Lumbar Tests

Question 1

Segmental Instability Test

Answer 1

Check for spondylolisthesis, segmental instability in joint

Prone on table, feet on floor
Pressure applied to lumbar spine

Positive if pain reproduced while relaxes, but disappears when legs lifted of floor.

Question 2

Valsalva testi

Answer 2

Tests for intrathecal pressure (usually due to space-occupying lesion. – tumour, herniated disc, osteophyte).

Possible sciatic nerve involvement.

Sit down. Bear down.

Positive if pain reproduced.

Question 3

Quadrant Test

Answer 3

Standing

Patient extends spine, laterally flexes, and rotates toward pain. Apply over pressure into shoulders.

Positive: reproduces pain

[narrowing foramen, stress facet joint]

Question 4

Dural Slump Test

Answer 4

Tests for tension in neuromeningeal tract.

Sit up, hands behind back
Slump with chin in neutral
Apply over pressure to shoulders
Flex neck
over pressure to cervical, thoracic and lumbar spine
Knee extension (possibly passive)
Dorsiflexion (passive)
Hold with max knee extension 
Overpressure to c-spine

Positive if symptoms REproduced (not just produced), if knee extension increases or symptoms decrease with neck extension.

Question 5

Neural tissue tends to adhere more at what points?

Answer 5

C6 T6 L4 Knee

Question 6

Straight Leg Raising Test

Answer 6

AKA Lasegue’s test

Tests for disc herniation, PN involvement, disc

Passive test
Unilateral. Unaffected side first.

Supine. Hip medially rotated, adducted, knee extended.
Passive flexion of hip until patient complains of back or hamstring
Lower leg until symptoms disappear.
Passive dorsiflexion
Can flex neck to make more provocative

Question 7

SLR: at what point in hip flexion is the sciatic nerve tensioned

Answer 7

35°

Question 8

SLR: 35-70°

Answer 8

Sciatic nerve tense over IVD

Range of deformation decreases as angle increases

Question 9

SLR 70°+

Answer 9

No further deformation of nerve root. Pain is probably joint pain.

Question 10

Unilateral SLR: sequence of tension

Answer 10

Greater sciatic foramen
Ala of sacrum
Where nerve crosses pedicle
Intervertebral foramen

Question 11

SLR: nerves tractioned

Answer 11

Sciatic
Lumbosacral nerve roots
Dura mater

L5-S2 nerve roots

Question 12

SLR: pain in back

Answer 12

Disc herniation

Likely smaller and more central if back pain only

Question 13

SLR: pain in posterior leg

Answer 13

Periphery nerve involvement

Question 14

SLR: pain in back and posterior leg

Answer 14

Disc herniation and peripheral nerve

Question 15

SLR: increase in pain

Answer 15

Dura mater or spinal cord involvement

Question 16

Lasegue’s sign

Answer 16

Pain when unaffected leg tested.
Large disc protrusion medial to nerve root
Bladder/bowel symptoms

Question 17

SLR: tibial nerve bias

Answer 17

Foot eversion

Toe extension

Question 18

SLR: sural nerve bias

Answer 18

Foot inversion

Question 19

SLR: common fibularis bias

Answer 19

Plantarflexion

Foot inversion

Question 20

Bilateral SLR

Answer 20

Pelvis not stabilized, rotates more on flexion,decreasing stress

Pain before 70°: SI joint

Pain after 70°: lumbar spine lesion

Question 21

Bowstring sign

Answer 21

After positive SLR
Tests for pressure on sciatic nerve

Knee slightly flexed (20°)
Ankle resting on shoulder

Apply pressure to popliteal area

Positive if radicular symptoms reproduced.

Question 22

Prone knee bending

Answer 22

Passive

Prone. Heel to buttocks

Pain in quad: rectus femoris

Pain in lumbar spine (especially radicular symptoms): lumbar spine issue – likely L3

IL ASIS rotates forward before 90° flexion: SI joint hypomobility