MSK LQ Unit 1 Special Tests

Lumbar Quadrant Test

Purpose: Facet joint involvement

How to Perform:

1. pt standing

2. Side bend → rotate toward the test side → extension

3. Apply OP only if pt has no pain

Positive Test: reproduction of symptoms

Interpretation: Highly sensitive, so a negative test helps rule OUT facet joint involvement

Prone Lumbar Instability Test

Purpose: See if active muscle stabilization reduces symptoms; Determine whether lumbar stabilization exercises may decrease the patient’s pain

How to Perform:

1. Patient prone at edge of table with both feet on the floor

2. Perform PA glide over the painful/hypermobile lumbar segment

3. Reassess the same PA glide with the legs lifted off the floor

Positive Test: Pain decreases or symptoms change when the legs are lifted

Interpretation:

• Positive = patient may benefit from stabilization exercises

• Negative = stabilization exercises may be less helpful/questionable

Passive Lumbar Extension Test

Purpose: Assess lumbar spine instability

How to Perform:

1. Patient prone on table

2. Lift both legs about 30 cm off the table

3. Add slight distraction

Positive Test: Reproduction of LBP and sense of heaviness

Interpretation: Suggests lumbar spine instability

SLR Test

Purpose: Assess hamstring flexibility and neural tension of the sciatic nerve

How to Perform:

1. Patient supine

2. Start with the tested leg straight

3. Passively lift the tested leg

4. Monitor for symptoms

Positive Test: Reproduction of symptoms (numbness & tingling) between 30°–70°

Interpretation:

• Suggests neural tension/sciatic nerve involvement

• May be associated with lumbar disc pathology

Crossed SLR Test

Purpose: Assess for lumbar disc herniation/neural tension

How to Perform:

1. Patient supine

2. Lift the non-symptomatic/opposite leg straight

3. Monitor for symptoms in the opposite leg

Positive Test: Symptoms are reproduced in the opposite leg between 30°–70°

Interpretation: Highly specific for ruling IN a herniated disc when positive

Slump Test

Purpose: Assess neurological pathology from the spinal cord, spinal nerve roots, or sciatic nerve

How to Perform: check symptoms at every step!

1. Patient seated EOB, hands behind back, neutral spine

2. Thoracolumbar flexion with neutral cervical spine

3. PT maintains pt’s thoracolumbar flexion

4. Cervical flexion

5. Knee extension (active or passive)

6. Ankle DF (active or passive)

Positive Test: Reproduction of neurological symptoms

Sensitizers: Cervical flexion and ankle DF

SIJ Compression Test

Purpose: Assess SIJ pain by compressing the innominates

How to Perform:

1. Patient supine

2. Place both hands on the ilium/innominates

3. Apply medial compression force for up to 30 seconds

Positive Test: Reproduction of unilateral or bilateral posterior SIJ pain

Interpretation: Suggests SIJ pain/involvement

SIJ Distraction Test

Purpose: Assess SIJ pain by stressing the anterior SI ligament

How to Perform:

1. Patient supine

2. Cross arms and place palms on both ASISs

3. Push outward/laterally for 30 seconds

Positive Test: Reproduction of groin or SIJ pain anteriorly/posteriorly

Interpretation: Highest specificity, so a positive test helps rule IN SIJ pain

Thigh Thrust Test aka Sacrotuberous Stress Test

Purpose: Assess SIJ pain with posterior shear force

How to Perform:

1. Patient supine

2. Flex test-side hip to 90° with knee bent

3. Place one hand under sacrum for support

4. Apply downward axial force through the femur

Positive Test: Deep localized buttock pain on the tested side

Interpretation: Most sensitive, so a negative test helps rule OUT SIJ pain

Sacral Thrust

Purpose: Assess SIJ pain with bilateral sacral shear

How to Perform:

1. Patient prone

2. Find S3 (PSIS → medial to S2 → inferior to S3)

3. Apply 3-5 quick PA thrusts over the sacrum using hand over hand technique

Positive Test: Pain reproduced over SIJs or posterior SI ligaments

Interpretation: Suggests SIJ pain/involvement

Gaenslen’s Test

Purpose: Assess SIJ pain using torsional SI stress

How to Perform:

1. Patient supine at edge of table

2. Non-tested leg flexed to chest

3. Tested leg hangs off table

4. Add OP into hip extension on tested leg and flexion on opposite leg

Positive Test: Reproduction of pain

Interpretation: May suggest SIJ lesion, hip pathology, or L4 nerve root involvement

FABER / Patrick’s Test

Purpose: Differentiate lumbar spine, hip, SIJ, or iliopsoas involvement

How to Perform:

1. Patient supine

2. Place test leg in figure-4 position (knee over opposite patella)

3. Allow test leg to drop/relax to see how far knee can drop

4. Assess for pain. If no pain, apply OP

   1. Stabilize opposite ASIS/ilium (PT on nontest side)

   2. Apply OP on test knee

5. Repeat on other side

Positive Test: Reproduction of pain

Interpretation:

• Groin pain = (anterior or lateral) joint or iliopsoas

• PSIS or buttock pain = SIJ involvement

Seated Flexion Test

Purpose: Assess SIJ mobility/asymmetry

How to Perform:

1. Patient seated (w/ both legs supported)

2. Palpate under both PSISs

3. Patient bends forward

4. Compare PSIS movement

Positive Test: One PSIS moves more superiorly than the other

• Normally, both PSIS should move superiorly

Interpretation:

• The side moving more superiorly may indicate SIJ restriction

• Poor reliability/validity

Standing Hip Flexion

• aka Gillette / Stork / Marching Tests

• MAYBE WRONG

Purpose: Assess SIJ mobility/asymmetry in standing

How to Perform:

1. Patient standing

2. Palpate under both PSISs

3. Patient raises one leg to flex one hip to 90 degrees

Positive Test: PSIS on raised leg remains where it is or moves superiorly

• Normally, the PSIS on the raised leg should drop

Interpretation:

• May suggest SIJ restriction

• Poor reliability/validity

Long Sitting Test / Supine to Sit Test

Purpose: Assess functional leg length change/innominate rotation

How to Perform:

1. Patient supine

2. Patient bridges and lowers to reset pelvis

3. Passively extend the pt’s legs & give slight pull

4. Assess if one leg is significantly longer than the other (or higher/lower at hips)

   1. Compare landmarks: medial malleoli, knees, hips (ASIS)

5. Assist patient into long sitting without moving legs

6. Give gentle pull on the legs & look for changes

Positive Test: Leg length changes from supine to sitting

Interpretation:

• Long in supine → anterior innominate rotation

• Short in supine that becomes long in sitting → posterior innominate rotation

• Low reliability

Active SLR Test

Purpose: Identify proper stabilization of the pelvic girdle

How to Perform:

1. Patient supine

2. Patient actively lifts one straight leg off table

3. Watch for pain, pelvic rotation/SB, rib flare, abdominal bulging, or Valsalva

4. If abnormal (pain or compensation), add manual pelvic compression medially

Positive Test: Pain/compensation improves with compression

Interpretation:

• Suggests force closure deficit

• Anterior compression helps = may need TrA stabilization

• Posterior compression helps = may need multifidus stabilization

Reverse Active SLR Test (unedited)

Purpose: Assess posterior force closure/motor control during hip extension

How to Perform:

1. Patient prone

2. Patient lifts one straight leg into hip extension

3. Watch for abnormal lumbopelvic rotation

4. Repeat with manual innominate compression or resisted contralateral shoulder extension

Positive Test: Symptoms or abnormal motion improve with added closure

Interpretation:

• Improves with force closure = dynamic stabilization exercises

• Improves with form closure/manual compression = may benefit from SI belt

Sign of the Buttock Test (unedited)

Purpose: Testing for noncapsular issue - bursitis or tumor - under the glutes

How to Perform:

1. Patient supine

2. Perform passive SLR until pain/resistance

3. Flex knee

4. Attempt more hip flexion

Positive Test: Hip flexion stays equally painful/restricted even with knee bent

Interpretation: Red flag for serious pathology like tumor, abscess, fracture, or osteomyelitis; needs medical investigation

Nachlas / Prone Knee Flexion Test

Purpose: Assess hip/SIJ pain, femoral nerve mobility/involvement, or quad/rectus femoris tightness

• Similiar to:

  • Ely’s Test = quads tightness

  • Femoral nerve test = paraesthesia down anterior thigh

How to Perform:

1. Patient prone

2. Stabilize pelvis (test side)

3. Passively flex knee and bring heel toward buttock

Positive Test: Reproduction of hip/SIJ pain or limited knee flexion

Interpretation: location of pain determines where the problem may be

• Anterior thigh pain = rectus femoris tightness or femoral nerve involvement

• Lumbar pain = possible L3 nerve root lesion

• ASIS rotates forward early = hypomobile SIJ

• Limited knee flexion = positive Ely test

Superoinferior Symphysis Pubis Stress Test (unedited)

Purpose: Assess pubic symphysis dysfunction

How to Perform:

1. Patient supine

2. Place one hand on superior aspect of one pubic ramus

3. Place other hand on inferior aspect of opposite pubic ramus

4. Apply slow shearing force

5. Reverse hand placement and repeat

Positive Test: Localized pubic pain reproduction

Interpretation:

• High specificity, so a positive test helps rule IN pubic symphysis dysfunction

• Sn: 81%, Sp: 99%