Lumbar Special Tests Flashcards
What is a test that can be used as part of a detailed examination for suspected facet DJD or lateral stenosis?
lumbar Quadrant Test
Prone Knee Bend: Indications for performing test
Radicular pain or signs of peripheral neural tension in the femoral nerve or upper lumbar spine
Prone Bridge: how to perform
Prone (plank) position propped on elbows spaced shoulder width apart; feet narrowly spaced. Stop when pt is unable to hold position.
Norms:
Males: asymptomatic - > 92.9s; symptomatic ->33.4s.
Females: asymptomatic -> 51.2s; symptomatic -> 24.3s
What special test assesses lumbar lateral flexor endurance?
Side Bridge (side plank)
Supine Bridge: how to perform
Supine in a hookline position w/hands positioned by ears. Raise pelvis up so that shoulders, hips, and knees are in straight line. Hold the position. If can hold for 2 min, dominant leg can be extended. Stop when pt is unable to hold position.
Norms:
Males: asymptomatic - > 188s; symptomatic ->77.9s.
Females: asymptomatic -> 152s; symptomatic -> 75.7s
What is a screeing test for lumbar problems?
Lumbar Quadrant Test
Straight Leg Raise: Response & Implications
Response: reproduction of s/s, usually at
Impl: Nerve root impinge or neural tension any LE periph nerves
- local pain reproduced in the 0-30º range may indicate hip dysfunction; pain in the 0-30º range may indicate a highly irritated nerve root
- Pain reproduced in the 30-50º range may indicate sciatic or other nerve involvement
- Posterior thigh pain reproduced in the 50-70ºrange may indicate hamstring involvement or neural tension
What special test assesses lumbar flexor endurance?
Prone Bridge (plank)
Lumbar Quadrant Test: Indications for performing test
Screening test for lumbar problems or part of a detailed examination for suspected facet DJD or lateral stenosis
Prone Bridge: Indications
To assess lumbar flexor endurance
Sorensen: How to perform
pt prone with the superior margin of iliac crests aligned with the ridge of the table.
Stablize the pelvis, knees, and ankles
Extend upper body to the horizontal position and hold until pt is unable to maintain the testing position one time
Norms:
Males: asymptomatic - > 198s; symptomatic ->163s.
Females: asymptomatic -> 197s; symptomatic -> 177s
4 Lower Quarter Neurodynamic Tests
- Straight Leg Raise
- Crossed Straight Leg Raise
- Slump Test
- Prone Knee Bend
Repeated Extension in Standing: How to perform
If first step in series, check flexion ROM before starting
Keep knees straight and extend actively and repeatedly (up to 10 times)
May help if patient puts hands on bottom and slides them down back of legs
What tests are indicated if pt presents with radicular pain or signs of peripheral neural tension in the femoral nerve or upper lumbar spine?
Prone Knee Bend
Prone Knee Bend: How to perform test
pt prone
passivly flex knee until pt feels pain, tightness, or reproduction of symptoms. There is no sensitizing manuver, so PT must ask about quality of sensation to differentiate between nerve and musclular pain/tightness
Response: Reproduction of s/s
Lumbar Quadrant Test: how to perform
pt standing
Passive (assisted) sequential combined extension, LF and rotation (both towards side of pain)
Sorensen: Response & Implications
Response: Stop when pt is unable to hold position.
Norms:
Males: asymptomatic - > 198s; symptomatic ->163s.
Females: asymptomatic -> 5197s; symptomatic -> 177s
Implications: To assess the endurance of the lumbar extensors and determine whether lumbar extensor strengthening is warranted in a treatment program
What tests are indicated if pt has radicular s/s in one LE?
Crossed Straight Leg Raise
Repeated Flexion in Testing: Response & Implications
Response:
- (+) if local or distal sumptoms peripheralize
- if symptoms centralize, it suggests and anterior disc derangemnt but this should be correlated with repeated extension
- If (+) then extension mobility will often be reduced afterward
Implications:
- If symptoms peripheraize (+), suspect a posterior disc derangement
- If symptoms centralize, suspect an anterior derangement
2 General Lumbar Special Tests
- Prone Instability Test
- Lumbar Quadrant Test
What special test is indicated if pt has redicular s/s in one LE?
Crossed Straight Leg Raise
Prone Instability Test: Indications for performing test
Central lumbar pain with or without radicular s/s
What tests are approprate if pt presents with radicular s/s ?
The Lower Quarter Nerodynamic Tests
- Straight Leg Raise
- Crossed Straight Leg raise (in one LE)
- Slump Test
- Prone Knee Bend (s/s in femoral nerve or upper lumbar spine).
Prone Instability Test (Central Lumbar pain with radicular s/s)
What UE Special Tests are analogous with the Lower Quarter Neurodynamic Tests?
ULTT
(upper limb tension tests)
4 Lumbar Endurance Tests
- Sorensen
- Supine Bridge
- Prone Bridge
- Side Bridge
Prone Knee Bend: Response & Implications
Response: Reproduction of s/s
Implications: Nerve root impingement at an upper lumbar level or nearual tension along pathway of femoral nerve
Repeated Flexion in Standing: How to perform
If first step in series, check extension ROM before starting
Keep knees straight and flex actively and repeatedly (up to 10 times)
Lumbar Quadrant Test: Response & Implications
Response: Reproduction of s/s on the ipsilateral side
Implications:
- If done as a lumbar screen, then (+) means that lumbar spine should be investigated further
- If done as part of a specific lumbar spine examination:
- (+) with diffuse local pain suggests fecet DJD
- (+) with radicular pain suggests lateral stenosis
Which two tests are indicated if pt has radicular pain or signs of neural tension?
Straight Leg Raise
Slump Test
What test is indicated when there is central lumbar pain with or without radicular s/s?
Prone Instability Test
What tests are indicated if pt has signs of neural tension?
Straight Leg Raise
Slump Test
Prone Knee Bend (if it is in femoral nerve distribution or upper lumbar spine)
Slump Test: How to perform test
pt sits in dependant postion with back of knees against the plinth.
Ask pt to slump forward into full back flexion. Passively straighten leg until pt reports pain or reproduction of symptoms. Perform sensitizing manuver: lower leg just enough for symptoms to subside. Ask pt to lift head. If pain/symptoms return, then it implicates nerve tension problem.
Response: reproduction of s/s within dermatomal pattern
Prone Instability Test: Response and Implication
Response: Compare pain during step 2 to step 1:
- If pain decreases, then test is (+)
- If pain = or increases, then test is (-)
Implications: Decreased pain during ste 2 compared to step 1 suggests lumbar instability is contributing to symptoms
Repeated Flexion in Lying: Response and Implications
Response:
(+) if local or distal symptoms change (either centralize or peripheralize)
Implications:
If symptoms peripheraize (+), suspect a posterior disc derangement
If symptoms centralize, suspect an anterior disc derangement
Prone Instability Test: How to perform test
pt prone with hips and LE’s off end of table (basically standing on floor bent over table with edge of table hitting hip crease).
- Perform CPA (at any lumbar level) & assess pain response.
- have pt lift both legs slightly off floor and repeate CPA & assess pain response.
Pain MUST DECREASE in part 2 to have positive test (like O’Brien’s test in shoulder)
Straight Leg Raise: How To Perform Test
Patient in Supine WITH NO PILLOW! & opposite knee stabilized.
Gradually and passively flex hip until pt reports pain. Perform sensitizing manuver to differentiate between nerve and muscle tension (lower leg just until symptoms resolve, then passively dorsiflex foot). If symptoms return with dorsiflexion, then it is most likely neural pain.
+ response is reproduction of s/s; usually at
Side Bridge: How to perform
Sidelying (side plank) position propped on elbow & feet. Top foot in front of bottom foot. Uninvoved arm placed acrosss the chest and resting on contalateral shoulder (we learned it with that arm placed along the side) Stop when pt is unable to hold position.
Norms:
Males: Right - > 94s; Left ->97s.
Females: Right -> 72s; Left -> 77s
Supine Bridge: Implications for performing test
To assess lumbar extensor endurance
Repeated Flexion in Lying: how to perform test
If first step in series, check extension ROM before starting
pt supine in hooklying position
use arms to pull knees to chest repeatedly (up to 10 times - stop if reproduction of symptoms or symptoms worsten - peripheralize)
Crossed Straitght leg raise: How To Perform Test
Patient in Supine WITH NO PILLOW! & opposite knee stabilized?
Perform Straight Leg Raise on contralateral LE:
Gradually and passively flex hip until pt reports pain. Maybe Perform sensitizing manuver to differentiate between nerve and muscle tension (lower leg just until symptoms resolve, then passively dorsiflex foot). If symptoms return with dorsiflexion, then it is most likely neural pain. I’m not sure if this test has a sensitizing manuver
Response: if (P) increases in contralateral symptomactic LE (not the one being lifted) in dermatomal pattern, test is (+)
What lumbar special tests assess for lumbar disc derangement?
Repeated Movement Tests (4)
- Repeated Flexion in standing
- Repeated Extension in standing
- Repeated Flexion in lying
- Repeated Extension in lying
Crossed Straight Leg Raise: Response & Implications
Response
- If pain increases in contralateral symptomatic LE (not the one being lifted) in the dermatomal pattern, test is (+)
- If pain in symptomatic LE (not the one being lifted) is unchanged, test is (-)
Implications: Suggestest that a disk herniation is causing the nerve root irritation
Slump Test: Response & Implications
Response: Reproduction of s/s within a dermatomal pattern
Implications: Nerve root impingement or neural tension anywhere in LE peripheral nerves
Sorensen: Implications for performing test
To assess lumbar extensor endurance
Which two tests assess lumbar extensor endurance
- Sorensen
- Supine Bridge
Side Bridge: Response & Implications
Response: Stop when pt is unable to hold position.
Norms:
Males: Right - > 94s; Left ->97s.
Females: Right -> 72s; Left -> 77s
Implications: To assess the enduracne of the lumbar lateral flexors and determine whether lumbar lateral flexor strengthening is warranted in a treatment program
Straight Leg Raise: Indications for performing test
Radicular pain or signs of neural tension
4 Repeated Motion Tests
- Repeated Flexion in Standing
- Repeated Extension in Standing
- Repeated Fexion in Lying
- Repeated Extension in Lying
Side Bridge: Indications
To assess lumbar lateral flexor endurance
Prone Bridge: Response & IMplications
Response: Stop when pt is unable to hold position.
Norms:
Males: asymptomatic - > 92.9s; symptomatic ->33.4s.
Females: asymptomatic -> 51.2s; symptomatic -> 24.3s
Implications: To assess the endurance of the lumbar flexors and determine whether lumbar flexor strengthening is warranted in a treatment program
Supine Bridge: Response & Implications
Response: Stop when pt is unable to hold position.
Norms:
Males: asymptomatic - > 188s; symptomatic ->77.9s.
Females: asymptomatic -> 152s; symptomatic -> 75.7s
Implications: To assess the endurance of the lumbar extensors and determine whether lumbar extensor strengthening is warranted in a treatment program
Indications for Repeated Motion Tests (any of them)
Assesses for lumbar disc derangement
Crossed Straight Leg Raise: Indications for performing test
Radicular s/s in one LE
Repeated Extension in Standing: Response & Implications
Response:
(+) if local or distal symptoms peripheralize
if symptoms centralize, it suggests a posterior disc derangement but this should be correlated with repeated flexion
If (+) then flexion mobility will often be reduced afterward
Implications:
If symptoms peripheraize (+), suspect an anterior disc derangement
If symptoms centralize, suspect a posterior derangement
Repeated Extension in Lying: Response & Implications
Response:
(+) if local or distal symptoms change (either centralize or peripheralize)
Implications:
If symptoms peripheraize (+), suspect an anterior disc derangement
If symptoms centralize, suspect a posterior derangement
Slump Test: Indications for performing test
Radicular pain or signs of neural tension
Repeated extension in lying: how to perform
If first step in series, check flexion ROM before starting
pt prone with hands under shoulders
extend elbows repeatedly to extend lumbar spine but keep trunk relaxed (up to 10 times - stop if reproduction of symptoms or symptoms worsten - peripheralize)
