One of the features that I look for in a patient who complains of mechanical low back pain or spinal pain is the Hip Rib Gap.
This is the amount of space they have between their 11th rib and the iliac crest. The smaller the space makes it more likely that they suffer from hip rib impingement as a major cause or perpetuating factor in their back pain. When you ask a person to put their hands on their hips, they usually place them on their greater trochanter which is part of the leg bone. they don’t realise that the iliac crest which is the top part of the hip bone is much higher up. With the patient standing straight, I try to squeeze my fingers in between their 11th rib and the top of the iliac crest and try to estimate the amount of gap that they have. Apart form documenting this gap, by demonstrating how small the gap is to the patient, they are more easily convinced that they suffer from hip rib impingement. I no longer get my patients to bend from side to side as this movement can cause impingement and exacerbate the patients pain at the consultation which is not a good thing as they usually come to be fixed and not to go home feeling worse. I also do away with the slump test and the touching of the toes test as they can also cause a severe exacerbation of their symptoms. I still do a straight leg raising test to check for nerve root entrapment. Another test performed for lumbosacral integraty is to get the patient to squat and walk like a duck. I have seen many instances where patients without back problems ended up with chronic back problems performing this exercise.
In 2004 I measured 50 people with back pain and they averaged a gap of 5 cm in the supine position. I have given many public talks on back pain and I always teach my audience to measure their own gaps and I have not come across many people with a gap much greater than 5 cm while standing. It looks like the gaps portrayed in anatomy books and illustrations are a bit misleading as they usually show a wide gap.