Lumbar Spine Special Tests - Mod 5 Ortho Study Guide

two stage treadmill test

tests for spinal stenosis

-10 minute level walking

-10 minute rest

-10 minute inclined walking

pt can walk longer and farther on incline than on flat surface (because they will lean forward and relieve symptoms as they walk)

segmental hypomobility testing

tests for presence of hypomobiliy

asses AROM, abnormality of segmental motion AbAROM, passive accessory intervertebral motion PAIVM, passive physiological intervertebral motion PPIVM

Straight Leg Raise Test

test to determine whether a patient with lower back pain has an underlying herniated disc

Crossed Straight Leg Raise Test

test for herniation; have the patient lay supine. The examiner will passively flex the patient's uninvolved hip while maintaining the knee in full extension. A positive test is considered when the patient reports reproduction of pain in the involved limb at 40 degrees of hip flexion or less in the uninvolved limb. The examiner should make note of the degree of hip flexion where the patient reported pain or reproduction of symptoms.

Bicycle test of van Gelderen

Have patient pedal against resistance on an upright stationary bike

1. Leg pain/paresthesia/cramping -> vascular claudication

2. lateral spinal stenosis will tolerate test well

3. intermittent cauda equina compression -> increased symptoms

Patrick test / FABER

-Pt hip is flexed, abducted and externally rotated

-pelvis stabalized and overpressure applied to medial aspect of knee

-positive for SIJ if buttock and groin pain reproduced

posterior gapping of the SIJ (compression test)

positive if symptoms are reproduced

pt in supine, cross-over pressure applied to both ASIS

Gaenslen's Test

Patient is supine with the involved side near the edge of the examining table. The opposite knee and thigh are fully flexed and fixed against the abdomen by the patient. The involved leg is gradually extended off the table by the doctor. The doctor then applies downward pressure against clasped knee and knee of the extended hip.

Positive sign is pain the SI joint indicating an SI lesion

Long Sitting Test

SIJ dysfunction due to functional leg length discrepancy. Have patient come from Supine to long sitting. Observe change in medial malleolar positions

Thigh Thrust Test

___Pt is supine & examiner passively flexes hip to 90 degrees

___One hand palpates the SI joint while the other hand thrusts (pushes) down through the knee and hip (long axis compression)

___Bilaterally performed

___Positive finding: SIJ pain on the same side

___Indication: SIJ syndrome

Sacral Thrust Test

Also called Prone Springing & Sacral apex pressure

___Pt is prone

___Examiner puts base of their hand on the center of sacrum and applies a P-A force

___Positive finding: pain over the SIJ

___Indication: SIJ syndrome

Mennell's Test

+Exacerbation of SI pain

Myofascial involvement of gluteal muscles

SI subluxation or sprain.

pt sidelying involved side down and in hip and knee flexion. clinician places one hand on the ipsilateral buttock and iliac crest and other hand on the semiflexed knee and lightly forces leg into extension

Gillet test

pt standing feet spread 12 inches apart, clinician palpates S2 spinous process with one hand and PSIS with other. pt then flexes the hip and knee on the side being tested.

positive if PSIS fails to move in posteroinferior direction relative to S2

Standing flexion test

Purpose: Sacroiliac articular restriction

Method: Pt is standing. PT palpates PSIS and monitors its movement as pt bends forward

Positive Test: One PSIS moves farther in the cranial direction than the other PSIS.

Sitting flexion test

Purpose: Sacroiliac articular restriction

Method: Pt is sitting with feet on floor. PT palpates PSIS and monitors its movement as pt bends forward and touches the floor.

Positive Test: inequality of PSIS movement is found