Lumbar region Flashcards
Straight leg raise (SLR)
Assists with diagnosis of radiculopathy, dural irritation, peripheral neuropathy.
Patient supine.
Practitioner contacts the patient’s ankle, and slowly lifts the leg off the couch a little, then internally rotates the hip and adducts lower extremity .
Practitioner then passively flexes hip (ie. raises leg off couch) until symptoms are reproduced
Reproduction of LEX pain and or neurological symptoms is a positive test
Examiner can also flex the knee with the hip flexed in symptomatic range to assess possible reduction in symptoms, which would further confirm a positive test. This is known as Lasegue’s Test, also used to differentiate hip joint pain from neural compression if pain is present with hip flexed and knee flexed.
Local Lsp pain alone is considered indicative of mechanical low back pain and is not a positive SLR. Pain experienced above 45 degrees of hip flexion would also suggest hip, hamstring, SIj, mechanical low back issues.
Crossed SLR
Assists with diagnosis of radiculopathy and dural irritation
Test is performed as previous SLR test but using asymptomatic leg
Also known as “well leg raise”
Reproduction of neurological symptoms in contralateral LEX is a positive test and would suggest severe or central discal disruption.
Reported as having a 90% + sensitivity for radiculopathy combined with normal SLR
Modified SLR and Neural Tension Tests
These tests can be used following the SLR test to further tension the nerve if the SLR is negative or equivocal.
They should not be used following an obviously positive /severe SLR
Braggard’s
Brudzinski’s
Kernig’s
Braggard’s Test.
Practitioner performs SLR test, then lowers leg just below symptomatic range and then dorsiflexes ipsilateral foot.
Reproduction of neurological symptoms may indicate a positive SLR.
Brudzinski’s Test
Patient supine with hands behind neck.
Patient actively and maximally flexes neck.
Reproduction of pain and / or neurological symptoms in the LEX is a positive for this test.
Kernig’s Test
Patient supine with hands behind neck and maximally flexed
Patient actively flexes hip with knee fully extended until pain or neurological symptoms are elicited.
Patient then flexes knee, reduction of symptoms during knee flexion is considered a positive test as flexing the knee reduces neural tension.
Slump test
Assists with diagnosis of radiculopathy, dural irritation or peripheral neuropathy by gradually increasing neural tension.
Patient seated with posterior thighs fully supported
Patient ‘slumps’ (relaxed flexion) T-sp and L-sp keeping chin in neutral position
Actively flexes C-sp (chin to chest) and practitioner introduces caudal axial compression.
Practitioner gently extends one knee, dorsiflexes foot and asks patient to bear down (Valsalva test)
Reproduction of LEX neurological symptoms at any point during the test is considered a positive
Local Lsp pain alone is indicative of mechanical low back pain and is not a positive result.
Bowstring test
Assists with diagnosis of radiculopathy, dural irritation, peripheral neuropathy.
Practitioner performs SLR to symptomatic range.
Whilst maintaining hip flexion, the practitioner flexes the knee until symptoms are reduced.
Examiner applies pressure within popliteal fossa and slowly extends LEX to traction sciatic nerve.
Reproduction of LEX neurological symptoms is a positive test
LSP Quadrant test
• Assists with diagnosis of Lsp facet joint pathology, and internal disc disruption (eg annular tear).
- Patient seated with arms folded.
- Practitioner stabilizes contralateral iliac crest and, with guiding hand on patients opposite shoulder, sidebends and extends l-sp. Practitioner applies axial compression and then repeats the manuouver on the other side.
- Test is then repeated in a flexed and sidebent position on both sides
- Reproduction of Lsp pain is a positive test – depending on the position which ilicits pain, various structures are implicated which may aid with a tissue specific diagnosis. Generally speaking extension with axial compression loads the facets joints, and flexion with axial compression loads the discs.
Femoral nerve traction test
• Patient sidelying on unaffected side with LEX slightly flexed at hip and knee.Practitioner stands at patient’s back
- Patient’s T-sp and L-sp in neutral with C-sp slightly flexed.
- Examiner passively extends patients affected LEX to about 15 degrees with knee extended. • Examiner then passively flexes knee to further induce tension in the femoral nerve
• Reproduction of anterior thigh pain and / or neurological symptoms in a femoral distribution is considered a positive test.
What is Lasegue’s test?
After positive result for SLR test, examiner can also flex the knee with the hip flexed in symptomatic range to assess possible reduction in symptoms, which would further confirm a positive test.
Why perform a Lasegue’s test?
To differentiate hip joint pain from neural compression if pain is present with hip flexed and knee flexed.
what is lumbarization or sacralization?
Lumbarization - S1 is mobile and thus there are six lumbar vertrebra (2-8% incidence)
Sacalization - L5 is fused with sacrum (maybe only hemi) and thus there are four lumbar vertebra (3-12% incidence)
Four interesting characteristics of Lumbar vertebra
L5 Sp is always smaller than L4 Sp
T12 Sp is always smaller than L1 Sp
Post Ant pressure on an Sp moves the vertebrae slightly anteriorly
Rotation ( in a coupled movement) in one segment can create a palpable step between two neighbouring Sps.
What can regularly be found between neighbouring lumbar and thoracic SPs?
bursae
diagram showing anterior, posterior, joint capsule, and lig. flava
Diagram showing ligamenta flava, and the supraspinous and interspinous ligaments
diagram of middle thoracolumbar fascial layer
Function is.. (2)
separates the back extensors from the Q.L.
Site of origin of transversus abdominis, and Q.L.
Thoracolumbar fascia and lat. dorsi diagram
(superficial layer for fascia)
