NMS II Test - Lumbar

Question 1

Adam’s Position

Answer 1

1) Pain and Point

2) See scoliosis or raised shoulder / Patient standing, flexes forward
scoliosis disappears - functional scoliosis
scoliosis remains - structural scoliosis

3) Two Tests:

Question 2

Amoss Sign

Answer 2

1) Pain and Point

2) Patient lying on side, side to sitting without assistance
positive: pain and utilizing upper body strength to assist

3) Two Tests

Question 3

Antalgia Sign

Answer 3

1) Pain and Point

2) Patient will stand in a certain position to alleviate pain
lean away from pain: posterolateral herniated disc / lateral to nerve root
lean towards pain: posteromedial herniated disc / medial to the nerve root
lean forward: posterocentral herniated disc (rhizal)

3) Two Tests:

Question 4

Straight Leg Raiser (SLR)

Answer 4

1) Pain and Point

2) Patient supine, dr. raise symptomatic leg, raise until pain and note angle and where the pain is located
Sciatica from lumbosacral lesion or
SOL (tumor or herniated disc) that is causing pressure and irritation of the nerve/nerve roots or causing the dura to stretch or
SI issue or
IVD Lesion

3) Two Tests: bechterews and slump test

Question 5

Bechterew’s Test

Answer 5

1) Pain and Point

2) seated SLR / patient seated straight, extends leg at knee and dr applies downward pressure above knee and asks patient to raise leg
positive: similar pain as SLR
Sciatica from lumbosacral lesion or
SOL (tumor or herniated disc) that is causing pressure and irritation of the nerve/nerve roots or causing the dura to stretch or
SI issue or
IVD Lesion

3) Two Tests: SLR and Slump Test

Question 6

Slump Test

Answer 6

1) Pain and Point to Pain

2) Bechterew's Test except slumped over 
Sciatica from lumbosacral lesion or 
SOL (tumor or herniated disc) that is causing pressure and irritation of the nerve/nerve roots or causing the dura to stretch or 
SI issue or
IVD Lesion

3) Two Tests: SLR and Bechterew

Question 7

Bragards Sign

Answer 7

1) Pain and Point

2) Patient is supine, if (+) SLR lower leg 5 degrees and dorsiflex foot
positive: reproduce pain from SLR
Sciatica from lumbosacral lesion or
SOL (tumor or herniated disc) that is causing pressure and irritation of the nerve/nerve roots or causing the dura to stretch or
SI issue or
IVD Lesion

3) Two Tests: SLR and Bechterew

Question 8

Crossed Leg Straight Leg Raiser

Answer 8

1) Pain and Point

2) perform SLR on asymptomatic side
positive: reproduce pain on symptomatic side like SLR
if pain occurs at same spot as SLR - posteromedial IVD bulge or herniated disc (mc)
if pain occurs at increased angle - posterolateral IVD bulge or herniated disc

3) Two Tests: SLR and Fajersztajn’s test

Question 9

Fajersztajn’s Test

Answer 9

1) Pain and Point

2) perform Crossed SLR (asymptomatic side), lower foot 5 degrees and dorsiflex foot / Crossed SLR and Braggards combined
positive: reproduce pain on symptomatic side like SLR
pain same as braggards - posteromedial ivd bulge / herniation
pain at increased angle - posterolateral ivd bulge / herniation

3) Two Tests: Crossed Leg SLR and Braggards

Question 10

Cox Sign

Answer 10

1) Pain and Point

2) patient will raise ipsilateral hip while performing SLR
idicates: SOL, IVF encroachment, sciatica, radiculopathy, nerve root, tension (not subluxation)

Question 11

Elys Test

Answer 11

1) Pain and Point

2) patient prone, dr touches heal to contralateral buttock
positive: produce pain in anterior thigh or groin
radiating pain: femoral nerve or upper lumbar spine nerve root compression
localized: quadriceps

3) Two Tests: Femoral N Traction and Nicholas’s Test

Question 12

Femoral Nerve Traction

Answer 12

1) Pain and Point

2) lie on unaffected side (affected side up), bottom leg straight, top leg flexed and dr. extends leg
positive: produce pain in anterior thigh
radiating to groin: L1 nerve root radiculopathy
radiating to anterior mid thigh: L3 nerve root radiculopathy

3) Two Tests: Elys Test and Nicholas’s Test

Question 13

Heel / Toe Walking Test

Answer 13

1) Pain and Point

2) Walk on Heels - tests dorsiflexion
problem: L5 / L4 IVD

Walk on Toes - tests plantar flexion
problem: S1 / L5 IVD

3) Two Tests:

Question 14

Kemps Test

Answer 14

1) Pain and Point

2) Patient seated, laterally flex away, flex forward, laterally flex toward dr, extension and compression of shoulder (circumduction)
positive: pain, localized lbp
local pain / rotation, convex: capsulitis
local pain / extension, concave: facet issue
general pain at waist: lumbar sprain/strain
radiating leg pain with flexion: IVD lesion

3) Two Tests:

Question 15

Brudzinski Sign

Answer 15

1) Pain and Point

2) Patient supine, dr flexes head towards xiphoid process
positive: pain w/fever = meningitis

3) Two Tests: Sotohall and Lindners Sign

Question 16

Kernig’s Sign

Answer 16

1) Pain and Point

2) Patient supine, dr flexes hip and knee 90 degrees and dr tries to extend leg
positive: pain in head, spine or involuntary flexion of opposite knee or hip
pain w/ fever = meningitis

3) Two Tests: Brudzinski and Sotohall

Question 17

Lasegue Test

Answer 17

1) Pain and Point

2) Patient is supine, dr flexes hip and knee 90 degrees, dr tries to extend leg
positive: elicit pain in hip, low back, thigh
pain in hip: hip pathology
pain in leg or thigh: radiculopathy
bilateral pain: tight hamstrings

3) Two Tests: Kernigs and

Question 18

Lindners Sign

Answer 18

1) Pain and Point

2) Patient seated or supine, dr flexes chin to chest - puts traction on meninges and nerve roots
lbp and sciatic nerve: nerve root irritation
supine: meningitis (brudzinski)
seated: meningitis or cervical myelopathy (lhermitte)

3) Two Tests: Brudzinski and Lhermitte

Question 19

Milgrams Test

Answer 19

1) Pain and Point

2) Patient supine, patient lifts heals 6” off table, holds 30 s
unable to hold b/c lbp = herniation or lumbar strain/sprain
unable to hold no pain = weak core muscles

3) Two Tests:

Question 20

Minors Sign

Answer 20

1) Pain and Point

2) stand from seated position
positive: pain, recruits upper body to stand
SI joint lesion, L5 strain/sprain, lumbo pelvic fracture, IVD syndrome, muscular dystrophy, sciatica

3) Two Tests: Sicards

Question 21

Nachlas’s Test

Answer 21

1) Pain and Point

2) Patient prone, dr attempts to touch heel to ipsilateral butt
positive: produce pain in anterior thigh / grain
radiating: femoral nerve or lumbar spine nerve root compression
localized: quadriceps muscle contracture

3) Two Tests: Elys Test and Femoral Nerve Traction

Question 22

Quick Test

Answer 22

1) Pain and Point

2) 5 deep squats with bounce / can hold for support
don’t perform on elderly / pregnant
positive: pain, locking, crepitus in low back, hips, knees, ankles

3) Two Tests:

Question 23

Sicards Sign

Answer 23

1) Pain and Point

2) perform SLR, braggards and dorsiflex toe
positive: radiating pain
L5 nerve root irritation (mc)
S1 nerve root irritation

3) Two Tests: SLR and Braggards

Question 24

Bilateral Leg Lowering

Answer 24

1) Pain and Point

2) Patient supine, dr flexes hip 90 degrees with legs extended, patient lowers legs until dr says to stop, 45 degrees
positive:
- pain in butt, SI joints, lower extremity, legs drop
- lumbo-sacral sprain/strain, facet syndrome, IVD lesion

3) Two Tests: