Lumbar Special Tests Flashcards
Valsava Test
Tests for something in the spinal canal
- pt seated
- asked to increase intrathecal pressure
POSITIVE if symptoms worsen
Iliolumbar Ligament Stress Test
Tests integrity of the iliolumbar lig (SP of L4-5 to innominate)
- pt lays prone
- PT contacts lateral aspect of SP with one hand and contralateral ASIS with other
- PT stabilizes SPs (prevent rotation) while attempting to post rotate the innominate
- hold position for 15-20sec to allow creep
POSITIVE if pain in area
Prone Instability Test
Tests for lumbar instability
- pt prone with their hips off the table
- PT gives P-A force on vert segment of suspected instability
- elicits pts symptoms - pt raises legs from the floor while PT maintains P-A force
POSITIVE if relief of symptoms with active leg raise
Passive Lumbar Extension
Tests for lumbar instability
- pt prone on table with legs on the floor
- PT passively extends the pts spine
- raise legs >30deg or 30cm
POSITIVE if onset of symptoms
Kemp Compression Test (Quadrant)
Tests for facet joint irritation
- pt sitting with their arms crossed
- pt placed into ext, SB, rotation to side of symptoms
- PT gives an axial load caudally through the pts shoulders
POSITIVE for increased symptoms - compression of compromised structures
Extension-Rotation Test
Tests for facet joint irritation
- pt sitting with feet supported
- PT pushed into extension via local P-A
- PT takes pt into full rotation on painful side while maintaining ext
- PT gives overpressure through the shoulders to accentuate movement
POSITIVE for pain
Spondylolysis Test (SLS)
Tests for single fracture at pars articulates
- pt stands on one foot while maintaining an upright position
POSITIVE for an increase in local lumbar pain
Osteopathic Hip Drop
Tests L-S relationship
- pt standing and asked to slightly bend one knee
- should result in an ipsilateral pelvic drop - PT assesses excursion and compares it to the other side
POSITIVE if the drop is not equal on both sides
Schober Test
Tests for ankylosing spondylosis
- pt standing
- PT marks 10cm above and 5cm below the L-S junction
- pt flexes forward
- PT remeasures
POSITIVE if increase is <5cm
(5cm or more is normal)
Hoover Test
Tests for malingering
- pt supine, PT supports each heel with their hand
- pt asked to perform a unilateral SLR
- PT monitors the amount of pressure applied by the pts other heel
POSITIVE if little to no pressure is felt on the pts heel while they “struggle” to perform the SLR
Carnettt’s Sign
Tests for visceral involvement/hernia
- pt lays supine
- PT palpates abdomen and assess for tenderness
- PT puts pressure on a tender point and pt asked to lift their legs off the table
POSITIVE for muscle strain/hernia if tenderness increases
POSITIVE for visceral involvement if tenderness is relieved
Vertical Compression Test
Tests axial stability
- pt stands with their knees relaxed (not locked out)
- PT stands behind and over the pt and gives an axial load through the pts shoulders
- apply pressure until the force has reached a firm, bony end feel (grade 1)
- double the force for grade 2
- triple the force for grade 3 - build force until pt buckles, rotates or a grade 5 is reached
Grade 5/5 is normal
** ask pt to fix posture, then try again **
Elbow Flexion Test
Tests for core initiation
- pt stands with elbows flexed to 90deg and forearms in full supination
- PT stands in front of pt and places the palms of their hands on the pts distal forearms
- PT applies applies weight to the pts forearms - pt told to hold their position
- break test - stop when the pt buckles or a grade 5 is reached
Grade 5/5 is normal
Lumbar Protective Mechanism
Tests trunk responsiveness - core initiation, strength and endurance
SUPPORTED
- pt stands in front of the table with one foot slightly in front of the other
- PT stands to the side of the pt on a diagonal
- PT grips pts coracoid process in a lumbrical grip and gives an A-P force at a diagonal for 30 sec
- pt told to hold their position
UNSUPPORTED
- away from table - progression
**assess both flexion and extension quadrants **
