Lumbar orthopedic test ***FINDINGS ONLY

NMS 1

Heel Walk: Screening Test

Positive Finding: Toe drop/inability to walk on heels

Suggests: L5 Radiculopathy, L4-L5 disc pathology, common fibular nerve injury, weak anterior tibialis

Toe Walk: Screening Test

Positive finding: heel drop/ inability to walk on toes

Suggests: S1 radiculopathy, L5-S1 disc pathology, tibial nerve injury, weak calf muscles (soleus, gastroc), compromised achilles tendon

Straight Leg raise

Positive Finding: low back pain with radiating symptoms on side of testing

Suggests:

• 0-30 degrees: SI lesion or piriformis syndrome

• 30-70 degrees: nerve root irritation due to IVD pathology or intradural lesion

• 70+ degrees: lumbar facet joint involvement/encroachment

Bragard’s Test

Positive Test: reproduction of SLR symptoms (LBP w/radiating down same side)

Suggests:

• 0-30 degrees: extradural sciatic nerve irritation

• 30-70 degrees: intradural problems like IVD pathology causing sciatic nerve root irritation

Sicard’s

Positive Test: reproduction of SLR and Bragard’s positive (LBP + radiating down same side)

Suggests: stretching of dura mater of spinal cord, or spinal cord lesion (herniated disc, tumor, meningitis)

Well Leg Raise

Positive Test: LBP with radiating pain down OPPOSITE leg (not raised)

Suggests: central/medial disc protrusion

Crossover test

Positive Test: LBP with radiating pain down OPPOSITE leg (not raised)

Suggests: central/medial disc protrusion

Fajersztajn’s Sign

Positive Test: reproduction of WLR/crossover test, radiating pain down OPPOSITE leg

Suggests: central/medial disc protrusion

Smith-Peterson Test

Positive:

Suggests:

• Low back pain before lumbar fanning: SI lesion or hip pathology

• Radicular pain during lumbar fanning: intradural lesion (disc defect, osteophyte, mass)

• Local pain after lumbar fanning: posterior lumbar joint disorder

Goldthwaits Test

Positive:

Suggests:

• Low back pain before lumbar fanning: SI lesion or hip pathology

• Radicular pain during lumbar fanning: intradural lesion (disc defect, osteophyte, mass)

• Local pain after lumbar fanning: posterior lumbar joint disorder

Lasegue Test

Positive: pain when knee extended, but not when flexed

Suggests: lumbar nerve root compression

Bechterew’s Test

Positive: Low back pain with radiating symptoms or if patient must lean back due to pain

Suggests: compression of sciatic nerve or lumbar nerve roots due to lumbar disc protrusion

knee flexion test

positive: affected knee flexes

suggests: space occupying lesion causing nerve root irritation/compression

bowstring sign

positive: pain in lumbar region or radiculopathy

suggests: sciatic nerve compression

slump test

positive: pain at any step OR relief with cervical extension (step 6)

suggests: meningeal tract irritation due to space occupying lesion

Thomas Test

Positive Test: flexion of contralateral femur (leg unable to lie flat) or the lumbar spine stays in lordosis

Suggests: flexion contracture of iliospoas muscle

Lewin Supine

Positive Test: inability to pull self up to seated position without pain

Suggests: ankylosing spondylitis, facet arthritis, disc herniation, sciatic n compression

Milgram’s Test

Positive Test: pain in low back (may radiate) when holding legs for 30+ seconds

Suggests: space occupying lesion OR spinal sprain/strain

Prone Knee Bending Test

Positive: Radicular anterior thigh pain

Suggests: L2-L4 nerve root compression, irritation by an intradural lesion, or lumbar plexus or femoral nerve compression due to iliopsoas hypertrophy

OTHER

• pain in buttock= SI lesion

• pain in lumbosacral joint= lumbosacral lesion

Nachlas Test

Positive: Radicular anterior thigh pain

Suggests: L2-L4 nerve root compression, irritation by an intradural lesion, or lumbar plexus or femoral nerve compression due to iliopsoas hypertrophy

OTHER

• pain in buttock= SI lesion

• pain in lumbosacral joint= lumbosacral lesion

Kemps Test

Positive: local lumbar pain with radiating symptoms

Suggests: nerve root compression due to space occupying lesion (disc herniation, tumor, osteophyte)

Pheasants Test

Positive: lumbar pain or guarding

Indicates: spinal instability (ie spondylolisthesis)

Prone Segmental Instability Test

Positive: pain reduced/eliminated when legs elevated

Suggests: spinal instability (spondylolisthesis, sprain/strain)

Apprehension Sign

Positive: Patient has experienced feeling of Low back “giving out” or collapsing in past week due to sudden onset of low back pain during transitional movements (sit-stand, stand-sit)

Suggests: spinal instability (spondylolisthesis, sprain/strain)

Instability Catch Sign

Positive: pain reduced/eliminated with ADIM

Suggests: spinal instability (spondylolisthesis, sprain/strain)

Painful catch sign

Positive: pain is reduced and performance improves (more steady lowering of legs) with ADIM compared to first attempt

Suggests: spinal instability (spondylolisthesis, sprain/strain)

Beighton Scale

Positive: 5+/9 for general adult population

• 4+/9 for adults over 50

• 6+/9 for kids before puberty

Suggests: hypermobility