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Gaenslen's Test
Steps
Athlete is supine, lying close to the side of the table
Examiner allows the near leg to hang over the side edge of the table
Examiner instructs the athlete to actively flex the other leg to
his/her chest & hold
Examiner stabilizes the athlete & applies pressure to the near leg,
forcing it into hyperextension
Positive Test
Pain in the SI region
Positive Test Implications
SI joint dysfunction
See Test
Fulcrum's Test
Steps
Athlete is seated with his/her knees bent at the end of the table
Examiner places his/her forearm or a similar bolster underneath of the
athlete's midthigh
Examiner uses other hand to forcefully push down on the athlete's
distal anterior thigh
Positive Test
Athlete experiences pain in his/her thigh
Positive Test Implications
Possible femoral stress fracture
Torque Test
Steps
Patient lies supine & close to the edge of the table so that the involved
leg can abduct over the edge of the table
Examiner passively extends the involved hip (with his/her hand
supporting at the ankle) until the pelvis begins to rotate anteriorly
Examiner then medially rotates the hip to EROM and then places a
posterolateral force at the hip joint in an attempt to distract it
Positive Test
Groin or lateral hip pain
Positive Test Implications
Sprain of the coxofemoral joint capsule or supporting ligaments
See Test
Gillet's Test
Steps
Athlete is standing with his/her PSISs visible
Examiner palpates the athlete's PSISs
Examiner has the athlete pull one knee towards his/her chest & hold
while examiner observes PSISs
Positive Test
Restricted side moves very little; unilateral stance is painful on the
involved side
Positive Test Implications
SI joint pathology
See Test
SI Compression Test
Steps
Athlete is supine
Examiner applies pressure to spread the ASIS
Positive Test
Pain arising from the SI joint
Positive Test Implications
SI pathology
See Test
SI Distraction Test
Steps
Athlete is in the sidelying position
Examiner is positioned behind the athlete with both hands over the
lateral aspect of the pelvis
Examiner applies downward pressure through the anterior portion of the
ilium, spreading the SI joints
Positive Test
Pain through the SI joint
Positive Test Implications
SI pathology
See Test
Ely's Test
Steps
Athlete lies prone with the knees extended
Examiner passively flexes the athlete's knee
Positive Test
The hip on the same side passively flexes as the examiner flexes the
knee
Positive Test Implications
Rectus femoris tightness
See Test
Thomas's Test
Steps
Athlete is supine with his/her knees bent at the end of the table
Examiner places one hand between the lumbar lordotic curve & the
tabletop
Examiner passively flexes one of the athlete's legs to his/her chest,
allowing the knee to flex during the movement
Examiner observes the involved leg for movement
Positive Test
The knee of the leg on the table cannot flex past 90 (i.e. the knee
of the leg on the table will extend as the examiner flexes the
contralateral hip); the involved leg (i.e. the leg on the table) rises
up off the table (i.e. the contralateral hip to the one being moved
will flex)
Positive Test Implications
Rectus femoris tightness (the knee extends as the examiner flexes the
hip); iliopsoas tightness (the leg on the table will rise off of the
table)
See Test
Trendelenburg's Test
Steps
Athlete stands with the feet evenly distributed (i.e. approximately
shoulderwidth apart from each other)
Examiner sits or kneels behind the athlete
Examiner slightly lowers the athlete's shorts so that the examiner may
palpate the right & left PSIS and/or iliac crests
Examiner instructs the athlete to flex the hip thereby lifting the
right (and then the left knee) while observing the pelvis
Positive Test
The PSIS or iliac crest on the same side as the leg lifted will drop
in relation to the contralateral side
Positive Test Implications
Contralateral (i.e., stance leg) gluteus medius (hip abductor)
weakness or decreased innervation of the same muscles
See Test
Valsalva Test
Steps
With subject sitting examiner asks subject to take a deep breath and
blow against closed glottis (as if trying to have a bowel movement)
This increases intrathecal pressure
Positive Test
Pain or neurologic symptoms in buttox and thigh
Positive Test Implications
Herniated disc, abdominal trauma, tumor, or osteophyte in lumber canal
See Test
Seated Straight Leg Raise Test
Steps
Subject sitting with hip flexed to 90 & hands grasping table on each
side
Subject actively extends knee
Positive Test
1) Subject breaks tripod or subject is unable to fully extend knee
2) Subject arches back & or complains of pain in buttocks, posterior
thigh and calf
Positive Test Implications
1) Tight hamstrings
2) Sciatic nerve irritation
See Test
Oppenhiem Test
Steps
Run metal edge of neurlogic hammer, or fingernail along the tibial
crest
Positive Test
Great toe extension with flexion and splaying of the lateral four toes
Positive Test Implications
Upper motor neuron lesion
See Test
Bowstring Test
Steps
Subject begins supine with legs extended
Examiner performs a passive straight leg raise on the involved side
If radiating pain is reported, the examiner then flexes the subjects
knee until symptoms are reduced
The examiner then applies pressure to the popliteal area in attempt
to reproduce the radicular pain
Positive Test
Reproduction of radicular pain with popliteal compression
Positive Test Implications
Sciatic nerve pathology
See Test
Babinski Test
Steps
Run metal edge of neurlogic hammer, or fingernail along the tplantar
surface of the foot from the calcaneus, along the lateral border of
the foot to the forefoot
Positive Test
Great toe extension with flexion and splaying of the lateral four toes
Positive Test Implications
Upper motor neuron lesion
See Test
Slump Test
Steps
Subjects sits at end of table and leans forward while the examiner holds
the head and chin upright
Examiner then flexes the subjects neck and assesses for any changes
in symptoms
If no changes are noted the examiner passively extends one of the
subjects knees
Again, note symptomatic changes
If no changes are noted, the examiner passively dorsiflexes the
subjects ankle while the knee remains extended
Subject is then returned to original position and the test is repeated
for the opposite leg
Positive Test
A complaint of sciatictype pain or any reproduction of symptoms is
indicative of a positive test
Positive Test Implications
Sciatica or dural irritation
See Test
Kernig Test
Steps
Subject supine with hands cupped behind head
Subject is instructed to flex cervical spine by lifting head
Each hip is unilaterally flexed to no more than 90, with knee fully
extended
The opposite leg should remain on the table
Positive Test
Increased pain with both hip and neck flexion and pain is relieved when
knee is allowed to flex
Positive Test Implications
Meningeal irritation, nerve root impingement, dural irritation
aggravated by spinal cord elongation
See Test
Stork Test
Steps
Subject begins standing and is asked to extend back, while the examiner
spots subject
The subject is then asked to stand on one foot and extend their back
once again
Finally the subject is asked to stand on the opposite foot and extend
the back
Positive Test
Complaints of pain in the lumbar region
Positive Test Implications
Possible pars intrarticularis pathology
Hoover Test
Steps
Subject is supine while examiner cups both heels of the patient with
their hands
Subject is asked to perform a unilateral straight leg raise
Positive Test
1) Inability to raise leg
2) A positive finding is also noted when the examiner does not feel
pressure in the palm of the hand underlying the restimg leg
Positive Test Implications
1) neuromuscular weakness
2) lack of effort by subject
See Test
Lumbar Examination
Introduction
Subjective
Patient Intake
Special Questions
Red Flags
Cancer
Ankylosing spondylitis
Lumbar stenosis
Spinal infection
[9]
During the investigation, you must pay attention to any red flags
that might be present indicating serious pathology. Koes et al
(2006)[10] mentioned the following red flags:
Thoracic pain
Feeling unwell
Weight loss
Outcome Measures
Investigations
Has the patient had any other investigations such as radiology (Xray,
MRI, CT, ultrasound) or blood tests?
Objective
When assessing the lumbar spine, the examiner must remember that
referral of symptoms or the presence of neurological symptoms often
makes it necessary to clear or rule out lower limb pathology. Many
of the symptoms that occur in the lower limb may originate in the
lumbar spine. Unless there is a history of definitive trauma to a
peripheral joint, a screening or scanning examination must
accompany assessment of that joint to rule out problems within the
lumbar spine referring symptoms to that joint.
Observation
Movement Patterns
How does the patient get up from the chair? A patient with
low back pain may splint the spine in order to avoid painful
movements.
Posture
Kyphosis (thoracic)
Other observations
body type
attitude
facial expression
skin
hair
Functional Tests
Neurologic Assessment
Myotomes
[14]
Dermatomes
[15]
Reflexes
[16]
Circulatory Assessment
7]
Palpation
It is crucial for a reliable diagnosis and intervention of treatment to
adequately palpate the lumbar spinous processes.
Within the scientific world, there has been a debate about the
palpation of the spinous processes because scientists assumed that
often different persons indicated the processes in a different place
(Mckenzie et al) [18]. However, Snider et al (2011) [19] have shown
that the indicated points of the different therapists lie that the
distance between the indicated points of the different therapists is
much smaller than it had always been claimed. Obviously, there were
differences because some therapists have more experience and others
have more anatomical knowledge. Also, the difference in personality
between the therapists led to differences in locating the processes.
3]
Special Tests
Centralization/peripheralization
Cross straight leg raise test
4]
H and I test
Quadrant test
Ober test
Thomas test
Other tests:
Brief Examination
If you have little time a brief examination of patients with back pain
has two basic purposes.
1. Firstly it will help screen patients for possible serious spinal
pathology even though taking a good history is much more
important.
4. SLR (if leg pain or if you feel is needed for reassurance) +/-
slump test
What Next?
Lumbopelvic disorders are not a homogeneous group of conditions,
and subgrouping or classification of patients with back pain has been
shown to enhance treatment outcomes [25][26]. Classification of
lumbopelvic disorders should adequately define the primary signs
and symptoms and guide therapeutic interventions. The examination
allows us to arrive at a diagnosis and impairment classification for
the condition. These classification systems help us to avoid the pitfalls
of attempts to identify the pathoanatomic cause of the patients
symptoms.
References
1. Jump up to:1.0 1.1 1.2 Koes BW, van Tulder M, Lin C-WC,
Macedo LG, McAuley J, Maher C. An updated overview of clinical
guidelines for the management of non-specific low back pain in
primary care. Eur Spine J 2010;19:207594
8. Jump up to:8.0 8.1 Deyo, R. et al. What Can the History and
Physical Examination Tell Us About Low Back Pain? JAMA. 1992.
268(6):760-766.
10. Jump up Koes B.W. van Tulder M. W., Thomas S.; diagnosis
and treatment of low back pain; BMJ volume 332, 17 June 2006;
1430-1434
25. Jump up Brennan GP, Fritz JM, Hunter SJ, et al. Identifying
subgroups of patients with acute/subacute nonspecific low back
pain: results of a randomized clinical trial, Spine 31(6):623631,
2006.