The consequences of a spinal cord injury can be catastrophic. Motor vehicle accidents, falls and other mechanisms of injury with the potential to cause spinal cord injuries are common. The first challenge to the EMS provider is recognition and assessment of potential spine injuries. Once a spine injury is suspected, traditional management involves preventing secondary injury with spine immobilization to limit movement and mitigate further injury. Examination of the patient with suspected spine or spinal cord injury by the EMS provider involves an assessment of motor and sensory function. It has long been axiomatic that the spine should be immobilized whenever a patient experiences trauma that has the potential to cause spine injury. The requirement that the patient have no painful, distracting injury in order to avoid immobilization has proven to be challenging to apply, in part because it is not well defined.