Lumbar Spine Orthopedic Tests Procedure Rationale, Findings

Bechterew’s Test

- Active, seated - Extend one knee, then the other knee, then both

- Test for lumbar radicular pain

- ↑ traction of the sciatic nerve - (+) unable to perform due to radicualr pain, or perform

with leaning back: ↑ compression to the sciatic nerve or lumbar nerve roots, disc protrusion

Slump Test

- Active, seated, hands behind back - Flex trunk, flex neck, extend one leg, dorsiflex foot (affected side) - Bilateral then with both leg extend

- ↑ traction of dura - ↑↑↑↑ pain: disc defect

Kemp’s Test

- Passive, seated - Stabilize the PSIS w/ one hand - Reach around to front of pt & grasp shoulder w/ the other hand - Rotate, laterally flex, and extend the trunk

- Test for lumbar radicular pain - When pt bends obliquely backward, the dural sac on the side of bending moves laterally - (+) ↑↑↑↑ local pain: facet capsulitis, lumbar spasm

- (+) ↑↑↑↑ radicular ipsilateral pain: lateral disc

- (+) ↑↑↑↑ radicular contralateral pain: medical disc

Turyn’s Test

- Passive, supine - Dorsiflex great toe of affected side

- (+) ↑↑↑↑ pain: sciatic radiculopathy

Well Leg Raise Test

- Passive, supine - Raise unaffected leg to the point of pain or 90°

- Test for lumbar radicular pain - This test causes ipsilateral & contralateral stretching of the nerve roots, pulling laterally on dural sac - (+) ↑↑↑↑ radicular pain on affected leg: medial disc protrusion

Straight Leg Raise Test

- Passive, supine - Raise affected leg to the point of pain or 90˚ - Place an inclinometer at the tibial tuberosity

- Test for lumbar radicular pain

- ↑ stretch of sciatic nerve and spinal nerve roots at the L5-S2

- (+) ↑↑↑↑ pain at 0-35˚: priformis syndrome, SI joint restriction

- (+) ↑↑↑↑ radicular pain at 35-70˚: disc pathology

- (+) ↑↑↑↑ pain at 70- 90°: lumbar joint problem

- (+) ↑↑↑↑ dull posterior thigh pain: tight hamstring - Confirm with Bragard’s and Lasegue’s tests

Bragard’s Test

- Passive, supine - Raise affected leg to the point of pain, then lower 5˚ and dorsiflex the foot

- Test for lumbar radicular pain

- ↑ traction of sciatic nerve

- (+) ↑↑↑↑ pain at 0-35˚: priformis syndrome, SI joint restriction

- (+) ↑↑↑↑ radicular pain at 35-70˚: disc pathology

- (+) ↑↑↑↑ pain at 70- 90°: lumbar joint problem

- (+) ↑↑↑↑ dull posterior thigh pain: tight hamstring

Bonnet’s Test

- Passive, supine - Straight leg raise w/ hip adducted and internally rotated

- (+) radicular pain or paresthesia: sciatica, especially piriformis syndrome

Milgram’s Test

- Active, supine - Raise and hold legs for 3-6 inches off the table - Hold for as long as possible

- Test for Space-Occupying Lesion (SOL)

- ↑ intrathecal pressure - Normally, should be able to perform the test for > 30 s w/o low back pain - (+) low back pain: space occupying lesion

Hoover’s Sign - Active, supine - Instruct pt to lift the affected leg while you place one hand under the heel on the unaffected side

- Test for malingering low back pain - (+) pt will not raise the affected leg & no posterior pressure on the unaffected heel

- If pt is genuinely trying to raise the leg but cannot do so, you should feel pressure from the unaffected heel

Prone Lumbar Hyperextension Test

- Active, prone - Stabilize ankles and instruct pt to attempt to extend trunk

- (+) ↑↑↑↑ pain: lumbar sprain/strain

Pelvic Orthopedic Tests Procedure Rationale

Sitting Flexion Test (Piedallu’s sign)

- Active, seated - Place thumb on the superior part of PSIS and tissue pull down - Ask pt to bend forward

- (+) PSIS raises superior as pt flex forward: SI restriction

Anvil Test

- Passive, supine, leg straight - Tap (strike) the heel

- Compression type blows to the hip joint - Test for hip fractures - (+) ↑↑↑↑ pain: femoral head fracture

Straight Leg Raise Test

- Passive, supine - Raise affected leg to the point of pain or 90˚ - Place an inclinometer at the tibial tuberosity

- Test for lumbar radicular pain

- ↑ stretch of sciatic nerve and spinal nerve roots at the L5-S2

- (+) ↑↑↑↑ pain at 0-35˚: priformis syndrome, SI joint restriction

- (+) ↑↑↑↑ radicular pain at 35-70˚: disc pathology

- (+) ↑↑↑↑ pain at 70- 90°: lumbar joint problem

- (+) ↑↑↑↑ dull posterior thigh pain: tight hamstring - Confirm with Bragard’s and Lasegue’s tests

Bonnet’s Test

- Passive, supine - Straight leg raise w/ hip adducted and internally rotated

- (+) radicular pain or paresthesia: sciatica, especially piriformis syndrome

Patrick’s Test (Hip FABER test)

- Passive, supine - First flex the knee and press the thigh into the acetabular cavity - Then rest the heel on the opposite knee. Stabilize the opposite side of ASIS and press down the involved side knee

- FABER (flexion, abduction, external rotation) - Test for SI & acetabular dysfunction - This test forces the femoral head into the acetabular cavity, giving maximal congruence to the articular surfaces. - (+) pain at the hip: inflammation of the hip or trauma

Laguerre’s Test (FABER in air)

- Passive, supine - Flex the hip & knee to 90° - Rotate the thigh outward & the knee medially - Press down on the knee w/ one hand, and pull up on the ankle w/ the other hand

- Stressing the anterior aspect of the hip joint - (+) pain at the hip: inflammation of acetabular joint

Thomas Test

- Passive, supine - Bring unaffected side of the knee to the chest - Observe the hip flexion and palpate the affected side of quads - Make sure that lumbar curve is relatively flat on the table

- Test for hip contracture (a condition of soft tissue stiffness that restrict joint motion) - (+) ↑↑↑↑ hip flexion or tightness of quads: contracture of hip flexor (ex. iliopsoas), rectus femoris or restriction of hip joint

Rectus Femoris Contracture Test

- Passive, supine - Bring unaffected side of the knee to the chest - Observe the hip flexion, knee extension and palpate the affected side of quads - Make sure that lumbar curve is relatively flat on the table

- Test for hip contracture - (+) ↑↑↑↑ hip flexion, knee extension or tightness of quads: contracture of hip flexor, rectus femoris or restriction of hip joint

Ober’s Test #1

- Passive, side lying (affected side up) - Abduct leg and release it

- Test for hip contracture - (+) leg fails to descend smoothly: suspect contracture of the TFL muscle or IT band

Ober’s Test #2

- Passive, side lying (affected side up) - Extend & slightly abduct leg, then grasp ankle and flex the knee to 90˚ - The thigh is abducted and slightly extended

- (+) leg remains abducted: contracture of TFL and/or IT band

Piriformis Test

- Passive, side lying (affected side up) - Flex the hip to 60° and flex the knee fully. Stabilize the hip and push the knee down

- (+) ↑↑↑↑ sciatic pain: piriformis syndrome

Prone Glide Test for SI Restriction - Passive, prone - Press down on SI joint of one side and observe movement on the other side

- (+) movement on opposite side: SI restriction

Yeoman’s Test

- Passive, prone - Place the hand over the affected side SI joint to stabilize the pelvis - Flex the affected side knee and extend the hip

- (+) ↑↑↑↑ pain: inflammation of SI joint, or sprain of anterior sacroiliac, iliofemoral or ischiofemoral ligament

Hibb’s Test

- Passive, prone - Flex the knee and move the leg outward (internal rotation of hip) - Also palpate the SI joint motion

- (+) ↑↑↑↑ pain at SI join: inflammation of the SI joint

- (+) ↑↑↑↑ pain at the hip: inflammation of ischiofemoral ligament - (+) lack of SI joint motion: SI restriction