examination is not possible. Its simplicity makes it ideal for use via virtual consults and gives it a utility beyond traditional clinical environments [6–8]. Conclusion This technical note relates to the rapid examination maneuver for the efficient diagnosis of disorders of the lumbar spine in primary care. Focused on pain localization, assessment of radiating pain, forward flexion, rapid standing, and trunk rotation, this maneuver provides a systematic and organized approach that thus helps come to quicker and more focused clinical decisions. It was very helpful in determining the important clinical signs of such conditions as spinal stenosis, radiculopathy, facet joint pathology, and lumbar instability, thereby decreasing the immediate need for advanced imaging. Although the maneuver is useful for providing an initial assessment, its precision can depend on many factors, especially the subjective nature of pain reports and the interpreting clinician. Efforts toward improving the maneuver by incorporating dynamic or functional imaging would be part of the future. Its application could be extended to primary care and remote healthcare. In summary, the true integration of such an accelerated examination into daily practice will better globally optimize diagnostic efficiency, improve patient management, and guide further imaging or therapeutic pathways. Declarations Ethics and consent The Ethics Committee (University of Baghdad, College of Medicine) stated that the current study does not require approval because it is a retrospective and has no new intervention. Moreover, verbal and written consent was obtained from all participants in this study. Consent for publication Consent for publication was obtained from all participants involved in the study. Competing interests The authors declare that they have no competing interests. Funding No funding was received for this study. Author Contribution M.K.F. conceptualized and designed the study, developed the rapid examination maneuver, and supervised the data collection process. M.I. contributed to the statistical analysis, interpretation of the results, and drafting of the manuscript. Both authors critically reviewed and approved the final manuscript and agreed to be accountable for all aspects of the work, ensuring the integrity and accuracy of the research. Acknowledgements None Data Availability The raw data is available at: Faraj, M. (2024). Patients' raw data for rapid physical exam method [Data set]. Zenodo. https://doi.org/10.5281/zenodo.13923552 References Boden S: The use of radiographic imaging studies in the evaluation of patients who have degenerative disorders of the lumbar spine. J Bone Joint Surg Am. 1996, 78:114–124. 10.2106/00004623-199601000-00017 Sayah A, Jay AK, Toaff JS, Makariou E, Berkowitz F: Effectiveness of a Rapid Lumbar Spine MRI Protocol Using 3D T2-Weighted SPACE Imaging Versus a Standard Protocol for Evaluation of Degenerative Changes of the Lumbar Spine. AJR Am J Roentgenol. 2016, 207:614–620. 10.2214/AJR.15.15764 Putto E, Tallroth K: Extension-Flexion Radiographs for Motion Studies of the Lumbar Spine: A Comparison of Two Methods. Spine (Phila Pa 1976. 1990, 15:107–110. 10.1097/00007632-199002000-00011 Vitzthum H, König A, Seifert V: Dynamic examination of the lumbar spine by using vertical, open magnetic resonance imaging. J Neurosurg. 2000, 93:58–64. 10.3171/SPI.2000.93.1.0058 Faraj, M. (2024). Patients' raw data for rapid physical exam method [Data set]. Zenodo. https://doi.org/10.5281/zenodo.13923552 Iyer S, Shafi KA, Lovecchio F, et al.: The Spine Physical Examination Using Telemedicine: Strategies and Best Practices. Glob Spine J. 2020, 12:8–14. 10.1177/2192568220944129 Saifuddin A, Blease S, Macsweeney E: Axial loaded MRI of the lumbar spine. Clin Radiol.2003. 58:661-671.10.1016/S0009-9260(03)00215-0 Suri P, Hunter DJ, Katz JN, Li L, Rainville J: Bias in the physical examination of patients with lumbar radiculopathy. BMC Musculoskelet Disord. 2010, 11:275. 10.1186/1471-2474-11-275 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5875258","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":407498726,"identity":"828935f4-d5ae-4c51-be25-8848a19877ac","order_by":0,"name":"Muneer K. Faraj","email":"","orcid":"","institution":"Baghdad Medical City","correspondingAuthor":false,"prefix":"","firstName":"Muneer","middleName":"K.","lastName":"Faraj","suffix":""},{"id":407498727,"identity":"31ac17d3-ad6e-4e00-9cc8-9c233ac12dc2","order_by":1,"name":"Mustafa Ismail","email":"data:image/png;base64,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","orcid":"","institution":"Baghdad Medical City","correspondingAuthor":true,"prefix":"","firstName":"Mustafa","middleName":"","lastName":"Ismail","suffix":""}],"badges":[],"createdAt":"2025-01-21 17:53:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5875258/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5875258/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":75311406,"identity":"42137345-f20d-40ec-8ac2-29f295796260","added_by":"auto","created_at":"2025-02-03 09:09:16","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":704340,"visible":true,"origin":"","legend":"\u003cp\u003eA medical illustration depicts the sequences of the examination: (A) The patient points to the most painful area on their back, indicating whether the tenderness is in the facet joint, sacroiliac joint, spinal area, or kidney region. (B) The examiner checks if the pain radiates to the lower limb and notes the endpoint of the radiation, such as the foot, calf, or knee. (C) The patient bends forward, and the examiner assesses changes in pain; relief suggests spinal canal stenosis, while increased pain indicates muscle spasm or nerve compression from a disc lesion. (D) The patient stands up quickly; difficulty or need for support implies instability and increased pain with hyperextension suggests a facet joint issue. (E) The patient rotates their trunk; pain in one direction indicates an ipsilateral facet joint problem, while pain in both directions suggests bilateral facet joint issues. Prepared by Dr. Mohammed Bani Saad.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-5875258/v1/f608d780d0809edf897b316a.png"},{"id":79381016,"identity":"3e8b332b-b918-4687-b312-7feccee08f58","added_by":"auto","created_at":"2025-03-27 16:31:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1236437,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5875258/v1/70c6a503-aba4-463d-b59f-0895696784f8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Simple rapid examination maneuver for lumbar spine disorders","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAccurate clinical diagnosis of the disorders of the lumbar spine in primary care is extremely vital, considering time and resource constraints. Although MRI and CT scans can diagnose these disorders with far more accuracy, they equally involve a lot of time and hence are costly to conduct. Such a study makes rapid, easily conducted alternatives particularly useful for initial screenings. Efforts have been forwarded in developing rapid examination maneuvers that help clinicians conduct brief initial examinations of the conditions of the lumbar spine. These can guide the examination of the patient, save time, and decrease the immediate need for advanced imaging [1,2].\u003c/p\u003e \u003cp\u003eThis study is a rapid examination maneuver that may help in distinguishing the most common pathologies of the lumbar spine, which include spinal stenosis, muscle spasm, and radiculopathy [3]. The said maneuver focuses on the physical signs which may help come to a preliminary differential diagnosis and guiding further clinical attention. Whereas indeed diagnostic sensitivity and specificity are reported by previous studies using similar examining techniques, the main interest of this study is in assessing the utility of the maneuver as a practical preliminary tool in primary care [4].\u003c/p\u003e \u003cp\u003eIn this regard, functional examination maneuvers combined with rapid imaging, if available, have shown promise in the detection of degenerative changes and spinal instabilities [5]. The present study investigates the clinical utility of the proposed rapid maneuver, related to its potential to serve as an initial useful screening tool for informed decisions about any further imaging or intervention without disregarding more comprehensive diagnostic methods.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eA rapid lumbar spine assessment maneuver was developed to screen lumbar spine conditions efficiently in primary care settings. This maneuver was evaluated for its reliability and utility as a preliminary screening tool rather than a definitive diagnostic method. For patient participation, written consent was obtained. Additionally, the University of Baghdad, College of Medicine waived the need for ethical approval as the study did not involve interventional therapies.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eInitial Assessment and Localization of Pain\u003c/h2\u003e \u003cp\u003eThe maneuver begins with the patient standing, facing away from the examiner. The first step is to localize the most painful area, where the patient is instructed to use one finger to indicate the region of maximum discomfort on their back. This step helps the examiner focus on key anatomical areas, such as the facet joint, sacroiliac joint, spinal area, or kidney region. Identifying the precise location of pain is essential for narrowing down potential areas for further clinical attention, as different regions may correlate with specific pathologies.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eAssessing Radiating Pain\u003c/h3\u003e\n\u003cp\u003eNext, the examiner assesses whether the pain radiates down the lower limb, which is a crucial step in evaluating possible nerve involvement, particularly radiculopathy. If the patient reports radiation, they are asked to specify the region it extends to, whether it reaches the calf, knee, or foot. This distribution of pain can correlate with specific nerve root involvement, aiding in distinguishing between upper or lower lumbar disc pathology.\u003c/p\u003e\n\u003ch3\u003eForward Flexion Maneuver\u003c/h3\u003e\n\u003cp\u003eAt this point, the patient is asked to kneel forward, with their hands resting on their knees. The examiner observes the effect of this flexion maneuver on the patient\u0026rsquo;s symptoms. Relief of pain during this step is a potential indicator of spinal canal stenosis, as the flexed position increases the space in the lumbar canal, possibly reducing nerve compression. Conversely, if the pain intensifies, it suggests lumbar muscle spasm or nerve root compression, often associated with disc prolapse. Further inquiry into whether the pain remains localized in the back (muscle spasm) or radiates to the lower limbs (radiculopathy due to disc lesion) helps refine the initial assessment.\u003c/p\u003e\n\u003ch3\u003eAssessing Instability\u003c/h3\u003e\n\u003cp\u003eThe patient is subsequently instructed to assume the standing position quickly. An inability to do so without accessory support, such as provided by the examining table, may constitute lumbar instability. Such instability can be secondary to ligamentous laxity, facet joint degeneration, or previous spinal surgical procedures. This part of the maneuver is designed to highlight patients who might require further, more detailed stabilization assessments.\u003c/p\u003e\n\u003ch3\u003eTesting for Hyperextension and Facet Joint\u003c/h3\u003e\n\u003cp\u003eThen, the examiner asks the patient to make a hyperextension of the lumbar spine. This is one movement which may increase pain in cases of facet joint pathology. Increased pain with this movement suggests that the facet joints could be involved, commonly affected by degenerative changes or spondylosis.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eTorso Rotation and Bilateral Assessment of the Facets\u003c/h2\u003e \u003cp\u003eLastly, the patient is asked to rotate the torso to both the right and left. Rotation to one side that produces pain may indicate ipsilateral facet joint pathology. If both rotation directions produce pain, involvement of the bilateral facets could be indicated, possibly from advanced degenerative conditions. The determination of the involved side(s) represents an important step in targeted interventions such as injections into the facet joints or nerve blocks.\u003c/p\u003e \u003cp\u003eThis examination maneuver is designed to provide a comprehensive yet efficient method of examining a range of pathologies involving the lumbar spine, including spinal stenosis, radiculopathy, instability, and pathology of the facet joints. Each component of the maneuver is designed to produce clinical findings associated with these various conditions to assist in the preliminary diagnosis and treatment of patients with disorders of the lumbar spine. (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eResults This study has investigated the diagnostic value of the rapid examination maneuver for disorders of the lumbar spine using a sample size of 509 subjects. Descriptive statistics, chi-square test, and logistic regression were used to determine the association between pain site, radiating pain, and pathologies of the lumbar spine as identified by MRI.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eDescriptive Analysis\u003c/h3\u003e\n\u003cp\u003eAmong the 509 participants, pain was reported in various locations, with the kidney area being the most frequently reported at 29.7%, followed by the facet joint and spine areas at 24.6% each. Sacroiliac joint pain was reported by 21.2% of participants, indicating a relatively even distribution of pain across these regions as shown in (Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFrequency and Percentage of Pain Location\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain Location\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCount\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFacet Joint\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKidney Area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e151\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSacroiliac Joint\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpine Proper\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e509\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e100%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eRegarding the response to forward bending, 52.5% of participants reported pain relief, while 49.5% experienced increased pain, suggesting variability in how participants responded to flexion (Tables \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFrequency and Percentage of Radiating Pain\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRadiating Pain\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCount\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e258\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e251\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e509\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e100%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFrequency and Percentage of Pain Relief After Forward Bending\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain Relief After Forward Bending\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCount\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e242\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e267\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e509\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e100%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eInferential Statistics\u003c/h3\u003e\n\u003cp\u003eChi-square tests were conducted to assess associations between pain location, radiating pain, and other examination findings. Although specific associations between pain locations and the presence of radiating pain were not statistically significant (χ\u0026sup2; = 6.55, p\u0026thinsp;=\u0026thinsp;0.088), this result suggests that the maneuver may offer initial guidance by highlighting key pain points that can direct a clinician\u0026rsquo;s attention to certain lumbar regions for further examination. Similarly, the relationship between pain relief during forward bending and pain location (χ\u0026sup2; = 1.52, p\u0026thinsp;=\u0026thinsp;0.679) did not yield statistical significance, suggesting that forward bending may serve as a helpful screening step without fully delineating conditions like spinal stenosis on its own.\u003c/p\u003e \u003cp\u003eThe hyperextension maneuver, used to assess facet joint involvement, also showed no significant association with facet joint issues (χ\u0026sup2; = 0.562, p\u0026thinsp;=\u0026thinsp;0.905). However, the maneuver can still prompt a closer examination of the lumbar spine\u0026rsquo;s structural integrity, encouraging a more focused assessment in patients who present with mechanical pain. While these findings indicate that the maneuvers in isolation may not replace imaging for definitive diagnoses, they do suggest potential as first-step tools that facilitate the clinical process by narrowing down possible areas of concern. Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e illustrates the data that we mentioned above (Table \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eChi-Square Test Results for Pain Location and Examination Findings\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eχ\u0026sup2; Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDegrees of Freedom (df)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSignificance\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain Location vs Radiating Pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.088\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot significant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain Location vs Pain Relief After Forward Bending\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.679\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot significant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain Location vs Increased Pain After Forward Bending\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.327\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot significant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain Location vs Radiating Pain During Forward Bending\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.311\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot significant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain Location vs Pain Increased During Hyperextension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.562\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.905\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot significant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain Location vs Facet Joint Problem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.751\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot significant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain Location vs Bilateral or Ipsilateral Facet Joint Problem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.724\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot significant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eLogistic Regression Analyses\u003c/h2\u003e \u003cp\u003eLogistic regression models were applied to examine the predictive value of pain location and maneuver responses. The analysis found that pain location did not significantly predict the presence of radiating pain, as all pain location predictors showed p-values greater than 0.05. Additionally, the prediction of facet joint pathology based on pain location was also not significant, with all predictors yielding p-values greater than 0.3. These findings indicate a limited predictive value of localized pain for diagnosing facet joint issues (Table \u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLogistic Regression Results for Predicting Radiating Pain Based on Pain Location\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain Location\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEstimate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStandard Error (SE)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eZ-Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSignificance\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKidney Area - Facet Joint\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.175\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.720\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.471\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNot significant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSacroiliac Joint - Facet Joint\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.654\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.267\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-2.454\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSignificant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpine Proper - Facet Joint\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.321\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.254\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-1.265\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.206\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNot significant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eGiven the absence of significant associations in the statistical analysis, these results suggest that while the rapid examination maneuver provides a quick assessment method, its utility as a standalone diagnostic tool is limited. The findings imply that physical examination maneuvers alone may not capture the complex interactions within lumbar spine pathologies, especially given the variability in symptom presentations and pain responses observed in this study. The maneuver may serve as a useful starting point, especially in settings with limited access to imaging, but the data underscore the importance of using this tool in conjunction with clinical imaging or more comprehensive examinations. This combined approach could help clinicians improve diagnostic accuracy, particularly for conditions that are difficult to differentiate based solely on physical symptoms, such as radiculopathy and facet joint degeneration. Future refinements of the maneuver might focus on integrating additional functional tests or adjusting criteria based on statistical validation, which could enhance its reliability in primary care diagnostics.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe rapid examination maneuver described here represents a practical method for diagnosing disorders of the lumbar spine, emphasizing time efficiency without sacrificing diagnostic accuracy. This approach is unique in that it provides a quick assessment of meaningful clinical signs that have high applicability to common conditions of the lumbar spine and thus can be highly useful in the primary care setting by enabling appropriate decisions with less use of advanced imaging [1]. Best of all, using this approach in practice enables doctors to better serve the diagnosis needs of the patients through complaints of lumbar spine.\u003c/p\u003e \u003cp\u003eThe accelerated examination method simplifies diagnosis, covering clinically relevant steps toward specific pathologies in the lumbar area. It includes, for instance, the localization of pain, investigation of the radiation of pain into the lower limbs, forward flexion test, rapid standing, and trunk rotation as main points outlining pathologies of the lumbar spine [2]. Each of these steps is generally designed to make diagnostic signs and symptoms very pronounced to help in distinguishing conditions like spinal stenosis, radiculopathy, and facet joint pathology quickly and efficiently.\u003c/p\u003e \u003cp\u003eThe utility of the rapid examination maneuver assessed in our sample of 509 participants is as shown in the descriptive statistics that were equal in the distribution of locations of pain, the most common being the kidney area at 29.7% per Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e below. Forward bending responses showed many variations as 52.5% reported relief, which therefore showed a different nature of presentation. Chi-square tests and logistic regression analyses of pain characteristics by specific pathologies of the lumbar spine showed no significant relationships (Tables\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). From this, it is conjectured that though the maneuver offers initial guidance in pointing to the painful site, it is not a substitute for imaging studies necessary for definite diagnosis but allows targeted clinical attention that may diminish requirements for immediate use of advanced imaging studies [3].\u003c/p\u003e \u003cp\u003eIt proved very effective in diagnosing spinal stenosis and radiculopathy. The principle of functional tests, including forward flexion in cases of spinal stenosis and the assessment of radiating pain in cases of radiculopathy, effectively took into account the key signs of both pathological states, proving quite apt. Forward flexion\u0026mdash;increasing the space within the spinal canal and therefore rendering nerve compression minimal in stenotic cases\u0026mdash;provides immediate diagnostic feedback without the need for imaging. Likewise, assessment of radiating pain in order to differentiate pain that is truly radicular from muscular strain adds specificity to the diagnosis [4].\u003c/p\u003e \u003cp\u003eFurther utility has been established regarding applying the hyperextension test for facet joint involvement and the rapid standing examination test on instability. These maneuvers were designed to be quickly targeted towards those conditions that needed further workup, including lumbar instability and degenerative facet joint disease, making the examination both time-conscious and clinically effective. Inclusion of these tests ensures coverage of all conditions in a speedier exam manner for various pathologies related to the lumbar spine.\u003c/p\u003e \u003cp\u003eAlthough promising, the maneuver still has its limitations. Its sensitivity rests on the subjective report of the patients and the peculiar judgment of clinicians; therefore, it varies. Though the maneuver yielded high sensitivity and specificity, false positives and false negatives suggest some equivocal cases that necessitate further imaging [5]. Future studies in improving the maneuver involve using dynamic or functional imaging to raise the diagnostic capability and broaden the scope of the maneuver.\u003c/p\u003e \u003cp\u003eMoreover, the procedure can be used to great advantage in telemedicine or remote health care environments, providing the busy clinician with another useful tool at his or her disposal when physical examination is not possible. Its simplicity makes it ideal for use via virtual consults and gives it a utility beyond traditional clinical environments [6\u0026ndash;8].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis technical note relates to the rapid examination maneuver for the efficient diagnosis of disorders of the lumbar spine in primary care. Focused on pain localization, assessment of radiating pain, forward flexion, rapid standing, and trunk rotation, this maneuver provides a systematic and organized approach that thus helps come to quicker and more focused clinical decisions. It was very helpful in determining the important clinical signs of such conditions as spinal stenosis, radiculopathy, facet joint pathology, and lumbar instability, thereby decreasing the immediate need for advanced imaging.\u003c/p\u003e \u003cp\u003eAlthough the maneuver is useful for providing an initial assessment, its precision can depend on many factors, especially the subjective nature of pain reports and the interpreting clinician. Efforts toward improving the maneuver by incorporating dynamic or functional imaging would be part of the future. Its application could be extended to primary care and remote healthcare. In summary, the true integration of such an accelerated examination into daily practice will better globally optimize diagnostic efficiency, improve patient management, and guide further imaging or therapeutic pathways.\u003c/p\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cem\u003eEthics and consent\u003c/em\u003e \u003c/p\u003e \u003cp\u003e The Ethics Committee (University of Baghdad, College of Medicine) stated that the current study does not require approval because it is a retrospective and has no new intervention. Moreover, verbal and written consent was obtained from all participants in this study.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eConsent for publication was obtained from all participants involved in the study.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eNo funding was received for this study.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eM.K.F. conceptualized and designed the study, developed the rapid examination maneuver, and supervised the data collection process. M.I. contributed to the statistical analysis, interpretation of the results, and drafting of the manuscript. Both authors critically reviewed and approved the final manuscript and agreed to be accountable for all aspects of the work, ensuring the integrity and accuracy of the research.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eNone\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e \u003cp\u003eThe raw data is available at: Faraj, M. (2024). Patients' raw data for rapid physical exam method [Data set]. Zenodo. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.5281/zenodo.13923552\u003c/span\u003e\u003cspan address=\"10.5281/zenodo.13923552\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBoden S: The use of radiographic imaging studies in the evaluation of patients who have degenerative disorders of the lumbar spine. J Bone Joint Surg Am. 1996, 78:114\u0026ndash;124. 10.2106/00004623-199601000-00017\u003c/li\u003e\n\u003cli\u003eSayah A, Jay AK, Toaff JS, Makariou E, Berkowitz F: Effectiveness of a Rapid Lumbar Spine MRI Protocol Using 3D T2-Weighted SPACE Imaging Versus a Standard Protocol for Evaluation of Degenerative Changes of the Lumbar Spine. AJR Am J Roentgenol. 2016, 207:614\u0026ndash;620. 10.2214/AJR.15.15764\u003c/li\u003e\n\u003cli\u003ePutto E, Tallroth K: Extension-Flexion Radiographs for Motion Studies of the Lumbar Spine: A Comparison of Two Methods. Spine (Phila Pa 1976. 1990, 15:107\u0026ndash;110. 10.1097/00007632-199002000-00011\u003c/li\u003e\n\u003cli\u003eVitzthum H, K\u0026ouml;nig A, Seifert V: Dynamic examination of the lumbar spine by using vertical, open magnetic resonance imaging. J Neurosurg. 2000, 93:58\u0026ndash;64. 10.3171/SPI.2000.93.1.0058\u003c/li\u003e\n\u003cli\u003eFaraj, M. (2024). Patients' raw data for rapid physical exam method [Data set]. Zenodo. https://doi.org/10.5281/zenodo.13923552\u003c/li\u003e\n\u003cli\u003eIyer S, Shafi KA, Lovecchio F, et al.: The Spine Physical Examination Using Telemedicine: Strategies and Best Practices. Glob Spine J. 2020, 12:8\u0026ndash;14. 10.1177/2192568220944129\u003c/li\u003e\n\u003cli\u003eSaifuddin A, Blease S, Macsweeney E: Axial loaded MRI of the lumbar spine. Clin Radiol.2003. 58:661-671.10.1016/S0009-9260(03)00215-0\u003c/li\u003e\n\u003cli\u003eSuri P, Hunter DJ, Katz JN, Li L, Rainville J: Bias in the physical examination of patients with lumbar radiculopathy. BMC Musculoskelet Disord. 2010, 11:275. 10.1186/1471-2474-11-275\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Lumbar spine disorders, diagnostic maneuver, primary care, spinal stenosis, radiculopathy, facet joint spondylosis, MRI correlation, clinical examination","lastPublishedDoi":"10.21203/rs.3.rs-5875258/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5875258/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eTimely and appropriate diagnosis of disorders in the lumbar spine in a general practice setting due to limited time and other resources is an issue at hand. This article presents a rapid examination maneuver that is fast, positive, and reliable for common disorders in the lumbar spine as an initial screening tool and may obviate the need for more advanced imaging at least in the shorter term.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA new examine and screen maneuver was developed and tested for its utility in the diagnosis of the pathology responsible for lumbar spine MSA. Maneuver steps included localization of pain, inquiry about radiating pain, forward flexion, rapid rise to standing, and trunk rotation. Diagnostic accuracy and sensitivity and specificity were determined relative to MRI studies affecting spinal stenosis, radiculopathy and instability.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eIn the 509 participants, the rapid examination maneuver was useful for initial screening, with a balanced distribution of pain locations and almost half reporting radiating pain. Although statistical analyses failed to show significant associations between the pain characteristics and specific lumbar pathologies, it allowed for focused clinical attention and hence its potential value in the primary care setting.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eRapid physical examination is useful and time-effective in primary care, with a possible improvement in reduced dependency on urgent advanced imaging. This maneuver may be included to improve the management of the patient and efficiency in diagnosis.\u003c/p\u003e","manuscriptTitle":"Simple rapid examination maneuver for lumbar spine disorders","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-03 09:08:26","doi":"10.21203/rs.3.rs-5875258/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4f412e86-c637-4dfa-ba91-29115aed8792","owner":[],"postedDate":"February 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-03-27T16:23:23+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-03 09:08:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5875258","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5875258","identity":"rs-5875258","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}