Lumbar special tests

Question 1

Dyanamic Abdominal Endurance Test/Isometric Abdominal Test

Answer 1

Hooklying position with hands at sides. draw line 8 cm (>40) or 12 cm (<40) distal to fingers.
Patient tucks chin and curls trunk to touch line (25 reps/min). Record number of reps

Question 2

Dyanamic Abdominal Endurance Test/Isometric Abdominal Test Grading scale

Answer 2

Normal = Hands behind neck, scapula clear 20-30 sec hold
Good = Arms crossed, 15-20 second hold
Fair = Arms straight 10-15 sec
Poor = arms straight only top part of scapula clears 1-10 second hold
trace = can't lift more than head off of table

Question 3

Dyanamic Extensor test/Isomeric extensor test/Sorenson Fatigue test

Answer 3

Prone, hips on end of table and strapped down. Pt leans over table in 30 degrees of flexion, extend to neutral at 25 reps/min
Sorensen Fatigue = hold as long as possible with arms at side

Question 4

Dyanamic Extensor test/Isomeric extensor test/Sorenson Fatigue test grades

Answer 4

Normal = Hands behind head 20-30 sec hold
Good = hands at side, 15-20 second hold
Fair = Arms at side, doesn't lift as far, 10-15 sec
Poor = Arms at side and lifts only head off ground 1-10 second hold
trace = slight contraction

Question 5

Dynamic horzontal side support test

Answer 5

sidelying with knee bent to 90 (legs straight for younger). Lift pelvis and straighten spine. do as many reps as possible or hold isometrically

Question 6

Dynamic horzontal side support test grades

Answer 6

Normal = lift pelvis and hold spine straight 10-20 seconds
Good = lift pelvis and doesn't hold spine straight 5-10 seconds
Fair = lift pelvis and doesn't hold spine straight <5 seconds
Poor = cannot lift pelvis off ground

Question 7

Back rotators/Multifidi

Answer 7

quadruped, hold neutral pelvis and do single straight arm lif, single straight leg lift and contralateral arm and leg lifts

Question 8

Back rotators/Multifidi grades

Answer 8

normal = contralateral hold 20-30
good = neutral pelvis with single leg lift but not arm 20 seconds
fair = single arm lift 20 sec
Poor - cannot maintain neutral pelvis with single arm lift

Question 9

SLR

Answer 9

perform SLR. + if pain on DF extends from back down Sciatic nerve distribtuion
+ if pain after 70 degrees for SI or facet or tight hamstrings
+ cross over sign then disc protrusionmedial to nerve root (poor prognosis)

Question 10

Slump test

Answer 10

slump, flex neck, and DF foot. then active extend knee.

+ sign when increase knee extension after extending neck (neuromeningeal sign)

Question 11

Prone knee bend

Answer 11

Pt. is prone while the therapist passively flexes the knee as far as possible so that the heel rests on the butt. This position is held for 45-60 seconds.

Can do it with knee bent and extend the hip if a knee injury prevents full flexion

+ Unilateral neurological pain in the lumbar, buttock, posterior thigh indicates an L2 or L3 nerve root lesion

+ Pain in anterior thigh indicates tight quads or femoral nerve stretching.

Question 12

Pron instability test

Answer 12

Pt. leans over the table with the chest on the table and the feet on the floor. Therapist puts pressure on different lumbar levels. Then the therapist does the same thing with the pt. lifting their feet slightly on the ground.

+ = hypermobility if there is pain with feet on the ground and it goes away once the feet are lifted. This occurs because the muscles are kicked in and mask the instability when the feet are off the ground.

If it feels the same then lumbar stabilization is probably not the answer.

Question 13

Quadrant test

Answer 13

Pt. stands straight while the therapists puts some pressure through the facet joints and then guides the pt. into extension, side flexion, and rotation to the side of pain. Movement is continued until the end range or pain is produced.

+ = This causes maximal narrowing of the IVF and stresses the facet joints. If the pain shoots down the leg, then it is + for an inflamed nerve root. If just pain in the back then probably a facet joint issue.

Question 14

Stork standing

Answer 14

Have pt. stand on one leg at a time and have them bend backwards. Can also add rotation to stress the facet joints on the side of rotation

+ = if pain is produced in the back and suggests a SPONDYLOLISTHESIS (just the extension part.)

Question 15

• Bicycle test of Van Gelderen

Answer 15

Pt. sits on an exercise bike and pedals against resistance. The first part of the tests has the patient lean back (lumbar lordosis) while pedaling. The 2nd part has them lean forward as they pedal

+ = if there is an increase in pain in buttock or posterior thigh during the 1st part and the pain subsides during the second part. This is suggestive of a NEUROGENIC INTERMITTENT CLAUDICATION.

Question 16

Blue Stabilizer Bladder

Answer 16

Put the stabilizer under the patients back then have them contract the transverse abdominis and do heel slides keeping them activated.
40 lbs - don’t let it move (2-5 mmHg)

Question 17

Waddel Signs (3/5 significant)

Answer 17

Test for malingering

1. Tenderness - light touch over little area, deeper it hurts over large area or everywhere (non-anatomic)
2. stimulation - standing trunk rotation and compression on shoulders and head
3. Distraction - SLR was intolerable but sitting with extension is fine
4. Regional disturbances (giving way) - MMT is weak and herky jerky or sensation doesn’t follow anatomical presentation
5. overreaction - everything gollapses, overdramatic

Question 18

Approximation/Compression squish tests

Answer 18

Sidelying and therapist hands are placed on the upper part of the iliac crest and press toward the floor.

+ = Increased pressure in the SI joint indicates a possible SI lesion or sprain of posterior SI ligament

Question 19

Distraction/Gap test

Answer 19

Patient lies supine while the therapist applies crossed arm pressure to the ASIS in a down and out direction.

+ = if there is unilateral gluteal or posterior leg pain indicating an anterior SI ligament strain.

Question 20

Structure LLD

Answer 20

measurement from the ASIS to medial malleolus (1-1.3 cm difference is normal)

Question 21

Functional LLD

Answer 21

Pt. stands relaxed and therapist palpates the ASIS and PSIS noting asymmetry. The patient is then placed in the correct stance (subtalar neutral, knees fully extended, toes facing forward) and then the therapist palpates the same structures and if the asymmetry is corrected they have a functional length difference

i. (Can measure from the measured from umbilicus to medial malleolus)

Question 22

Trendelenburg sign

Answer 22

Same as from screen. Looking for hip drop to see if the abductors on the stance leg are weak.

Question 23

FABER/ Patricks/Figure Four test

Answer 23

Pt. lies supine and the therapist places the patients test leg on the opposite knee (Indian style sitting). Stabilize the pelvis and push down on knee

+ = if the knee cannot be parallel with the opposite knee - posterior pain in SI area indicated SI , groin could indicate a hip

Question 24

Long Sitting/Supine-to-sit Test

Answer 24

Pt. is supine with the legs straight and medial malleoli are level. Pt. is then asked to sit up and the therapist observes whether one leg moves up farther than the other

+ = functional leg length difference- useful for assessing anterior/posterior innominates

Question 25

Gaenslen’s

Answer 25

Sidelying with lower leg flexed and the upper leg (test leg) is extended while stabilizing the pelvis.

Pain= + test which indicates a ipsilateral SI joint lesion, hip pathology, or L4 nerve root lesion. Can sometimes do it supine as well.

Question 26

Thigh Thrust/4P

Answer 26

Supine, hip is flexed to 90. One hand is under the buttocks to palpate the SI joint and the examiner pushes through the knee to put a shear on the SI joint.

Pain indicates a + test.

Question 27

Squish/Compression

Answer 27

Supine, and the therapist pushes down and in on the ASIS’s and iliac crests at a 45 degree angle.

+ = pain indicating a posterior SI ligament issue.

Question 28

Sacral Thrust

Answer 28

Prone, hand on the sacrum and then thrust through it.

+ = pain

Question 29

Fortin Finger test

Answer 29

When asked where the pain is the pt. points to the PSIS area

Question 30

Standing Flexion test

Answer 30

+ = PSIS move more in standing than in sitting = innominate issue

+ = ILA moving more in sitting = SI (forward torsion)

Need to compare to sitting flexion tests

Question 31

Sitting Flexion test

Answer 31

+ = more movement here for sitting than standing = SI forward torsion (LoL, RoR)

• = go to sphynx while palpating ILAs => get more movement with extension = SI backward torsion (LoR, RoL)

Question 32

Standing Lunge test

Answer 32

Do a lunge with the good leg in front and have them try to touch the floor until the heel of the back leg lifts off the floor.

+ = Pain in the lower trunk on the affected side i= unilateral forward displacement of the ilium relative to the sacrum.

Question 33

SI cluster 2/4 = SI

Answer 33

• Distraction (supine) - Hand on ASISs and push them apart, be sure that your arms are parallel to be more comfortable. (anterior ligaments) - HIGH SPin
• Thigh thrust – supine, hand on sacrum then push through the thigh to shear the hip on the SI joint (high Sn)
• Test Compression (sidelying)- hand on pelvis, then lean weight through it
• Sacral Thrust – prone, hand on sacrum, sink in then thrust
• Gasenslen’s Test Compression (sidelying)- one knee bent, the other extended off the table, puts a twisting motion on the pelvis (posterior tilt and anterior tilt on the other) if pt doesn’t like one side or the other then maybe pt is already tilted on that side. (dropped from cluster)