Lumbar Spine and SIJ

Question 1

Lumbar Spine AROM

Answer 1

Flexion 40-60 degrees
Extension 20-35 degrees
Side Flexion 15 to 20 degrees
Rotation 3 to 18 degrees

Question 2

Lumbar Spine PROM

Answer 2

Flexion - Tissue Stretch
Extension - Tissue Stretch
Side Flexion - Tissue Stretch
Rotation - Tissue Stretch

Question 3

Cough, Sneeze, Valsalva (Dejerine Sign)

Answer 3

• Purpose:
– This manoeuvre is designed to increase intrathecal pressure which may replicate the symptoms
experienced by a patient when they cough, sneeze or strain
– Commonly associated with disc herniation causing radiculopathy

• Procedure:
1.The patient is asked to cough (the intensity of the cough can be gradually increased up to maximum
capacity)
2.Symptoms that are reproduced upon sneezing are usually revealed during the case history
3.To test the valsalva component, the patient is asked to take a breath, hold it, and then bear down as if
evacuating the bowels

• Indication of a Positive Test:
– Reproduction of radicular symptoms
• Notes:
– Consider the impact on cardiovascular, gastro-urogenital, and retinal structures

Question 4

Lumbar Compression/Distraction

Answer 4

• Purpose:
– To increase intra spinal pressure

• Procedure:
– The examiner places downward pressure through both shoulders and down through the spine of the patient(compression
component). The patient is asked to report any change in symptomatology\
– The patient is then asked to brace their arms and shoulders so that the practitioner may apply an upward distractive force
– The examiner then places both arms under the patients folded arms and lifts vertically in an effort to traction the spine
(distraction component). The patient is asked to report any change in symptomatology

• Indication of a Positive Test:
– The aim of this testis to increase the compressive forces on the intervertebral disc with the compression component of the
test
– If the lower back and or thigh and leg symptoms are reproduced with the compressive test, and/or relieved with the
distraction test, this is indicative of an intervertebral disc involvement

• Note:
– The distraction component of the testis redundant if there was no reproduction of the patient’s symptoms with the
compressive manoeuvre
– The patient can be placed into different positions (i.e. flexion, extension, rotation or lateral flexion) in order to stress
different regions of the lumbar spine
– Compressive and distractive forces should be applied and released slowly

Question 5

Slump Test

Answer 5

• Purpose:
– Test for neuro meningeal tension
– Used to assess movement restriction of the dura, spinal cord, and/or nerve roots

• Procedure:
– The patient is seated on the examining table with the legs supported, the hip is in the neutral position and
the hands behind the back
– The patient is asked to slump so that only the lumbar and thoracic spine go into full flexion
– The examiner maintains the patient’s chin in neutral position to prevent head and neck flexion
– The examiner then uses one arm to apply over-pressure and maintain flexion of the lumbar and thoracic
spine
– While this position is held the patient is then asked to flex the cervical spine and head as far as possible
– The examiner then applies over-pressure to maintain flexion in all three parts of the spine using the same
arm to maintain over-pressure in the cervical spine
– While the examiner holds these positions, the patient is asked to actively straighten the knee as much as
possible
– With the other hand, the examiner then moves the patient’s foot into maximum dorsiflexion
– The test is repeated with the other leg, and then with both legs together

• Indication of Positive Test:
– If the patient is unable to fully extend the knee because of pain, the examiner
releases the pressure on the cervical spine and the patient actively extends
the neck
– If the knee extends further and the symptoms decrease with neck extension,
then the test is considered positive for increased tension in the neuro meningeal tract

• Note:
– If symptoms are produced at any stage, further sequential movements are not
attempted

Question 6

Straight Leg Raise (SLR)

Answer 6

• Purpose:
– Test for impingement of the dura and spinal cord or nerve roots of the lower lumbar spine, in particular
the sciatic nerve (L4, L5, S1)

• Procedure:
– The SLR is a passive test and should be performed with the patient supine in a relaxed position with the
head in neutral and the knees extended
– The examiner then flexes the patients hip, with the knee extended, until the patient complains of pain or
tightness
– The practitioner notes at what point in the arc of the lift that the patient experiences symptoms
– The test is repeated on the opposite leg

• Indication of a positive test:
– The test is positive if pain extends from the back down into the leg in the sciatic nerve distribution
– A unilateral straight leg raise is full at 70 where the nerve roots (sciatic nerve) are completely stretched
– Pain experienced after 70 is more likely to be joint pain from the lumbar area or tension in the
hamstring muscles
– The examiner should compare the two sides differences

Question 7

Prone knee bend

Answer 7

• Patient is in the prone position
• Examiner passive flexes the knee to maximum – up to 45-60 seconds
• Extend the hip if the knee cannot bend beyond 90 degrees
• Femoral nerve

Question 8

Bragard’s Test

Answer 8

• Purpose:
– Used in combination with the SLR to indicate neuro meningeal
tension

• Procedure:
– If pain is present while performing the SLR, the examiner carefully
drops the leg back slightly until there is no pain or tightness reported
by the patient, and then performs dorsiflexion on the foot

• Indication of a Positive Test:
– Pain that increases with ankle dorsiflexion, indicates aberrant neuro meningeal tension

Question 9

Bonnet’s Test

Answer 9

• Purpose:
– Test for piriformis syndrome: entrapment of the sciatic nerve as it traverses the region of the piriformis muscle

• Procedure:
– Patient is supine
– The examiner carries out a straight leg raising test which results in pain (Part 1)
– The leg is lowered and the patient’s leg is slightly adducted, and fully internally rotated
– The practitioner passively flexes the patient’s hip until pain is again felt (Part 2)
– The practitioner takes note of the difference in the range of the straight leg raise before the onset of pain between the first and second parts of the test

• Indication of a Positive Test:
– Reproduction of a patient’s symptoms: local and referred pain and abnormal neurological symptoms in the posterior thigh and calf

• Note:
– Internal rotation stretches the piriformis muscle
– Leg pain may result from sciatic nerve irritation or compression from a contracted piriformis muscle
– Similarly, SLR with external rotation may be performed. This may also affect the sciatic nerve via contraction of the piriformis muscle

Question 10

Bowstring Test (Cram test or Popliteal Pressure)

Answer 10

• Purpose:
– Test for aberrant neuro meningeal tension

• Procedure:
– The examiner carries out a straight leg raise test which provokes pain
– The knee is then flexed slightly while keeping the patient’s thigh in the same
position, which reduces the symptoms if there is aberrant neuro meningeal
tension
– The practitioner then applies thumb or finger pressure to the popliteal area in
an attempt to re-establish the tension on the neuro meningeal complex

• Indication of a Positive Test:
– The test is an indicator of tension or pressure on the sciatic nerve

Question 11

Well Leg Raise (Crossed SLR)

Answer 11

• Purpose:
– Test for neural tension

• Procedure:
– Same as SLR however the non-affected leg is the primary test leg

• Indication of a Positive Test:
– If the well leg is lifted and the patient complains of pain on the opposite side, is an indication of a space-occupying lesion (e.g. herniated disc)
– It is usually indicative of a rather large intervertebral disc protrusion, usually medial to the nerve root.
– The test causes stretching of the ipsilateral as well as the contralateral nerve root, pulling laterally on the dural sac

Question 12

Myotomes – Lower Limb

Answer 12

L2: hip flexion
L3: knee extension
L4: ankle dorsiflexion
L5: big toe extension
S1: ankle plantarflexion
S4: bladder and rectum motor supply

Question 13

Dermatomes - Lower Limb

Answer 13

L1: the inguinal region and the very top of the medial thigh.
L2: the middle and lateral aspect of the anterior thigh.
L3: the medial epicondyle of the femur.
L4: the medial malleolus.
L5: the dorsum of the foot at the third metatarsophalangeal joint.
S1: the lateral aspect of the calcaneus.
S2: at the midpoint of the popliteal fossa.
S3: at the horizontal gluteal crease (the horizontal crease formed by the inferior aspect of the buttocks and the posterior upper thigh).
S4/5: the perianal area.

Question 14

Bicycle Test of van Gelderen

Answer 14

• Purpose:
– Test for neurogenic claudication

• Procedure:
– Part 1:
• The patient is seated on an exercise bicycle and is asked to pedal against light resistance
• The patient is asked to maintain an upright posture during the first portion of the test. The upright posture
accentuates the lumbar lordosis.
• The patient is asked to continue peddling until a reproduction of symptoms occurs

– Part 2:
• The patient is then asked to lean forward and continue peddling against resistance
• Indication of a positive test:
– Pain into the buttock and posterior thigh accompanied by tingling is elucidated by the first component of
the test
– The test is considered positive if the patient’s symptoms subside after a short period of time while
peddling in the forward leaning posture

• Notes:
– This test can be timed and used as a ‘tag test’ in the treatment in patients with neurogenic claudication

Question 15

Stoop Test/Treadmill Test

Answer 15

• Purpose:
– Test for neurogenic claudication
– To assess if there is a relationship between symptoms and posture/walking posture

• Procedure:
– Part 1:
• The patient is asked to walk briskly with an upright posture until symptoms are produced

– Part 2:
• The patient is then asked to flex forward and continue walking

• Indication of a Positive test:
– Pain into the buttock and posterior thigh accompanied by tingling is elucidated by the first component
of the test
– The test is considered positive if the patient’s symptoms subside after a short period of time while
walking in a forward flexed posture

• Notes:
– This test can be performed on a treadmill or on a stable surface for a distance of at 50 metres
– This test can be timed and used as a ‘tag test’ in the treatment in patients with neurogenic
claudication

Question 16

Cluster of Cook

Answer 16

Associated with neurogenic claudication

Positive findings form the patient history:

1. Bilateral symptoms
2. Leg pain > Low back pain
3. Pain during walking/standing
4. Pain relief with sitting
5. Aged > 48 years

Question 17

Squat Test

Answer 17

• Purpose:
– This test is designed to provide the practitioner a quick assessment of the peripheral joints of the lower
extremity

• Procedure:
– The patient squats down as far as possible while maintaining a neural spine position
– The patient may gently bounce two or three times at the bottom of their movement
– The clinician should watch for compensation and asymmetry

• Indication of a Positive Test:
– Aggravation or provocation of symptoms in the lower extremity
– If the patient can squat without any signs or symptoms derived from the periphery there is unlikely to be
any significant pathology of the lower extremity joints

• Note:
– The technique for the orthopaedic Squat test is designed to stress the joints of the lower extremity and
should therefore differ significantly from the ergonomically-sound squat technique used in fitness and
strength training

Question 18

Adam’s (Forward Bending) Test

Answer 18

• Purpose:
– To gain information about the nature of a patient’s scoliosis
– To assess if there is a structural and/or functional scoliosis present

• Procedure:
– The patient is asked to bend forward and touch their toes while keeping their knees straight
– The practitioner observes for changes in the severity of the scoliosis

• Indication of a Positive Test:
– A ‘true’ or ‘structural’ scoliosis is determined if rib humping is observed in the forward flexed
position
– The magnitude of a structural scoliosis should be unaffected by this manoeuvre
– The magnitude of a functional scoliosis may reduce slightly in the forward bending position
– Can be used to highlight primary (typically the stiffest of the various curves) and secondary
curves (typically the more mobile of the various curves)

Question 19

Trendelenburg’s Test

Answer 19

• Purpose:
– To assess gluteus medius weakness

• Procedure:
– The patient is asked to balance on one leg

• Indication of a Positive Test:
– The practitioner observes for the Trendelenberg’s sign which is a drop (inferior oblique shift) of the ilium on the contralateral side of stance
– This indicates a weak/inhibited gluteus medius muscle of the side of stance leg
– “The sound side sags”

• Notes:
– This test may be used for further qualitative analysis of neuromuscular compensation
– The gluteus medius is innervated by the superior gluteal n. which is a branch of L4, L5 and
S1 nerve roots

Question 20

Kemp’s (Quadrant) Extension-Rotation Test

Answer 20

• Purpose:
– To assess the response to maximum narrowing of the intervertebral foramen
– Test for lumbar radiculopathy

• Procedure:
– The patient stands with the examiner standing behind them forsupport
– The patient is asked to actively run their hand down the back of theirleg
– The aim of this test is to decrease the IVF and impact the facets by creating extension and
rotation in the lumbarspine

• Indication of a Positive Test:
– If this procedure reproduces neuropathic pain in the leg, lumbar radiculopathy is indicated
– If the pain is local or in a referral pattern that is distinct from a dermatomal distribution, the
facet joints or some other somatic structure may be responsible

Question 21

Flynn Clinical Prediction Rule

Answer 21

Associated with facet syndrome

Positive items from the patient history:

1. No symptoms distal to the knee
2. Recent onset of symptoms (<16 days)
3. Low FABQW score (<19)
4. Hypomobility of lumbar spine
5. Hip internal rotation > 35 deg of at least one hip

Note: 3 or more items increase the chance of success with lumbar manipulation

Question 22

One-Leg (Stork Standing) Lumbar Extension Test

Answer 22

• Purpose:
– To assess for lumbar joint dysfunction, spondylolysis and/or spondylolisthesis

• Procedure:
– The examiner is positioned behind the patient and observes
– The patient stands on one leg
– While standing on one leg, the patient is asked to extend the spine
– The practitioner asks the patient if, by extending, there is a change to their symptoms
– The test is repeated with the opposite leg
– The test can be performed by having the patient rotate while extending

• Indication of a Positive Test:
– A positive test result is indicated by pain in the lower back
– A positive test result may be associated with pars interarticularis stress fracture (spondylolysis) with/without spondylolisthesis

• Notes:
– Pain on ipsilateral side of stance (unilateral pars interarticularis fracture)
– Pain on normal lumbar extension –spondylolisthesis
– Pain on extension with rotation –facet mediated (the facet joint on the ipsilateral side of rotation is implicated with this manoeuvre)

Question 23

Prone Segmental Instability Test

Answer 23

• Purpose:
– To assess for anterior lumbar instability

• Procedure:
– The patient lies prone with their legs hanging off the examination table and resting on the floor
– The examination table is set to a height that allows approximately 45° of hip flexion whilst in the prone
position

– Part 1:
• The examiner applies P-A pressure on an individual lumbar vertebrae and asks the patient to report any change in
symptoms
• The practitioner slowly releases the pressure

– Part 2:
• The patient then activates the trunk extensor muscles so that the legs lift off the floor (approximately 6 inches) and
the practitioner repeats the P-A pressure

• Indication of Positive:
– If pain is felt during P-A pressure in the resting position (Part 1) but is reduced by activating the trunk
extensor muscles (Part 2) then instability may be present

Question 24

Passive Extension Test

Answer 24

Purpose: To assess lumbar instability
• Patient is lying prone, then the examiner passively raises the patients leg at the ankles, lifting them to about
30cm off the table, and applying a gentle pull

A feeling that the low back is about to ‘go out’ or experiencing severe pain or heaviness in the low back - is a positive outcome

Question 25

Pheasant’s Test

Answer 25

• Purpose:
– To assess for anterior lumbar instability

• Procedure:
– The patient is lying prone
– With one hand, the examiner gently applies P-A pressure to the posterior aspect of a lumbar vertebrae
– With the other hand, the examiner passively flexes the patient’s knees until the heels come as close to the
buttocks as possible
– The aim of this procedure is to decrease the size of the IVFs and the central canal and provoke P-A
displacement of an unstable segment
– In some cases this position may need to be maintained for up to 5 minutes before symptoms may be elicited

• Indication of a Positive Test:
– If the neuropathic pain is reproduced in the leg/s by this hyperextension of the spine, the test is considered
positive and indicates an unstable spinal segment that may be contributing to stenosis
– The achilles reflex may be checked before and after the test to determine any change in nerve function

Question 26

Sill Sign / Slipping Palpation

Answer 26

Purpose: identifying lumbar spondylolisthesis
• Patient is standing and back is exposed
• Examiner observes for a sill or capital “L”
• Patient runs their hand/thumb down the midline of the patients spine

Question 27

Test of Anterior Lumbar Spine Instability

Answer 27

• Purpose:
– To assess for anterior spinal instability of an individual segments in the lumbar spine

• Procedure:
– The patient is in the side lying position with hips flexed to 70° and knees comfortably flexed
– The examiner’s hands are placed over the test segment
– The patient’s knees are placed into the crease of the examiner’s hip
– The examiner palpates and stabilises the target spinous process
– The practitioner, using a hip contact, pushes posteriorly through the patient’s knees and along the line of
the femur
– The examiner can then feel for any relative movement of the segment caudal to the segment being
stabilized
– Other levels may be tested in a similar fashion

• Indication of Positive Test:
– If L3-L4 were being examined, the examiner would feel L3 slip forward relative to L4 as pressure was applied
– The practitioner may note spasm in the muscles surrounding an unstable motion segment

• Note:
– There should be little or no movement present under normal conditions

Question 28

Test of Posterior Lumbar Spine Instability

Answer 28

• Purpose:
– To assess for posterior spinal instability of the lumbar spine

• Procedure:
– The patient is sitting
– The practitioner stands facing the patient
– The patient places their pronated arms, with the elbows bent, on the anterior aspect of the examiner’s shoulders
– The examiner puts both hands around the patient so that the fingers rest over the lumbar spine, and with the heels of the
hands, gently pulling the lumbar spine into full lordosis/maximal extension
– To stress L5 on S1, the examiner stabilises the sacrum with fingers of both hands and asks the patient to push through the
forearms while maintaining the lordotic posture
– Other levels of the spine may then be tested in a similar fashion

• Indication of a PositiveTest:
– Excessive motion of the spinal segment or protective muscle spasm indicates a positive test result
– Pain is not an indicator of a positive test result
– In the example involving L5-S1, the examiner will feel L5 move posteriorly in relation to S1in a positive test

• Note:
– There should be little or no movement present under normal conditions during the performance of this test

Question 29

Beighton Scoring System for Joint Hypermobility Syndrome

Answer 29

The ability to:

1. Passively dorsiflex the 5th metarcarpophalangeal joint to equal to or greater than 90 degrees
2. Oppose the thumb to the volar aspect of the ipsilateral forearm
3. Hyperexted elbow to equal to or grater than 10 degrees
4. Hperextend the knee to equal to or greater than 10 degrees
5. Place hands flat on the floor without bending knees

A score equal to or greater than 4 out of 9 indicates hypermobility

Question 30

Quick Test for Joint Hypermobility Syndrome

Answer 30

1. Can you now (or have you ever?) been able to place your hand flat on the floor without bending your knees?
2. Can you now (or have you ever?) bend your thumb to touch your forearm?
3. As a child did you amuse your friends by contorting your body unto strange shapes or could you do the splits?
4. As a child or a teenager did your shoulder or knee cap dislocate more than once?
5. Do you consider yourself double jointed?

If the individual answers 2 or more as yes then there is a 80-85% sensitivity and 85-90% specificity for hypermobility

Question 31

SacroIliac Joint: Range of Motion

Answer 31

Lumbar Spine - Innominate - Sacrum:

• Flexion - Anterior Rotation - Counter Nutation
• Extension - Posterior Rotation - Nutation
• Lateral Flexion I/L: Anterior Rotation, C/L: Posterior Rotation - I/L: Counter Nutation C/L: Nutation
• Rotation I/L: Posterior Rotation, C/L: Anterior Rotation - I/L: Nutation, C/L: Counter Nutation

Question 32

Gillet’s Test (Sacral Fixation Test)

Answer 32

• Purpose:
– To assess sacral motion into nutation and counter nutation (MOVEMENT)
– Screening test for SIJ motion

• Procedure:
– Patient is standing
– Part 1:
• The practitioner kneels behind the patient palpates one of the PSIS’s with one thumb
while holding the other thumb on the S2 tubercle of the sacrum
• The patient is then asked to stand on one leg while lifting the opposite knee up toward
the chest
• This causes the innominate bone on the same side to rotate posteriorly
• The test is repeated with the other leg, this time with the examiner palpating the other
PSIS

– Part 2:
• The practitioner contacts the patient’s ischial tuberosity with one
hand and the other hand is placed on the S4 tubercle
• The patient is again asked to bring the knee to the chest

• Indication of Positive Test
– Part 1: During a normal test the PSIS moves inferiorly as
the patient flexes the hip. If the SIJ (PSIS) on the side on
which the knee is flexed moves minimally or up, the joint is said to be hypomobile and indicates a positive test.

– Part 2: During a normal test the ischial tuberosity should move laterally as the patient flexes their hip. If the SIJ is hypomobile or fixated there will be little or no movement laterally and in some cases the practitioner’s contact will move superiorly.

• Note:
– The practitioner can move their contacts (PSIS or ischial) to the stance side leg while the patient flexes the contralateral hip. This will indicate how well the stance side inominate is moving into extension relative to the opposite side

Question 33

Piedallu’s Sign

Answer 33

• Purpose:
– To assess for SIJ hypomobility (MOVEMENT)

• Procedure:
– The patient is seated on the examination table
– The examiner stands behind the patient and palpates the PSIS’s and compares their relative
heights
– If one PSIS is lower relative to the other (usually the painful affected side) the patient is asked
to flex forward
– The practitioner then observes/palpates the relative PSIS heights in the flexed position

• Indication of Positive Test:
– If the PSIS, which was initially lower, becomes higher (moves superiorly) on forward flexion,
the test is considered positive, indicating hypomobility on that side

Question 34

Gapping (Transverse Anterior Shear) Test

Answer 34

• Purpose:
– To assess the integrity of the anterior sacroiliac ligaments(PAIN PROVOCATION)

• Procedure:
– The patient is supine on the examination table
– The practitioner, crossing his or her arms, places the palms on the medial aspect of each ASIS
– The examiner then applies cross-armed pressure to the ASIS’s, pushing down and outward

• Indication of Positive Test:
– The test result is positive only if unilateral gluteal or posterior leg pain is produced, indicating
a sprain of the anterior sacroiliac ligaments

• Notes:
– Care must be taken due to sensitive anterior structures

Question 35

Thigh Thrust Test

Answer 35

• Purpose:
– To assess the integrity of the posterior sacroiliac ligaments (PAIN PROVOCATION)

• Procedure:
– The patient is supine on the examination table with knee fully flexed and hip flexed to 90°
– The practitioner stands on the contralateral side to the side being tested and places one hand under the
patient’s sacrum
– The practitioner contacts the patients knee with the other hand
– The practitioner applies an A-P force through the patient’s femur which causes a shearing force on the SIJ

• Indication of Positive Test:
– A reproduction of the patient’s symptoms

• Notes:
– The AP shearing motion can be performed either as a quick thrust or a gradual increase in pressure

Question 36

Approximation (Compression) Test

Answer 36

• Purpose:
– To evaluate the integrity of the posterior SIJ ligaments(PAIN PROVOCATION)
– To test for lesions of the SIJ

• Procedure:
– The patient is in the side-lying position with the involved side facing up
– The examiner stands behind the patient and places their hands over the lateral aspect of the
patient’s ilium near the iliac crest
– The examiner applies lateral to medial pressure toward the table
– This movement causes compression of the ilium against the sacrum and hence compression of
the SIJ

• Indication of Positive Test:
– An increased feeling of pressure in the SIJs indicates a possible posterior SIJ lesion/sprain
– Aggravation of unilateral gluteal or posterior pain

Question 37

Sacral Thrust Test

Answer 37

• Purpose:
– To assess the integrity of the sacroiliac ligaments(PAIN PROVOCATION)

• Procedure:
– The patient is prone on the examination table with examiner standing on the affected side
– The practitioner places the base of their hand on the patient’s S2 spinous process
– The practitioner applies an 3-6 higher velocity thrust increasing vertical direction pressure

• Indication of Positive Test:
– A reproduction of the patient’s familiar symptoms

Question 38

Gaenslen’s Test

Answer 38

• Pronounced:
– Jens-lens

• Purpose:
– Test for sacroiliac joint involvement

• Procedure:
– The patient can be positioned either in the side-lying or supine position
– The patient flexes the knee and hip of the unaffected leg to their chest and holds it there, which
causes flexion of both pelvis and lumbar spine
– The supine patient is then asked to drop their leg off the edge of examination table which creates a
torsional force through the SIJ the practitioner can exert over pressure on both the affected and
unaffected legs
– In the case of the side-lying patient, the practitioner stabilises the patient’s pelvis and hyperextends
the leg on the affected side

• Indication of Positive Test:
– Aggravation of unilateral gluteal or posterior pain

Question 39

Yeoman’s Test

Answer 39

• Purpose:
– To assess the integrity of the anterior SIJ ligaments and/or to screen for adjacent region
pathology that might mimic SIJ dysfunction

• Procedure:
– The patient is prone with the knee flexed to approximately 90°
– The practitioner stands on the side of the patient closest to the affected leg
– The practitioner extends the patient’s hip

• Indication of Positive Test:
– Pain localized in the region of the SIJ indicates pathology of the anterior SIJ ligaments
– Lumbar pain indicates lumbar spine involvement
– Due to the knee flexion and hip extension component the femoral nerve may be tractioned
during this procedure creating anterior thigh paraesthesia

• Note:
– The test can be performed in three parts:
• Part 1: The practitioner stabilizes/blocks the patient’s ischial tuberosity and extends the patient’s hip
which localizes the test forces to the hip primarily
• Part 2: The practitioner stabilizes/blocks the patient’s sacrum and extends the patient’s hip which
localizes the test forces to both the hip joint and SIJ
• Part 3: The practitioner stabilizes the patient’s lumbar spine, by blocking off L5, and extends the
patient’s hip which localizes the test forces to the hip, SIJ and lumbosacral articulation
• The patient will likely complain of pain when forces are localized to the problematic region
• The practitioner can isolate each region by using parts 1-3 of the procedure
• These parts may be performed in forward (1-3) or reverse (3-1) order

Question 40

2/4 Positive Provocation Tests

Answer 40

Cluster of Laslett:

1. Perform thigh thrust & distraction test
2. If both are positive → SIJ pain diagnosis
3. Continue if 0 or 1 are positive
4. Perform compression test … if 2 positive → SIJ pain diagnosis
5. Continue if 0 or 1 are positive
6. Perform sacral thrust test

Any 2 positive = SIJ pain diagnosis
1 out of 4 = SIJ pain unlikely
0 out of 4 = SIJ ruled out