Lumbar Evaluation

Basic Steps of an Eval

• Subjective

• Observation

• Palpation

• ROM

• MMTs

• Neurological

• Special Tests

Outcome Measures Surveys (6)

• Oswestry Disability Questionnaire

• Patient Specific Functional Scale

• Numeric Pain Scale

• STarT Back Screening Tool

• PEG-3

• PHQ-2

Seated Compression Test

• How: Pt sits upright, grabs seat and pulls upward; try different trunk/cervical positions

• Positive: Pain

• Pathology: lumbar disc/nerve root involvement 

Slump Test

• How: The patient “slumps” (flexes thoracic & lumbar spine), then flexes the neck. The examiner then extends one knee and dorsiflexes the ankle.

• Positive: reproduction of neurological symptoms

• Pathology: neural tension from lumbar disc herniation or nerve root compression

Seated Forward Flexion Test

• How: palpate PSISs and ask patient to bend forward

• Positive: unequal movement

• Pathology: SI joint dysfunction

Seated Piriformis Stretch Test

• How: Seated with hip flexed to 90 degrees and knee passively extended, Examiner palpates sciatic notch and then adducts and internally rotates the leg

• Positive: pain

• Pathology: piriformis injury

Quadrant Test (Kemp’s Test)

• How: Examiner passively extends, then laterally flexes and rotates to the same side

• Positive: pain/radiculopathy

• Pathology: facet joint irritation or nerve root compression

Stork Stand Test

• How: Pt extends and laterally flexes toward the standing leg

• Positive: pain

• Pathology: spondylolysis or facet joint irritation

Adam’s Forward Bending Test

• How: Pt stands with feet together, put hands together, bends straight forward

• Positive: rib hump or visible curvature

• Pathology: scoliosis

Forward Flexion Test

• How: palpate PSISs and ask patient to bend forward while standing

• Positive: one moves more superiorly than the other

• Pathology: SI joint dysfunction

Gillet Test

• How: The patient stands while the examiner palpates the PSIS and sacrum; the patient then flexes one hip/knee toward the chest

• Positive: PSIS does not move posteriorly

• Pathology: SI Joint dysfunction

Manual Iliac Crest Compression

• How: Apply pressure to iliac crests while walking – opens up the lower part of SI joints

• Positive: pain

• Pathology: SI joint dysfunction

Heel Drop Test

• How: standing with a neutral spine, pt raises up onto toes then drops down to a flat foot

• Positive: reproduces pain

• Pathology: end plate fx or vertebral body fx, facet joint involvement in extension

Straight Leg Raise

• How: passively raise pt’s leg while supine

• Positive: radiating pain between 30-70 degrees

• Pathology: sciatic nerve involvement

Lasegue’s Test

• How: Do SLR to point of symptoms, back off a bit, then dorsiflex the foot

• Positive: symptoms are brought back after DF

• Pathology: lumbosacral radiculopathy

Bowstring (Cram) Test

• How: SLR to point of Sx, Passively bend the knee slightly, then compress the popliteal area where sciatic nerve runs

• Positive: pain reproduction

• Pathology: lumbosacral radiculopathy

Well Straight Leg Raise

• How: SLR of uninvolved side

• Positive: pain produced on involved side

• Pathology: central disc herniation

FABER Test

• How: Pt puts involved leg in figure 4 position, examiner distracts ASIS and knee

• Positive: pain at SI joint

• Pathology: SI joint dysfunction

SI Distraction

• How: Cross arms and place heels of hand on ASISs, push apart

• Positive: SI joint pain

• Pathology: SI Joint dysfunction

Thigh Thrust Test (Posterior Shear)

• How: Hip passively flexed to 90, Anteroposterior force applied through femur

• Positive: pain at SI joint

• Pathology: SI joint dysfunction

Newton’s Test

• How: Passively flex hip and knee up towards chest

• Positive: SI joint pain

• Pathology: SI joint dysfunction

SI Compression Test

• How: Push downward over anterior portion of iliac crest to create gapping force at SIJ (sidelying)

• Positive: SI joint pain

• Pathology: SI joint dysfunction

Passive Piriformis Test

• How: Take knee and hip into flexion, resting their lower leg on the contralateral leg, Apply overpressure into adduction and IR (sidelying)

• Positive: pain in gluteal region, radiating down leg

• Pathology: Piriformis syndrome 

Active Piriformis Test

• How: Both hips and knees flexed, Then externally rotate top leg and plant foot on the table, Apply pressure at lateral knee and ask pt to push out into ER (sidelying)

• Positive: pain in gluteal region, radiating down leg

• Pathology: Piriformis syndrome 

Multifidi Lift Test

• How: pt prone elbows bent to 90 shoulders flexed to 120 degrees; pt asked to lift contralateral arm about 5 cm towards the ceiling

• Positive: one side activates more than the other

• Pathology: poor motor control, segmental instability

Sacral Thrust Test (Sacral Spring)

• How: Heel of hand over apex of sacrum, Apply PA force

• Positive: SI joint pain

• Pathology: SI joint dysfunction 

Prone Extension Test

• How: The patient lies prone and lifts the upper trunk off the table while keeping the pelvis down

• Positive: pain in lumbar spine

• Pathology: facet joint irritation

Spondylolisthesis Test

• How: Apply traction at ankles, Lift legs until knees off the table, Apply small side-to-side oscillations (prone)

• Positive: pain

• Pathology: spondylolisthesis

Ely’s Test

• How: passive knee flexion (prone)

• Positive: pain when pelvis lifts off of table

• Pathology: femoral nerve irritation

Endurance & Performance Tests (6)

• Sock test

• Villiger test

• Repeated sit to stand

• 6 minute walk test

• Loaded functional reach test

• McGill core endurance test

Lumbar Stenosis Rule

1/5 or fewer rule out, 4/5 or more rule in

• Bilateral Sx

• Leg pain more than back pain

• Pain during walking/standing

• Pain relief upon sitting

• Age > 48 years

Flexion Intolerant Conditions (4)

• Disc herniation/DDD

• Anterior/middle column fx

• Posterior ligamentous sprains

• Muscle strain

Extension Intolerant Conditions (5)

• Spondylolysis/spondylolisthesis

• Facet joint pathology

• Stenosis

• Posterior column fx

• Muscle strain

Load Intolerant Conditions (4)

• Compression fx or vertebral end plate fx

• Schmorl’s nodes

• Lumbar spondylosis

• Muscle strain