Clinical guidelines for the examination of work related low back injuries were discussed with emphasis on the scientific rationale, developmental process, and formulation of the NIOSH Low Back Evaluation (LBE) tool. The LBE tool focused on the presenting symptoms and signs of the encountered movement dysfunction syndrome for the low back injury patient. The test was being designed to be applicable to all clinical situations, reliable in terms of tests and measurements, and computer compatible. The examination needed to be easily administered and conducted by a specially trained examiner without regard to prior knowledge or bias; and the results of the examination needed to lead to a functional description of the spinal dysfunction. A comprehensive list of 85 individual tests and measurements was developed which comprised the universe of low back injury evaluation procedures, and multi/institutional research was proposed to evaluate the interrater and intrarater reliability of each test. The short term goal of the NIOSH LBE tool was to standardize the assessment of injury, while the long term goal was to provide better methods for relating symptoms and signs of workers with low back dysfunction to the specific tasks they performed. The author concludes that the proper combination of medical and ergonomic approaches may help to reduce the occurrence of low back injuries in the workplace.