Special tests - Lower back & Sacrum

Question 1

What is trunk flexion?

Answer 1

• Symmetry in movement
• Assessing the PSIS position, the side that elevates indicates the problem
• Pain along the spine indicates spinal ligament or disc involvement
• Paresthesia into the lower extremities indicates possible disc bulge / protrusion (confirm with SLR/Slump/Vasalva maneuver
• If pain close to the spine is alleviated with flexion, it usually means a facet joint problem (HJJ points)
• Pain on coming back indicates soft tissue problem of erector spinae or possible SIJ involvement

Question 2

What is trunk extension?

Answer 2

• Symmetry of movement and ease of extension
• Pain close to the spine indicates a facet joint problem (HJJ points)
• Pain lateral to BL31 usually indicates a SIJ problem
• If radiculopathy signs occur, causing paresthesia, usually or nerve/disc but more likely fact joint compression causing the referral
• If they can’t hold the position, weak abdominal muscles

Question 3

What is trunk lateral flexion?

Answer 3

• Look for symmetry and ease of movement without rotation forward to compensate
• In acute QL spasm, person may be already leaning to one side. Or possible facet joint compression present on side of flexion.
• If paraesthesia is present, rule in or out nerve root/disc injuries (confirm with SLR/Slump/vasalva maneuver)

Question 4

What is the Yeomans test?

Answer 4

• This test is used to assess for the presence of facet joint pathology of the lower lumbar vertebrae

Question 5

What is a positive Yeomans test?

Answer 5

• The test is positive if there is pain in the lumbar facet joints HJJ points on the same side as the tested leg.

Question 6

What is the Gillets test?

Answer 6

• This test is used to assess for the presence of sacroiliac joint fixation

Question 7

What is a positive Gillets test?

Answer 7

• Positive test is for ipsilateral to rise superiorly due to the fixation
• Normal movement of the pelvic bone is for the PSIS to drop inferiorly during hip flexion
• Dai Mai and Yang Wei master and confluent points are treated on the same side as the positive gillet’s test
• GB41 and TE 5 signal these two extraordinary vessels to normalise movement of the pelvic bone on the sacrum

Question 8

What is the SLR test?

Answer 8

• This test is used to assess for the presence of nerve root involvement/disc injury paraesthesia of the lower leg

Question 9

What is the slump test?

Answer 9

• This test assesses the presence of nerve root involvement / disc injury paraesthesia of the lower leg

Question 10

What is a positive slump test?

Answer 10

• Pain / worsening of signs and symptoms is positive

Question 11

What is the heel/toe walk test?

Answer 11

• This test is used to assess the strength of the dorsiflexors and plantar flexors if either of these is weak, this is highly suggestive of L5 nerve root lesion

Question 12

What is the Valsalva maneuver?

Answer 12

• This test is used to assess the presence of disc and spinal nerve root lesions

Question 13

What is a positive valsalva manoeuvre?

Answer 13

• Increase in abdominal pressure can recreate symptoms of disc and spinal nerve lesions
• Pain reproducing patterns of disc and spinal nerve lesions is considered a positive sign