Lumbar Spine Special Tests Flashcards
SLR Test (Lasegue’s Test)
PURPOSE- Identifies dysfunction of neurological structures supplying lower limb
DESCRIPTION- With the patient in the supine position, the hip medially rotated and adducted and the knee extended, the examiner flexes the hip until the patient complains of pain or tightness in the back or back of the leg. The examiner then slowly and carefully drops the leg back (extends it) slightly until the patient feels no pain or tightness. The patient is then asked to flex the neck, or the examiner may dorsiflex the patient’s foot.
RESULT- Reproduction of pathological neurological symptoms when foot is dorsiflexed
Femoral Nerve Traction Test
PURPOSE- Identify compression of femoral nerve
DESCRIPTION- The patient lies on the unaffected side with the unaffected limb flexed slightly at the hip and knee. The examiner grasps the patient’s affected or
painful limb and extends the knee while gently extending the hip approximately 15°. The patient’s knee is then flexed on the affected side; this movement further stretches the femoral nerve
RESULT- Neurological pain radiates down the anterior thigh if the test is positive.
Babinski’s Sign/Test
PURPOSE- Identifies UMN lesion
DESCRIPTION- The examiner runs a pointed object along the plantar aspect of the patient’s foot.
RESULT- A positive Babinski test or reflex suggests an upper motor neuron lesion. The reflex is demonstrated by extension of the big toe and abduction (splaying) of the other toes.
Quadrant Test
PURPOSE- Identify compression of neural structures at the intervertebral foramen and facet dysfunction
DESCRIPTION- The patient stands with the examiner standing behind. The patient extends the spine while the examiner controls the movement by holding the patient’s shoulders. Overpressure is applied in extension while the patient side flexes and
rotates to the side of pain. The movement is continued until the limit of range is reached or until symptoms are produced
RESULT- The position causes maximum narrowing of the intervertebral foramen and stress on the facet joint to the side on which rotation occurs. The test is positive if symptoms are produced
Stork Standing Test
PURPOSE-Identifies spondylolisthesis
DESCRIPTION- The patient stands on one leg and extends the spine while balancing on the leg. The test is repeated with the patient standing on the opposite leg.
RESULT- A positive test is indicated by pain in the back and is associated with a pars interarticularis stress fracture (spondylolisthesis). If the stress fracture is unilateral, standing on the ipsilateral leg causes more pain.
McKenzie’s Side Glide Test
PURPOSE- Differentiates between scoliotic curvature versus neurological dysfunction causing abnormal curvature of trunk
DESCRIPTION- The patient stands with the examiner standing to one side. The examiner grasps the patient’s pelvis with both hands and places a shoulder against the patient’s lower thorax. Using the shoulder as a block, the examiner pulls the pelvis toward the examiner’s body. The position is held for 10 to 15 seconds, and then the test is repeated on the opposite side.
RESULT- A positive test is indicated by increased neurological symptoms on the affected side. It
Van Gelderen’s Bike Test
PURPOSE- Differentiates between intermittent claudication and spinal stenosis
DESCRIPTION- The patient is seated on an exercise bicycle and is asked to pedal against resistance. The patient starts pedaling while leaning backward to accentuate the lumbar lordosis. If pain into the buttock and posterior thigh occurs, followed by
tingling in the affected lower extremity, the first part of the test is positive. The patient is then asked to lean forward while continuing to pedal. If the pain subsides over a short period of time, the second part of the test is positive; if the patient sits upright again, the pain returns.
A patient with intermittent claudication of the lower extremities typically experiences an increase in symptoms with continued exercise, regardless of the position of the spine.
Prone Instability Test
PURPOSE- Test for the likelihood of a patient with low back pain responding to a stabilization exercise program.
DESCRIPTION- The patient is positioned prone so that the trunk rests on the bed, and the feet rest on the floor, with the hips flexed and the trunk muscles relaxed. The clinician applies a P-A pressure over the most symptomatic spinous process, and any reproduction of symptoms is noted. The clinician then releases the P-A pressure, and the patient is asked to hold onto the sides of the table and to slightly lift his or her feet off the floor. This maneuver produces a co-contraction of the global abdominal, gluteal, and erector spinae muscles. While the patient maintains their feet off the floor, the clinician reapplies the P-A pressure over the same spinous process level. If a dramatic reduction or the complete elimination of the symptoms compared to the first application of P-A pressure is noted, it is considered a positive prone instability test.
RESULT- The patients with LBP, who present with negative prone instability test, are unlikely to respond to a stabilization exercise program.
