Lumbars

Question 1

Hoover Sign

Answer 1

Positive:
Lack of counter-pressure on the healthy side.
Indicates:
Lack of organic basis for paralysis (Malingering/hysteria). With organic hemiplegia, the patient will still exert downward pressure when attempting to raise paralyzed leg

Question 2

Straight Leg Raiser (SLR)

Answer 2

Positive:
Radiating pain and/or dull posterior thigh pain.
Indicates:
Sciatic radiculopathy or tight hamstrings.
Positive between 35 ~ 70 degrees = possible discogenic sciatic radiculopathy and positive >70 degrees = tight hamstrings

Question 3

Bragard’s Sign

Answer 3

Positive:
Radiating pain in posterior thigh.
Indicates:
Sciatic radiculopathy

Question 4

Buckling Sign (Cipriano)

Answer 4

Positive:
Pain in the posterior thigh with sudden knee flexion (buckle).
Indicates:
Sciatic radiculopathy.

Question 5

Bowstring Sign

Answer 5

Positive:
Pain in the lumbar region or radiculopathy.
Indicates:
Sciatic nerve root compression, helps rule out tight hamstrings.

Question 6

Goldthwait’s Sign

Answer 6

Positive:
Localized pain, low back or radiating pain down the leg.
Indicates:
Lumbo-sacral or sacroiliac pathology.

Pain occurring after the lumbar spinouses move indicates possible lumbo-sacral problem.

Pain occurring before the lumbars move indicates possible sacroiliac problem.

Question 7

Lasegue’s Test

Answer 7

Positive:
Reproduction of sciatic pain before 60 degrees.
Indicates:
Sciatica

Question 8

Milgram’s Test

Answer 8

Positive:
Inability to perform test and/or low back pain.
Indicates:
Weak abdominal muscles / Space occupying lesion.

Question 9

Valsalva maneuver

Answer 9

Positive:
Radiating pain from site of lesion, usually recreating the complaint in the cervical or lumbar area of the spine.
Indicates:
Space occupying lesion

Question 10

Bechterew’s Test

Answer 10

Positive:
Reproduction of radicular pain or inability to perform test correctly due to Tripod Sign.
Indicates:
Sciatic radiculopathy

Question 11

Anterior Innominate Test a.k.a. Mazion’s Pelvic Maneuver, Advancement Sign

Answer 11

Positive:
The inability to bend at the waist for more than 45 degrees, because of either/or
(1) Radiating pain along sciatic nerve, either unilateral or bilateral.
(2) Low back pain in the lumbar or pelvic regions.
Indicates:
(1) Sciatic neuralgia or radiculopathy, possibly due to lumbar disc pathology.
(2) Anterior rotational displacement of the ilium in relation to the sacrum.

Question 12

Heel Walk

Answer 12

Positive:
Inability to perform test.
Indicates:
L4-L5 disc lesion, L5 nerve root

Question 13

Toe Walk

Answer 13

Positive:
Inability to perform test.
Indicates:
L5-S1 disc lesion, S1 nerve root.

Question 14

Ely Heel to Butock Test
a.k.a
Ely Sign

Answer 14

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 15

Neri Bowing Test

Answer 15

Positive:
Pain accompanied be flexion of the knee on the affected side and body rotation away from affected side.

Indicates:
Variety of low back pathologies. Hamstring tension on the pelvis may trigger the response.

Question 16

Lewin Standing Test

Answer 16

Positive:
Radiating pain down the leg causing flexion of the patient’s knee or knees.

Indicates:
Gluteal, lumbosacral or sacroiliac pathologies

Question 17

Lumbar Spine

Bony Palpation

Answer 17

1) Lumbar spinous processes
2) Sacral tubercles – “Skin on skin 2nd tubercle and below on top of shorts”
3) Iliac crest
4) PSIS

Question 18

Lumbar Spine

Soft Palpation

Answer 18

1)	Paraspinaal muscles (palpate as a unit) superfical layer
• Spinalis
• Longissimus
• Iliocostalis
2)	Sciatic Nerve
3)	Gluteus Maximus
4)	Gluteus Medius
5)	Hamstrings
• Biceps femoris
• Semitendinosus
• Semimembranosus
6)	Anterior abdominal muscles – “Do Abb’s first”

Question 19

Lumbar Spine

Ranges of Motion

Answer 19

Active and Passive

1) Flexion 25°
2) Extension 30°
3) Left lateral bending 25°
4) Right lateral bending 25°
5) Left rotation 30°
6) Right rotation 30°