Lumbar Spine Orthopedic Tests

Bechterews Test Procedure - Active, seated - Extend one knee, then the other knee, then both Rationale, Findings - Test for lumbar radicular pain - traction of the sciatic nerve - (+) unable to perform due to radicualr pain, or perform with leaning back: compression to the sciatic nerve or lumbar nerve roots, disc protrusion

Slump Test

- Active, seated, hands behind back - traction of dura - Flex trunk, flex neck, extend one - pain: disc defect leg, dorsiflex foot (affected side) - Bilateral then with both leg extend

Kemps Test

Turyns Test

- Passive, seated - Test for lumbar radicular pain - Stabilize the PSIS w/ one hand - When pt bends obliquely backward, the dural sac on the side - Reach around to front of pt & of bending moves laterally grasp shoulder w/ the other hand - (+) local pain: facet capsulitis, lumbar spasm - Rotate, laterally flex, and extend - (+) radicular ipsilateral pain: lateral disc the trunk - (+) radicular contralateral pain: medical disc - Passive, supine - (+) pain: sciatic radiculopathy - Dorsiflex great toe of affected side

Well Leg Raise Test

- Passive, supine - Raise unaffected leg to the point of pain or 90

- Test for lumbar radicular pain - This test causes ipsilateral & contralateral stretching of the nerve roots, pulling laterally on dural sac - (+) radicular pain on affected leg: medial disc protrusion

Straight Leg Raise Test

- Passive, supine - Raise affected leg to the point of pain or 90 - Place an inclinometer at the tibial tuberosity

Bragards Test

Bonnets Test

- Test for lumbar radicular pain - stretch of sciatic nerve and spinal nerve roots at the L5-S2 - (+) pain at 0-35: priformis syndrome, SI joint restriction - (+) radicular pain at 35-70: disc pathology - (+) pain at 70- 90: lumbar joint problem - (+) dull posterior thigh pain: tight hamstring - Confirm with Bragards and Lasegues tests - Passive, supine - Test for lumbar radicular pain - Raise affected leg to the point of - traction of sciatic nerve pain, then lower 5 and dorsiflex - (+) pain at 0-35: priformis syndrome, SI joint restriction the foot - (+) radicular pain at 35-70: disc pathology - (+) pain at 70- 90: lumbar joint problem - (+) dull posterior thigh pain: tight hamstring - (+) radicular pain or paresthesia: sciatica, especially - Passive, supine - Straight leg raise w/ hip adducted piriformis syndrome and internally rotated

Milgrams Test

- Active, supine - Raise and hold legs for 3-6 inches off the table - Hold for as long as possible

Hoovers Sign

- Active, supine - Instruct pt to lift the affected leg

while you place one hand under the heel on the unaffected side

Prone Lumbar Hyperextension Test - Active, prone - Stabilize ankles and instruct pt to attempt to extend trunk

- Test for Space-Occupying Lesion (SOL) - intrathecal pressure - Normally, should be able to perform the test for > 30 s w/o low back pain - (+) low back pain: space occupying lesion - Test for malingering low back pain - (+) pt will not raise the affected leg & no posterior pressure on the unaffected heel - If pt is genuinely trying to raise the leg but cannot do so, you should feel pressure from the unaffected heel - (+) pain: lumbar sprain/strain

Pelvic Orthopedic Tests

Sitting Flexion Test (Piedallus sign) Procedure Rationale - (+) PSIS raises superior as pt flex forward: SI restriction - Active, seated - Place thumb on the superior part of PSIS and tissue pull down - Ask pt to bend forward

Anvil Test

- Passive, supine, leg straight - Tap (strike) the heel

- Compression type blows to the hip joint - Test for hip fractures - (+) pain: femoral head fracture

Straight Leg Raise Test

- Passive, supine - Raise affected leg to the point of pain or 90 - Place an inclinometer at the tibial tuberosity

- Test for lumbar radicular pain - stretch of sciatic nerve and spinal nerve roots at the L5-S2 - (+) pain at 0-35: priformis syndrome, SI joint restriction - (+) radicular pain at 35-70: disc pathology - (+) pain at 70- 90: lumbar joint problem - (+) dull posterior thigh pain: tight hamstring - Confirm with Bragards and Lasegues tests - (+) radicular pain or paresthesia: sciatica, especially piriformis syndrome

Bonnets Test

- Passive, supine - Straight leg raise w/ hip adducted and internally rotated

Patricks Test (Hip FABER test)

- Passive, supine - First flex the knee and press the thigh into the acetabular cavity - Then rest the heel on the opposite knee. Stabilize the opposite side of ASIS and press down the involved side knee

- FABER (flexion, abduction, external rotation) - Test for SI & acetabular dysfunction - This test forces the femoral head into the acetabular cavity, giving maximal congruence to the articular surfaces. - (+) pain at the hip: inflammation of the hip or trauma

Laguerres Test (FABER in air)

- Passive, supine - Stressing the anterior aspect of the hip joint - (+) pain at the hip: inflammation of acetabular joint - Flex the hip & knee to 90 - Rotate the thigh outward & the knee medially - Press down on the knee w/ one hand, and pull up on the ankle w/ the other hand

Thomas Test

- Passive, supine - Test for hip contracture (a condition of soft tissue stiffness - Bring unaffected side of the knee to that restrict joint motion) the chest - (+) hip flexion or tightness of quads: contracture of hip - Observe the hip flexion and palpate flexor (ex. iliopsoas), rectus femoris or restriction of hip joint the affected side of quads - Make sure that lumbar curve is relatively flat on the table

Rectus Femoris Contracture Test - Passive, supine - Test for hip contracture - Bring unaffected side of the knee to - (+) hip flexion, knee extension or tightness of quads: the chest contracture of hip flexor, rectus femoris or restriction of hip - Observe the hip flexion, knee joint extension and palpate the affected side of quads - Make sure that lumbar curve is relatively flat on the table

Obers Test #1

- Passive, side lying (affected side up) - Test for hip contracture - (+) leg fails to descend smoothly: suspect contracture of - Abduct leg and release it the TFL muscle or IT band

Obers Test #2

- Passive, side lying (affected side up) - (+) leg remains abducted: contracture of TFL and/or IT band - Extend & slightly abduct leg, then grasp ankle and flex the knee to 90 - The thigh is abducted and slightly extended

Piriformis Test

- Passive, side lying (affected side - (+) sciatic pain: piriformis syndrome up) - Flex the hip to 60 and flex the knee fully. Stabilize the hip and push the knee down

Prone Glide Test for SI Restriction - Passive, prone - (+) movement on opposite side: SI restriction - Press down on SI joint of one side and observe movement on the other side Yeomans Test - Passive, prone - (+) pain: inflammation of SI joint, or sprain of anterior - Place the hand over the affected sacroiliac, iliofemoral or ischiofemoral ligament side SI joint to stabilize the pelvis - Flex the affected side knee and extend the hip

Hibbs Test

- Passive, prone - Flex the knee and move the leg outward (internal rotation of hip) - Also palpate the SI joint motion

- (+) pain at SI join: inflammation of the SI joint - (+) pain at the hip: inflammation of ischiofemoral ligament - (+) lack of SI joint motion: SI restriction