Lower Back Flashcards
what are the lower limb tension tests
Sciatic nerve – LLTT
1. Perform the straight leg raising test (below)
Positive => radicular symptoms
Femoral nerve – LLTT
1. Patient lying prone – stand on same side as assessment side
2. Take patient’s ankle and passively flex knee brining ankle to buttocks
Positive => radicular symptoms in anterior thigh along femoral nerve distribution
what are the findings of lower limb tension tests
L2 or L3 nerve root lesion
(+) Unilateral neurological pain in
lumbar area or posterior thigh
what is the straight leg raise (SLR)
- Patient lying supine
- Hip is medially rotated and adducted – leg lifted by supporting foot
around calcaneus (keeping knee straight)
Positive => pain (at varying degrees)
what are the findings of SLR
Pain at 10-35 degrees → tight hamstrings
Pain at 35-70 degrees → IVD pressure on
sciatic nerve (usually lateral
herniation)
Pain at 70+ degrees → SI joint pain
what is the Well leg raise
- Patient lying supine
- Examiner raises uninvolved leg
Positive => back and sciatic pain on opposite side
what are the findings for well leg raise
Further evidence of a space
occupying lesion – such as
herniated disc (usually medial)
what is the Braggard’s test (sign)?
- Patient lying supine or sitting
- Examiner lifts leg off table (like SLR) to level of pain
- Examiner then lowers the leg just below the level of pain and adds
dorsiflexion of ankle stretching the sciatic nerve
Positive => pain radiating below knee
what is the findings for Braggard’s test?
- Disc herniation
- Neural impingement
what is the Bechterews Test?
- Patient seated with flexed neck
- Asked to extend on knee at a time
- If no symptoms, ask patient to extend both legs simultaneously
Positive => symptoms in back or leg
what is the finding of Bechterews test?
Sciatic nerve involvement
what is the valsalva test?
- Patient seated
- Patient takes a deep breath and blows out with closed mouth (bear down)
Positive => back pain or pain down the legs
what is the findings for valsalva test?
Space occupying lesion causing an
increase in intrathecal pressure
what is the findings for belt test?
Sacroiliac syndrome
what is the belt test?
- Patient in standing position with examiner standing behind the patient
- Ask patient to bend or flex forward until the lumbosacral pain is felt
- Patient then returns to upright position
- Examiner asks patient to bend forward again but with examiner
supporting the patient’s sacrum with his or her thigh – guiding movement
by grasping the ileum (pelvis immobilized
Positive => pain disappears
what is the Gillet’s test/marching test
- Patient standing
- Squatting examiner palpates the PSIS with one thumb and the other
thumb parallel with the first thumb on the sacrum - Ask patient to stand on one leg while pulling the opposite knee up
towards the chest (causes innominate bone on same side to rotate
posteriorly and sacrum to rotate to same side) - Repeat test with other leg palpating the other PSIS
Positive => if sacroiliac joint on the side on which the knee is flexed moves
minimally or up
what is the findings of Gillet’s test/marching test
Joint is hypo-mobile; normally the
tested PSIS moves down or
inferiorly
what is the kemp’s test?
- Patient standing
- Instruct patient to slowly extend, side bend, and rotate the thorax and
lumbar spine to affected side (having patient run their fingertips of hand
on affected side down the posterolateral aspect of the affected leg as far as
possible) - Movement compresses intervertebral foramen, nerve root and facet joints
Positive => radiating pain or other neurological signs in affected leg (nerve
involvement) or localized pain (facet involvement)
what is the findings for kemp’s test?
- Nerve involvement – radiating
pain in affected leg - Facet involvement – localized pain
what is the piriformis test?
- Patient lying on side; involved side up
- Flex upper hip (testing side) 60-90
- Flex knee 90
- Examiner stabilizes hip with free hand; place downward pressure with
other hand
Positive => pain in piriformis area or recreation of symptoms
what is the findings for piriformis test?
Tight piriformis or piriformis
syndrome
what is the brudzinski-kernig test?
- Patient lying supine with hands cupped behind head
- Patient flexes head onto chest
- Patient raises extended leg actively by flexing the hip until pain is felt
- When pain is felt, patient flexes knee to make pain disappear
Positive => if pain is felt and goes away with knee flexion
what is the findings for brudzinski-kernig test?
Meningeal irritation
Dural irritation or dural
involvement
what is the hoover test?
- Patient lying supine
- Examiner places one hand under each calcaneus
- Patient asked to lift one leg off table, keeping the knees straight
Positive => if patient does not lift the leg or the examiner does not feel pressure
under opposite heal
what is the findings for hoover test?
malingering
what is the milgram’s test?
- Patient lying supine
- Actively lifts both legs up at the same time, off the table about 2-4 inches
– hold this position for 30 seconds or symptoms are reproduced
Positive => if patient can’t hold for 30 seconds or symptoms are reproduced
what is the findings for milgram’s test?
Lumbosacral pathology
what is the single leg lumbar hyperextension test
- Patient stands in straddle position with one lower limb extended behind
the other - Patient stands on one leg and extends spine while balancing on the leg
- Patient leans back as far as possible while examiner prevents patient from
falling over - Repeat test with lower limb position reversed
Positive => pain in back and is associated with a pars interarricularis stress
what is the findings for single leg lumber hyperextension test?
Spondylolysis and
spondylolisthesis
what are the special test for lumbar disc herniation
- Straight leg raise (SLR)
- Well leg raise (opposite
SLR) - Braggard’s
- Bechterews
- Valsalva
what are the special test for lumbar facet syndrome?
- Spurling’s
- Maximal foramen test
- Bakody’s
- Cervical distraction
- Shoulder depression
- Kemps
what are the special test for lumbar sprain/strain
- Straight leg raise (SLR)
- Well leg raise
- Braggard’s
- Bechterews
- Belt test
- Marching test
- Kemps
Tests should be (-)
what are the special test for sacroiliac joint dysfunction
- Belt test
- Marching test
- Patrick Faber’s test
- Pelvic rock test
- Gaenslen’s
what are special test for pelvic instability?
- Belt test
- Marching test
- Patrick Faber’s test
- Pelvic rock test
- Gaenslen’s
- Yeoman’s
what are the special test for piriformis syndrome
- Pace
- Piriformis length test
- Sign of the Buttock’s test
- Palpation
what are the special test for lumbar spondylothesis
- Single leg lumbar
- hyperextension test
