Erector spinae
The thick paired columns of muscle (iliocostalis, longissimus, and spinalis) running up either side of the spine that hold the back upright and straighten it after bending.
Why the exam cares
These are the muscles a nurse strains by lifting with the back instead of the legs, so the NCLEX tests them through body mechanics and safe patient handling. They also sit at the center of low back pain, where the nurse must tell a simple muscle strain from nerve compression that needs an urgent report.
How to find it
- Paired ridges on either side of the spinous processes, running from the sacrum and iliac crest up the back, thickest in the low back.
- They harden under the fingers when the patient, lying prone, lifts the chest off the bed.
- A firm, tender band beside the spine suggests muscle spasm. Tenderness right over a spinous process points to bone, and tenderness at the costovertebral angle points to the kidney.
Procedure
Lifting and body mechanics
The nurse raises the bed to working height, stands with feet apart for a wide base, bends at the hips and knees, holds the load close, and lifts with the legs. The nurse pivots the feet instead of twisting the trunk, because twisting under a load strains the back muscles. A patient who cannot help is moved with a draw sheet, slide board, or mechanical lift and enough staff, not lifted by hand.
Assessment
Low back muscle spasm
For an acute strain, the nurse applies cold for about the first 48 to 72 hours and heat after that, and positions the patient supine with a pillow under the knees or side-lying with knees bent to take tension off the back. The nurse gives analgesics or muscle relaxants as ordered. Before treating the pain as muscle, the nurse checks leg strength, sensation, and bladder and bowel function.
Emergency
Red flags in low back pain
Numbness in the saddle area, new urinary retention or incontinence, new bowel incontinence, or worsening leg weakness points to compression of the nerve roots at the base of the spine, not a muscle problem. The nurse checks for a distended bladder and reports to the provider right away, because delay in decompression can cause permanent loss of bladder, bowel, and leg function.