Lumbopelvic Special Test Flashcards by Richie S

What is the purpose of Lumbar Forward-Bending PPIVM?

To evaluate the passive forward-bending motion of lumbar segments L5-S1 through T12-L1
- Pt is in sidelying
- The finger is used to palpate the interspinous space of the lumbar segments

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What is the procedure for Lumbar Forward-Bending PPIVM?

The PT induces forward bending by shifting the body weight towards the patients head while flexing the patients hip. The pad of the PT finger palpate the interspinous space as the inferior vertebra’s spinous process of the spinal segment moves inferiorly in relationshiop to the superior verebras spinous process

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What is the purpose of Lumbar Side Bending (Lateral Flexion PPIVM)?

To evaluate the passive side-bending (lateral flexion) motion in the lumbar segments L5-S1 through T12-L1

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What is the procedure for Lumbar Side Bending (Lateral Flexion) PPIVM?

If trying to assess R side
- The PT stands on the Pts right side and induces side bending to the right by abducting the patients right hip with the caudal hand.
- The PTs pad is palpating the right lateral aspect of the interspinous space of the specified lumbar segment
-PT palpates for the interspinous space to close down into the palpating finger by palpating the lateral edge of the inferior spinous process in relation to the lateral edge of the superior spinous process

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What is the purpose of Lumbar Rotation PPIVM (with rolling legs)

To evaluate the passive rotation of the lumbar segments L5-S1 though T12-L1

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What is the procedure for Lumbar Rotation PPIVM (with rolling the legs)?

If trying to assess R side
Both of the knees are ~45-60°
- Right rotation of the lumbar spine is induced with rolling the legs towards the right side, the pad of the long finger is used to palpate the right lateral aspect of the interspinous space of the specified segment

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What is the the purpose of the Lumbar Rotation PAIVM (Spring Testing through Transverse Process)?

This evaluates the passive rotation of the lumbar segments L5-S1 through L2-L3 ans assesses the level of reactivity of lumbar segments L5-S1 through L2-L3 (pain provocation)

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What is the the procedure of the Lumbar Rotation PAIVM (Spring Testing through Transverse Process)?

If assessing R rot.
- PT stands on Pts R side, the Ulnar aspect of the 5th metacarpal locates the iliac creast

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Muscle Performance Test

What is the Purpose of the Supine Hook-Lying Lumbopelvic Control test?

This test assesses the ability of the transverse abdominis to control lumbopelvic motion while imparting LE motions to challenge the system

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What is the Procedure of the Supine Hook-Lying Lumbopelvic Control Test?

The pressure feedback bag is inflated to 40mmHG and the patient is instructed to contract and hold the Transverse Abdominis muscle by performing the “drawing in” abdominal maneuver.
- The pressure gauge either increases 2 to 3 mmHG with the contaction of stays the same.
- The Patient should practice 10 second isometric hold in this position

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How can the Supine Hook-Lying Lumbopelvic Control test be further tested?

Leg motions can be induced as the patient attempts to maintain the pressure gauge reading steady throughout the movement.
- The leg motions that can be used (in order of difficulty) include a heel slide, a 3 inch march, a bent knee fall out (hip abd. with ER) and an SLR (8-10 inches)

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Muscle Performance Test

What is the purpose of the Prone Transverse Abdominis Test?

To assess the ability to isolate Transverse Abdominis muscle control in the absence of overdominance of the global abdominal muscles

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What is the Procedure Prone Transverse Abdominis Test?

The pressure pad is inflated to 70mmHG. The patient is instructed to breath in and out then, without breathing in, slowly draw in the abdomen to lift the abdomen off the bag, keeping the spine postion steady.
- Once the contraction has been achieved, the patient should return to relaxed normal breathing

A successful performance of the test reduces the pressure by 6 to 10mmHG, which indicates that the patient can perform an isolated Transverse abdominis contraction

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When is “Normal Strength” achieved with the Prone Transverse Abdominis Test? What should PT’s look out for when the patients are performing this test?

Normal strength is achieved when the patient can sustain up to 10 reps of 10 second holds of an isolated drawing in maneuver

The PT must ensure that the patient is not just tilting the pelvis or flexing the spine to attain the change in pressure

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Muscle Performance Test

What is the purpose of the Prone Hip Extension Neuromuscular Control Test?

To assess the strength, control, and firing pattern of the lumbopelvic stabilizers and hip extensor muscles during active hip extension

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What is the procedure for the Prone Hip Extension Neuromuscular Control Test?

The patient is instructed to lift a straight leg 8-10 inches off the table. The therapist observes for the patients ability to maintain a neutral spine position during this test and for the muscle firing pattern, which should progress as ipsilateral gluteus maximus/hamstrings, contralateral multifidus, ipsilateral multifidus, contralateral erector spinae and ipsilateral erector spinae

Pain provocation is also noted and may occur with poor ability to stabilize the lumbopelvic spine during this test

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Why might the patient “fail” the Prone Hip Extension Neuromuscular Control Test?

When the patient has poor ability to stabilize the lumbopelvic region with this maneuver, a pattern of overdominance of the global erector spinae muscles and delayed or poor firing of the deep local muscles (Multifidus and TrA) is common.
- With delayed firing and weakness of the Glute max, reduction in the degree of hip extension and compensation with an anterior pelvic tilt of the pelvis, hyperlordosis, and an increased pressure on the lumbar segments are found

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Muscle Performance Test

What is the purpose of the Trendelenburg Test?

To determine neuromuscular control of the hip, pelvis, and trunk with emphasis on glute med. strength, function and control to stabilize the pelvis during single leg stance

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What is the procedure for the Trendelenburg Test?

The patient is asked to balance on one leg by flexing the contralateral hip to 30°. The position is maintained for 30 seconds and then repeated on the other side.

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How do you determine if the Trendelenburg Test is (+) or (-)?

The test is negative if the pelvis on the nonstance side can be elevated and maintained for 30 seconds.

The test is positive:
- The patient is unable to hold the elevated pelvic position for 30 seconds
- No elevation is noted on the nonstance side
- The stance hip adducts allowing the pelvis on the nonstance side to drop downward below the level of the stance side pelvis

A goni may be used to quantify the amount of pelvic movement. The axis is on the ASIS and the stationary arm is on the invisible line connecting both ASIS, moving on the anterior midline of the femur

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What is the purpose of the Lumbar Extension/Side Bending/Rotation Combined Motion Test?

This assesses the amount of motion and pain provocation with the combined motions of backward bending, side bending and rotation

What is the procedure of the Lumbar Extension/Side Bending/Rotation Combined Motion test?

The PT guides the patient into lumbar extension, (L) side bend, (L) rotation with the right arm (this arm is positioned across the patients chest holding L shoulder) as the left arm finds a fulcrum point for the motion

What is the Purpose of the Lumbar Side-Glide (Lateral Shift Correction)?

To assess the effects of a manual lateral shift correction on the intensity and location of Low back and Leg pain

What is the procedure for the Lumbar Side-Glide (Lateral Shift Correction)?

The PT guides the patient into a lateral shift correction with a force couple of laterally directed forces of the therapist’s left should toward the right and hands pulling the pelvis toward the left.
- The patient is monitored for the effects on symptoms, and the procedure is repeated 10 times until determination on whether the correction has no effect, peripherizes or centralizes

With the Lumbar Side-Glide (Lateral Shift Correction), what happens if the patient has Centralized Symptoms?

The correction is repeated as part of the treatment program with other repeated movements that have a centralization effect on the patients Sx

With the Lumbar Side-Glide (Lateral Shift Correction), what happens if the patient has Peripheralized Symptoms?

If Sx peripheralize into the LE with this maneuver, further assessment is needed to determine whether other repeated movements, manipulation, exercise, or traction are required to affect the Sx in a more positive way

What is the purpose of the Prone Instability Test?

To assess for instability of lumbar segments L1-L2 through L5-S1

What is the procedure of the Prone Instability Test? What is considered (+)?

The examiner applies a PA pressure to each targeted lumbar vertebra. If provocation of pain is reported, the pt lifts the feet off the floor and the pressure is reapplied at the symptomatic vertebrae. - (+) if the pain is present the first position but is not reproduced to the same severity when pressure is reapplied to the symptomatic vertebra with the second position

What is the purpose of the Prone Lumbar Extension Test?

To determine lumbar instability and is positive if LBP is provoked with the test

What is the procedure of the Prone Lumbar Extension Test? What is considered (+)?

The PT lifts both legs concurrently off the table to a height of 30cm from the table while maintaining the knees extended and the gently pulling the legs - The test is (+) when passively lifting the legs provokes characteristic pain in the lumbar region that is relieved when the legs are lowered back to the table

What is the purpose of the Femoral Nerve Tension Test (Ely's Test)?

To assess irritation of the Femoral Nerve

What is the procudure of the Femoral Nerve Tension Test (Ely's Test)? What is considered (+)?

The PT passively flexes the test leg to 90° and then lifts the hip into full extension. - Positive test are found with provocation of anterior thigh pain with the stretching position ## Footnote This test position can be considered both a MLT for the rectus femoris or a nerve tension test. The results of this test should be correlated with other neurologic exam procedures to diagnose involvement of the femoral nerve

What is the purpose of the Slump Test?

To determine irritability and extensibility of the central spinal canal dural tissues

What is the procedure of the Slump Test?

The patient begins in an erect sitting position and is asked about any Sx. Then...

With the Slump Test, what is considered (+)?

Positive test are seen when LE Sx are reproduced and knee extension is limited in the slump sitting position and when Sx are alleviated and knee ROM is improved with a return of the neck to a neutral position

What is the purpose of the Straight Leg Raise?

To determine whether the cause of leg Sx is a lumbar herniated disk compressing a lumbar nerve root in the lower lumbar spine and is considered a test of lumbosacral neural tissue nechanosensitivity

What is the procedure for the Straight Leg Raise?

The patients hip is slowly flexed as teh knee is maintained in full extension. The patient is asked to respond to the movement, and the degree of hip flexion that is attained when Sx are reported is recorded with inquiries about the location and nature of the Sx. - To differentiate muscle lenght restirictions from neural irritation, 3 cycles of a 10 second isometric hamstring contraction are applied, following attempts to further flex the hip. - If greater than 15° hip flexion is attained with this maneuver, a muscle tightness component likely exists to the initial finding. - Further neural tension sensitizing maneuvers can be applied with either adding hip adduction to the SLR movement or adding dorsiflexion before raising the leg. Also passive neck flexion can be added to increase dural tensions during the SLR test

What is considered (+) with the Straight Leg Raise?

- If Sx are reported with less ROM during the re-test with the addition of the sensitizing maneuvers, a neural irriation is likely contributing to the report of the leg Sx - A (+) SLR for reproduction of lower leg pain at 30° of hip flexion or less has been more strongly correlated with herniated disk of the lower lumbar spine - The contralateral leg should also be tested, and if the SLR of the contralateral leg causes Sx of the involved leg (+ crossed SLR), a herniated disk as the cause of leg pain is suspected

What is the Purpose of the Active Straight Leg Raise Test?

Assesses the ability of the lumbopelvic region toaccept the load applied from the LE. - If the test is (+), the assumption is that a lack of motor control exists for dynamic stabilization of the pelvis

What is the procedure for the Active Straight Leg Raise Test?

The PT asks the patient to slowly and actively raise the elg off the treatment table 20 cm, pause then to slowly lower the leg to the table. - PT observes the patient ability to stabilize at the lumbopelvic region during the active leg raising and lowering and ask the patient to rate the level of difficulty in raising the leg and pain provocation with the ASLR. - If patient admits difficulty, PT applies compression of the Anterior Pelvic floor of the level of the pubic symphasis to simulate action of the anterior pelvic floor and the TrA. If Sx are relieved or ASLR improves the Test is (+). - Test is then repeated with compressive forces applied at the posterior pelvis at the level of the PSIS to simulate action of the sacral mutifidus. If Sx are relieved or ease of leg raising is improved the test is (+)

What is the purpose of the Distraction Provocation (ASIS Gap) SIJ Test?

To assess the level of reactivity of the SIJ and provokes SIJ pain (arthralgia)

What is the procedure for the Distraction Provocation (ASIS Gap) SIJ Test?

The PT crosses arms and contacts the medial aspects of each ASIS with the soft spot of each palm. A gentle force is applied to gap the ASIS pushing in a posterior lateral direction, and the force is gradually increased over approximately 10 seconds. - The patient should report and pain provoked by the test. - If no discomfort is reported, an impulse is given at the end of the application of the force. Then the patient is asked again to report any pain provoked by the test ## Footnote (+) if the test provokes pain at the SIJ or symphysis pubis

What is the purpose of the ASIS Compression Provocation SIJ Test?

To assess the level of reactivity of the SIJ and provoke SIJ-related pain (arthralgia)

What is the procedure for ASIS Compression Provocation SIJ Test?

The PT contacts the lateral aspect of each ASIS with the soft spot of each palm. A gentle force is applied to compress the ASIS toward midline, and the force is gradaully increased over approximately 10 seconds. - If no discomfort is reported, an impulse is given at the end of the application of the force, and the patient is asked again if there is any report of pain - This test can also be performed at side-lying ## Footnote (+) if the test provokes pain at the SIJ or symphysis pubis

What is the purpose of the Thigh Trust Procation Test?

This test attempts to reproduce posterior buttock pain

What is the procedure of the Thigh Thrust Provocation Test?

The patients hip is flexed approximately 90° and the PT applies a posterior directed force through the femor at varying angles of abduction/adduction

What is the purpose of the Gaenslen's Provocation SIJ Test?

To assess the level of reactivity of the SIJ and to provoke SIJ-related pain

What is the procudure of the Gaenslen's Provocation SIJ Test?

The PT fully flexes the patients hip and brings the patients knees towards the chest while the opposite hip remains in extension. Overpressure is applied to both legs at the end range of hip flexion and hip extension. - If the patient has good hip flexibility, the extended hip can be positioned over the side of the table to apply greater strain to the hip and pelvis - Sx could be reproduced on either side. The test is repeated by flexing the other hip - (+) test if pain is prokoved at SIJ region

What is the purpose of the Sacral Thrust Provocation SIJ Test?

To assess the level of reactivity of the SIJ and provoke SIJ-related pain

What is the procedure for Sacral Thrust Provocation SIJ Test?

The PT contacts the posterior base and mid portion of the sacrum and gradually increases a PA force over approximately 10 seconds. The patient is instructed to report pain provocation. - If no discomfort is reported, an impulse is given at the end of the end of the application of the force and pain provocation is assessed

What is the Purpose of Posterior Ilial Rotation SI Manipulation?

This is used to manipulate an anterior ilial rotation displacement SIJ dysfunction and to restore posterior rotation of the ilium. Can also be used as an SIJ-related pain provocation test

What is the purpose for the Anterior Ilial Rotation SI Manipulation?

To manipulate a posterior ilial rotation displacement SIJ dysfunction and restore anterior rotation of the ilium. This technique can also be used as an SIJ related pain provocation test