Thoracic & Lumber Special Tests

Straight Leg Raise (Lasegue) Test

Patient: Supine

Examiner: Distal hand on heel and proximal hand on anterior knee

Action: Passively flex straight leg at hip, until full ROM or pain, if pain occurs lower test leg 10 degrees and passively dorsiflex ankle

Positive: Pain radiates distally down leg into foot, radiating symptoms reoccur

Implications: SI Nerve or intervertebral disc involvement, if symptoms don’t reoccur: hamstring tightness

Well (Cross) Straight leg raise test

Patient: Supine

Examiner: Distal hand on heel and proximal hand on anterior knee

Action: Passively raises straight leg at hip, until full ROM or pain

Positive: Pain on opposite limb that is not raised

Implication: Herniated intervertebral disc

Slump Test

Patient: sitting over end of table

Examiner: side of patient

Action:

• Slump forward at thoracolumbar spine, rounding shoulders

• Flexes cervical

• Extend one knee

• Dorsiflex ankle

• Repeat all steps on other side

Positive: SI pain or neurological symptom reproduction

Implication: Impingement of dural lining, spinal cord or nerve roots

Tension (Bow string) Test

Patient: Supine

Examiner: Test side, distal hand on heal, proximal hand grasps tight w/ thumb in popliteal fossa

Action: Passively flex knee and hip to 90 degree, knee is then extended as far as possible, while palpating the tibial portion of sciatic nerve

Positive: Sciatic pain'/symptoms or tenderness is elicited

Implication: Sciatic nerve irritation

Bow String: Passive straight leg raise, is radiating pain flex knee 20 degree or until symptoms relieved, apply pressure to tibial portion of sciatic nerve on posterior knee

Kernig test

Patient: Supine

Examiner: Side of patient

Action: Active SLR until pain then flex knee

Positive: Pain in spine and radiates done lower leg then relieved when patient flexes the knee

Implication: Nerve root impingement, meningeal irritation or dural irritation

Brudzinski’s test: Passively flex c-spine and repeats test, increases the tension on dural sheath

Milgram’s test

Patient: Supine

Examiner: At feet

Action: Patient actively performs bilateral SLR (2-6 inches) and hold for 30 seconds

Positive: Cannot left leg, maintain the position or experience pain

Implication: Intrathecal pressure causing an intervertebral disc to place pressure on lumbar nerve root

Valsalva’s Manuver

Patient: Sitting in depending position

Examiner: In front of patient

Action: Ask patient to take a deep breath, hold and bear down as if having a bowel movement

Positive: Increased pain or radicular symptoms

Implication: Increased intrathecal pressure causes pain secondary to herniated disc, tumor or osteophyte along spinal column

Babinski Reflex

Action: Examiner runs blunt device up plantar aspect of patients foot from calcaneus medially to ball of great toe

Positive: Great toe extends and others splay

Implication: Upper motor neuron lesion from brain or spinal cord injury

Oppenhein Test

Action: Examiner runs finger nail or blunt device along the crest of the anteromedial tibia

Positive: Great toe extends and other splay

Implication: Upper motor neuron lesion from brain or spinal cord injury

Stork Stand Test (Single leg stance)

Patient: Standing

Examiner: Behind patient

Action: Lift one leg and lean back (Trunk hyperextension), repeat on opposite leg

Postive: Pain in lumbar spine or SI area

Implication: Facet joint or spondylopathy

Srping test

Patient: Prone

Examiner: Thumb palpating spinous process

Action: Apply “springing” force through the spinous processes of each vertebra, assess anterior and posterior motion, can repeat at transverse process

Positive: Pain or an increase or decrease in motion at one vertebrae

Implication: Hypermobile or hypomobile (facet joint) or sprain

Quadrant test

Patient: Standing

Examiner: Behind patient grasping shoulders

Action: Patient extends, lateral flexes and rotates trunk, applies downward pressure through shoulders

Positive: Reproduction of patients symptoms

Implication: Nerve root produces radicular symptoms, facet joint produces local pain, SI joint pain at PSIS

Hoover Test

Patient: Supine

Examiner: At feet cupping both heels

Action: Active SLR on involved side and repeat on opposite side

Positive: No pressure felt in examiners hand

Implication: Not attempting to preform the test

Scoliosis

Patient: Stand

Examiner: Behind patient

Action: Patient bends forward, sliding hands down front of legs

Positive: Asymmetrical hump observed along lateral aspect of thoracolumbar spine/rib cage

Implication:

Disappears

• Disappears during flexion: Functional scoliosis

• Does not disappear during flexion: Structural scoliosis