Lumbar Spine

Question 1

Bony Palpation

Answer 1

1) Lumbar SP
2) Sacral tubercles
3) Iliac crest
4) PSIS

Question 2

Soft Tissue Palpation

Answer 2

1) Paraspinal Muscles (ILS)
2) Sciatic Nerve
3) Gluteus Maximus
4) Gluteus Medius
5) Hamstrings (Biceps femoris, Semitendinosus, Semimembranosus)
6) Anterior abdominal muscles

Question 3

Range of Motion

Answer 3

Flexion: 25
Extension: 30
Left lateral bending: 25
Right lateral bending: 25
Left Rotation: 30
Right Rotation: 30

Question 4

Hoover Sign

Answer 4

Instruct: Patient Supine, examiner instructs patient to lift the affected leg while the examiner places one hand under the heel of the non-affected leg (health side)
Positive: Lack of counter-pressure on the health side
Indicates: Lack of organic basis for paralysis (Malingering/hysteria)

Question 5

Goldthwait Sign

Answer 5

Instruct: Patient supine examiner places the fingers of their superior hand under the interspinous spaces of the patient’s lower lumbar vertebrae. Examiner then raises one of the patient’s extended legs
Positive: Localized pain, low back or radiating pain down the leg.
Indicates: Lumbo-sacral or scaroiliac pathology. Pain occurring after the lumbar spinouses move= possible lumbo-sacral problem. Pain occurring before the lumbars move= possible sacroiliac problem

Question 6

Bragard Sign

Answer 6

Instruct: Patient supine, examiner performs a (SLR) on the patient. Examiner lowers the raised leg (5 degrees) from the point of pain and sharply dorsiflexes patient’s foot.
Positive: Radiating pain in posterior thigh
Indicates: Sciatic radiculopathy

Question 7

Buckling Sign

Answer 7

Instruct: Patient is supine, examiner performs a SLR on the patient.
Positive: Pain in posterior thigh with sudden knee flexion (buckle)
Indicates: Sciatic radiculopathy

Question 8

Bowstring Sign

Answer 8

Instruct: Patient is supine, examiner places patient’s leg on their shoulder and first applies pressure to the hamstring muscle if pain is not elicited then apply pressure to the popliteal fossa.
Positive: Pain in the lumbar region or radiculopathy
Indicates: Sciatic nerve root compression, helps rule out tight hamstrings

Question 9

Lasegue Test

Answer 9

Instruct: Patient Supine. Hip and leg bent to 90 degrees. Slowly extend the knee (keeping hip at or close to 90 degrees)
Positive: Reproduction of sciatic pain before 60 degrees
Indicates: Sciatica

Question 10

Milgram Test

Answer 10

Instruct: Patient Supine, examiner raises both of patient’s leg 2-3 inches off the table
Positive: Inability to perform test and/or low back pain
Indicates: Weak abdominal muscles or space occupying lesion

Question 11

Valsalva Maneuver

Answer 11

Instruct: Patient seated, examiner instructs patient to take a deep breath and hold while bearing down as if straining during a bowel movement
Positive: Radiating pain from the site of lesion (usually recreating the complaint in cervical or lumbar area of the spine)
Indicates: Space occupying lesion (ex: disc pathology)

Question 12

Bechterew Test

Answer 12

Instruct: Patient seated, examiner instructs patient to extend one knee at a time alternately, then both together.
Positive: Reproduction of radicular pain or inability to perform correctly due to tripod sign
Indicates: Sciatic radiculopathy

Question 13

Neri Bowing Test (Neri Sign)

Answer 13

Instruct: Examiner instructs patient to bend forward from the waist
Positive: Pain accompanied by flexion of the knee on the affected side and body rotation away from the affected side
Indicates: Positive with a variety of low back pathologies. Hamstring tension on the pelvis may trigger the response.

Question 14

Anterior Innominate Test AKA Mazion Pelvic Maneuver (Advancement Sign)

Answer 14

Instruct: The patient is standing. Examiner instructs patient to advance one leg forward approximately 2-3 feet. Patient is then instructed to bend forward from the waist and touch the advanced foot with both hands (advanced knee should be straight)
Positive: The inability to bend at the waist more than 45 degrees, because of either/or 1) radiating pain along the sciatic nerve, either unilateral or bilateral 2) low back pain (lumbar or pelvic regions)
Indicates: 1) Sciatic neuralgia or radiculopathy, etc., possibly due to lumbar disc pathology 2) Anterior (rotational) displacement of the ilium relative to the sacrum.

Question 15

Lewin Standing Test

Answer 15

Instruct: Examiner instructs patient to bend forward slightly at the waist with knees slightly flexed. Examiner first brings one knee into complete extension. Next the examiner brings the other knee into complete extension. Finally the examiner brings both knees into complete extenson
Positive: Radiating pain down the leg causing flexion of the patient’s knee or knees
Indicates: Gluteal, lumbosacral, or sacroiliac pathologies

Question 16

Heel Walk

Answer 16

Instruct: Patient walks on heels
Positive: Inability to perform test
Indicates: L4-L5 disc lesion (L5 nerve root)

Question 17

Toe Walk

Answer 17

Instruct: Patient walks on toes
Positive: Inability to perform test
Indicates: L5-S1 disc lesion (S1 nerve root)

Question 18

Ely Heel to Buttock Test

Answer 18

Instruct: Patient prone, examiner flexes the knee of the patient’s affected leg to 90 degrees Examiner then approximates the heel of the affected leg to the contralateral buttock and hyperextends the thigh off the table.
Positive: 1) Inability to raise the thigh
2) Pain in the anterior thigh
3) Pain in the lumbar region
Indicates: 1) Iliopsoas spasm
2) Inflammation of lumbar nerve roots
3) Lumbar nerve root adhesion

Question 19

Straight Leg Raiser (SLR)

Answer 19

Pos: Radiating pain and /or dull posterior thigh pain
Ind: Sciatic radiculopathy or tight hamstrings. Pos b/t 35-70 = possible discogenic sciatic radiculopathy >70 = tight hamstrings