Methods 5-Lumbar & Pelvis Comp Eval Flashcards
Toe Walking
• HEEL DROP
• S1 RADICULOPATHY, L5-S1 DISC PROBLEM, TIBIAL NERVE INJURY, WEAK CALF MUSCLES
Heel Walking
• FOOT DROP
• L5 RADICULOPATHY, L4-L5 DISC PROBLEM,
COMMON PERONEAL NERVE INJURY, WEAK ANTERIOR TIBIAL MUSCLE
Kemp’s Test
• -LOCAL LUMBAR PAIN WITH RADIATION ON THE CONCAVITY (SIDE OF OBLIQUE BENDING) INDICATES LATERAL DISC LESION
• -LOCAL LUMBAR PAIN WITH RADIATION ON THE CONVEXITY (OPPOSITE SIDE OF OBLIQUE BENDING) INDICATES MEDIAL DISC LESION
• -LOCAL LUMBAR PAIN WITH NO RADICULAR PAIN INDICATES LUMBAR MUSCLE SPASM OR FACET CAPSULITIS
Slump Test
-EACH PHASE OF THE TEST INDUCES MOTION INDUCED SPINAL TRACTION THAT INCREASES WITH EACH PHASE
-PAIN DURING ANY PORTION OF THE PHASE INDICATES MENINGEAL TRACT IRRITATION USUALLY CAUSED BY A DISC DEFECT
-IF SYMPTOMS ARE PRODUCED WITH ANY PHASE THE TEST SHOULD BE STOPPED TO PREVENT FURTHER PAIN
Straight Leg Raise
• LOCAL PAIN WITH RADICULOPATHY AT
0˚ -35˚ SUSPECT SI LESION OR PIRIFORMIS SYNDROME
• LOCAL PAIN WITH RADICULOPATHY AT
35˚-70˚ SUSPECT SCIATIC NERVE ROOT IRRITATION BY INTERVERTEBRAL DISC PATHOLOGY OR INTRADURAL LESION
• LOCAL PAIN AT 70˚+ SUSPECT
LUMBAR JOINT INVOLVEMENT
Bragard’s Sign
• IF DORSIFLEXION PRODUCES PAIN AT 0˚-35˚: SUSPECT EXTRADURAL SCIATIC NERVE IRRITATION
• IF DORSIFLEXION PRODUCES PAIN AT 35˚-70: SUSPECT INTRADURAL PROBLEM (INTERVERTEBRAL DISC PATHOLOGY) CAUSING SCIATIC NERVE ROOT IRRITATION
• DULL POSTERIOR THIGH PAIN INDICATES TIGHT HAMSTRING MUSCLES – NOT A POSITIVE TEST
Well Leg Raise
• REPRODUCTION OF PAIN WITH
RADICULOPATHY ON THE AFFECTED SIDE
IS INDICATIVE OF A CENTRAL OR MEDIAL
DISC PROTRUSION.
Double Leg Raise
• RAISING BOTH LEGS SIMULTANEOUSLY
INCREASES TRACTION ON BILATERAL SCIATIC NERVES
• PAIN PRODUCED WHEN RAISING BOTH
LEGS IS INDICATIVE OF A CENTRAL SPINAL CANAL DISC DEFECT
Goldthwait’s Test
PAIN THAT IS PRODUCED BEFORE THE
SPINOUSES FAN (0˚ -35˚) SUSPECT SI LESION
• RADICULAR PAIN DURING LUMBAR
FANNING (35˚-70˚) INDICATES AN INTRADURAL LESION – DISC DEFECT, OSTEOPHYTE, MASS
• LOCAL PAIN AFTER LUMBAR FANNING
(70˚+) INDICATES A POSTERIOR LUMBAR JOINT DISORDER
Lewin Supine Test
INABILITY TO SIT UP IS ASSOCIATED WITH LUMBAR ARTHRITIS, LUMBAR FIBROSIS/ANKYLOSIS, LUMBAR DISC PROTRUSION, OR SCIATICA
• PATIENTS WITH WEAK ABDOMINALS WILL EXPERIENCE DIFFICULTY WITH THIS TEST
Linder’s Sign
• PASSIVE FLEXION OF THE NECK STRETCHES THE DURAL SAC
• REPRODUCTION OF DISCOMFORT INDICATES A DISC LESION AT THE LEVEL OF PAIN
• SHARP, DIFFUSE PAIN OR INVOLUNTARY HIP FLEXION: MENINGEAL IRRITATION
Pheasant’s Test
Spinal Instability
Ely’s
• FEMORAL RADICULAR PAIN: LUMBAR NERVE ROOT INFLAMMATION
• UPPER LUMBAR DISCOMFORT INDICATES LUMBAR NERVE ROOT ADHESIONS
• SIGNIFICANT HIP LESIONS WILL MAKE PERFORMING THE TEST IMPOSSIBLE
• ILIOPSOAS MUSCLE IRRITATION WILL MAKE PERFORMING THE LEG EXTENSION PORTION IMPOSSIBLE
Side Posture Hypothenar Mamillary Push
PP: Side posture with dysfunctional side up – verbalize how you found the segment
DP: Modified fencer stance on side of dysfunction
CH: Caudal( R) hand hypothenar contacts MP with fingers parallel to spine
IH: Cephalic (L) hand slight upward traction holding the pt’s up-side shoulder or overlapping hand
LOD: P – A, slight I – S
Side Posture Hypothenar Mamillary Push, Close-Wedge Side
PP: Side posture – verbalize how you found the segment
DP: Modified fencer stance on side of dysfunction
CH: Cephalad ( L) hand, hypothenar (pisiform) on L2 MP with fingers running parallel to the spine
IH: Caudal (R) hand slight upward traction on shoulder/overlapping hand
LOD: P – A, I – S (To assist LF – place a roll or tent the table up under the segment)
Side Posture Hypothenar Mammillary Push, Open-Wedge Side
PP: Side posture – verbalize how you found the segment
DP: Modified fencer stance on side of dysfunction
CH: Cephalad ( L) hand, hypothenar (pisiform) on L4 MP
with fingers running parallel to the spine
IH: Caudal (R) hand slight downward traction on
shoulder/overlapping hand to assist the LF
LOD: P – A, L – M, S – I (To assist LF – lower the thoracolumbar breakaway or place patient’s down arm cephalad)
Side Posture Hypothenar Spinous Push (5.238)
-Loss of L Rotation (RR)
PP: Side posture – verbalize how you found the segment
DP: Modified fencer stance on side of dysfunction
CH: Cephalad ( R) hand, hypothenar on L2 SP with
fingers crossing the spine
IH: Caudal (L) hand slight upward traction on
shoulder/overlapping hand
LOD: P – A, L – M
Side Posture Digital Spinous Kick Pull (5.251A)
PP: Side posture with dysfunctional side up – verbalize
how you found the segment
DP: Square stance on side of dysfunction & contact their
knee with your knee/distal tibia
CH: Caudal (L) hand, digital contacts of 2nd, 3rd, 4th
digits hooks the down side of the L3 SP
IH: Cephalad (R) hand slight upward traction on
shoulder/overlapping hand
LOD: L – M pulling movement to induce axial rotation with quick extension (kick) of contact leg
Side Posture Bilateral Digital Spinous Push, Pull (5.239)
PP: Side posture with superior dysfunctional side down –
verbalize how you found the segment
DP: Square stance & contact their knee with your
knee/distal tibia
CH: Cephalad ( L) hand reaches under pt’s up-side arm to
place 3rd & 4th digital contacts on the lateral surface
of L3 SP
IH: Caudal (R) hand digital contact hooks the downside
of the L4 SP
LOD: CH: pushes L – M/IH: pulls L – M with quick extension kick of contact leg
Side Posture Hypothenar Spinous Push (5.244)
-Loss of RR and RLF
PP: Side posture – verbalize how you found the segment
DP: Modified fencer stance on side of dysfunction
CH: Caudal ( L) hand, hypothenar (pisiform) on L4 SP with fingers crossing the spine
IH: Cephalad (R) hand slight downward traction on shoulder/overlapping hand to assist the LF
LOD: P – A, L – M (To assist LF – lower the
thoracolumbar breakaway or place patient’s down
arm cephalad)
Side Posture Hypothenar Spinous Push (5.247)
-Loss of Flexion (Extended)
PP: Side posture with either side up – verbalize how you found
the segment
DP: Modified fencer stance on either side
CH: Caudal hand hypothenar contacts L2 SP with fingers crossing the spine
IH: Cephalic hand slight upward traction holding the pt’s up- side shoulder or overlapping hand
LOD: P – A, I – S
Side Posture Hypothenar Spinous Push (5.248)
-Loss of Extension (Flexed)
PP: Side posture with either side up – verbalize how you found
the segment
DP: Modified fencer stance on either side
CH: Caudal hand hypothenar contacts L4 SP with fingers
crossing the spine
IH: Cephalic hand slight upward traction holding the pt’s up- side shoulder or overlapping hand
LOD: P – A, I – S
Prone Hypothenar Spinous Push (5.255)
PP: Prone – verbalize how you found the segment
DP: Square stance on side opposite of dysfunction
CH: Cephalad ( R) hand, hypothenar (pisiform)
on L3 SP with fingers crossing the spine
IH: Caudal (L) hand reinforces CH
LOD: P – A, L – M, S – I
Prone Bilateral Thenar Mamillary Push
-P-A over specified segments
Bowstring
-Applying pressure to the hamstring or popliteal fossa increases sciatic nerve tension
-Pain in the lumbar region or radiculopathy is a sign of sciatic nerve compression
Belt Test (Supported Adams)
-If lesion is lumbar in origin pain will be produced with or without pelvic bracing
-If lesion is pelvic in origin pain will be produced without pelvic bracing but lessened or eliminated with pelvic bracing
Bechterew’s Test
-Extending the leg tractions the sciatic nerve
-Radicular pain or if the patient must lean back due to pain indicate compression of the sciatic nerve or lumbar nerve roots often due to lumbar disc protrusion
Lasegue
- If there is pain when the knee is extended the test is positive for sciatic radiculopathy
Bonnet’s Test
-Radicular pain is indicative of sciatic nerve entrapment due to piriformis involvement
Nachlas Test
-Flexing the leg to the buttock stretches the quadriceps muscles and femoral nerve
-Radicular anterior thigh pain may indicate L2-L4 compression or irritation by an intradural lesion (disc defect, spur, mass), a lumbar plexus or femoral nerve compression from piriformis hypertrophy
-Pain in the buttock may indicate an SI lesion
-Pain in the lumbosacral joint may indicate a lumbosacral lesion
Erichsen’s Sign
-test should reproduce pain if sacroiliac is the source of pain
-test will not reproduce pain if iliofemoral joint is the source of pain
Iliac Compression test
-pain within either sacroiliac joint indicates sprain of posterior sacroiliac ligaments
-pain on lateral surface of either ilia could indicate contusion or compression of soft tissue
Sacroiliac Stretch Test
-local pain over the ASIS is attributed to compression of soft tissue structures and is NOT considered a positive test
-unilateral sacroiliac or gluteal pain signifies a positive test for anterior SI ligament sprain
Laguerre Test
-positive test produces pain within sacroiliac joint
-pain felt within the iliofemoral joint indicates possible hip pathology
Gaenslen’s Test
-positive test reproduces pain in the sacroiliac area -dull anterior thigh pain could indicate tight hip flexors -radiating symptoms down the thigh could indicate lumbar disc involvement
-if test is negative, a lumbosacral lesion is suspected
Milgram’s test
-This test increases intrathecal pressure
-If pain is present suspect a space occupying lesion inside or outside of the spinal canal
– disc protrusions usually produce positive test
-Patients with weak abdominal muscles may have difficulty performing this test
Lewin-Gaenslen’s test
-a positive test produces pain within the sacroiliac joint
-dull ache along the anterior thigh of the extended leg indicates tight hip flexors
Hibb’s test
-pain experienced within the sacroiliac joint indicates a positive test
-pain within the iliofemoral joint indicates hip pathology
Yeoman’s test
-pain within the sacroiliac joint indicates SI dysfunction
-dull, achy pain along the anterior thigh indicates tight hip flexors
Side Posture Hypothenar Ilium Push (5.282)
PP: Basic side posture position w/ dysfunctional side up
DP: Modified fencer stance on side of dysfunction
CH: Caudal (R) hand, hypothenar on R PSIS
IH: Cephalad (L) hand slight upward traction holding pt’s up-side shoulder or overlapping hand
LOD: P – A, M – L, I – S
Side posture hypothenar sacral base push, dys up (5.284A)
PP: Basic side posture position w/ dysfunctional side up
DP: Modified fencer stance on side of dysfunction
CH: Caudal (R) hand, hypothenar on R sacral base, medial to R PSIS
IH: Cephalad (L) hand slight upward traction holding pt’s up-side shoulder or overlapping hand
LOD: P – A, I – S
Side posture hypothenar sacral base push, dys down (5.283B)
PP: Basic side posture position with the dysfunctional side down
DP: Modified fencer stance on side opposite of dysfunction
CH: Caudal (R) hand, hypothenar on R sacral base, medial to R PSIS
IH: Cephalad (L) hand slight upward traction holding pt’s up-side shoulder or overlapping hand
LOD: P – A
Side Posture Forearm Ischium Push (5.284B)
PP: Basic side posture position with the dysfunctional side up
DP: Modified fencer stance on side of dysfunction
CH: Caudal (L) forearm, soft broad contact pulls inferior and lateral over the medial, inferior margin of R
ischium
IH: Cephalad (R) hand slight upward traction holding pt’s up-side shoulder or overlapping hand
LOD: P – A, along the shaft of femur
Side posture hypothenar sacral apex push, dys down (5.285A)
PP: Basic side posture position with the dysfunctional side down
DP: Modified fencer stance on side opposite of dysfunction
CH: Caudal (L) hand, hypothenar on upside of the SA, R lateral side of SA
IH: Cephalad (R) hand slight upward traction holding pt’s up-side shoulder or overlapping hand
LOD: P – A
Side posture forearm sacral apex push, dys down (5.285B)
PP: Basic side posture position with the dysfunctional side down
DP: Modified fencer stance on side opposite of dysfunction
CH: Caudal R forearm on upside of the SA, L
lateral side of SA
IH: Cephalad (L) hand slight upward traction holding pt’s up-side shoulder or overlapping hand
LOD: P – A
Prone Bilateral Hypothenar Ilium Sacral Apex Push (5.286A)
PP: Prone
DP: Modified fencer stance on opposite side of dysfunction
CH: Cephalad ( L) hand, hypothenar (pisiform) on R PSIS
IH: Caudal (R) hand knife-edge on side of sacral apex closest to you
LOD: CH: P-A, I-S, and M-L/IH: P-A, slight S-I
Prone Unilateral Reinforced Pisiform Ilium Push (5.286B)
PP: Prone
DP: Modified fencer stance on opposite side of dysfunction
CH: Cephalad ( R) hand, hypothenar (pisiform) on L PSIS
IH: Reinforcing CH
LOD: P-A, M-L, (I-S)
Prone Bilateral Hypothenar Ischium Sacral Base Push (5.287B)
PP: Prone
DP: Modified fencer stance on opposite side of dysfunction
CH: Caudal ( R) hand, hypothenar (calcaneal) on R ischial tuberosity
IH: Cephalad (L) hand hypothenar (pisiform) on R sacral
base (just medial to R PSIS)
LOD: CH: P-A, S-I/IH: P-A, I-S
Prone Hypothenar Ilium Push with Hip Extension (5.288)
PP: Prone
DP: Modified fencer stance on opposite side of dysfunction
CH: Cephalad ( L) hand, hypothenar (pisiform) on R PSIS
IH: Caudal (R) hand front of distal thigh on R
LOD: CH: P-A, M-L, (I-S)/IH: Reinforcing with shallow lift of the thigh contact
Side Posture Hypothenar (Pisiform) Sacral Base Push, Dysfunctional Side UP
PP: Basic side posture position w/dysfunctional side up
DP: Modified fencer stance on side of dysfunction
CH: Caudal hand, hypothenar (pisiform) on the sacral base (just medial to PSIS)
IH: Cephlad hand slight upward traction holding the pt’s up side shoulder or overlapping hand
LOD: P-A, slight I-S
Hypothenar/Thigh, Superior Pubis
PP: Supine off center of table to side of involvement & corresponding lags hangs off table
DP: Modified fencer stance on involving side facing caudal
CH: Palmar contact of caudal hand to distal femur of leg on involved side
IH: Palmar contact on opposite ASIS to stabilize pelvis
LOD: CH applies A-P stress on pt’s thigh. Ask pt to raise thing against resistance and after 4-5s, then apply S-I
5.287A Prone Thenar Sacral Base Hypothenar
Ischium Push
PP: Prone
DP: Square or modified stance on side opposite of dysfunction
CH: Caudal hand, hypothenar contact on ischial tuberosity
IH: Cephlad hand, hypothenar on sacral base
LOD: CH: P-A, S-I/IH: P-A, I-S
5.287C Prone Hypothenar Sacral Base Push
PP: Prone
DP: Modified fencer stance on the same side of dysfunctio
CH: Caudal hand hypothenar on superior margin of sacral base just medial to PSIS
IH: Reinforcing CH
LOD: P-A, I-S
