There should be no significant difference in the degree of hip flexion with sitting or supine SLR or when the patient bends forward while standing. Nondermatomal or otherwise nonanatomic distributions of sensory loss should also be noted. In the motor examination, sudden giving way, jerky movements, or weakness appearing to involve many muscle groups should raise suspicion. Note whether the patient appears to overreact during the examination, including what appears to be a disproportionate verbalization of pain on minimal provocation, dramatic facial expressions, muscle tension and tremors, collapsing when asked to bear weight, and requiring a companion for dressing and undressing. These observations must be considered in the context of the overall examination.
Severe pain can cause extreme reactions in some patients.
Laboratory Evaluation Laboratory tests are not necessary in every patient. They are important to verify the diagnosis if surgery is contemplated and are sometimes necessary to clarify the differential diagnosis. Since X rays, CT and MRI scans, myelograms, and other tests may be abnormal in asymptomatic patients, the results must be interpreted with the entire clinical presentation in mind. Some guidelines are outlined in Table 4 . Management Most patients with back pain will respond to conservative treatment.