Special Txs

Question 1

Selective Tissue Tension Test Joints =

Answer 1

Compress or traction

Question 2

Selective Tissue Tension Test

Muscle =

Answer 2

Stretch or Contract
Muscle Grades 0-5.
0 - No evidence of any muscle contraction
1 – Trace - feeble contraction
3 – Poor –
4 – Fair – Muscle can hold in test position against
gravity
5 – Normal – Hold test position test position
against strong pressure “full strength”

Question 3

Selective Tissue Tension Test

Circulation =

Answer 3

Pulse palpation

Question 4

Selective Tissue Tension Test

Nerves=

Answer 4

• Tap
• Stretch
• Myotomes
• Dermatome
• Deep Tendon Reflex Grading is described as:
0- Absent 
1- Dimished
2- Average (Normal) 
3- Exaggerated 
4- Clonus (brisk)

Question 5

Selective Tissue Tension Test

Ligaments =

Answer 5

Stretch / stress

Question 6

Selective Tissue Tension Test

Organs =

Answer 6

Look at characteristic referral patterns

Question 7

Referred pain from sacroiliac joint
(A) From the sacroiliac joint
(B) To sacroiliac joint

Answer 7

(A) from sacrum to low back, glutes, deep rotators, leg.

(B) Lumbar/ pubis region to sacrum

Question 8

PELVIS – Motion Palpation

Answer 8

• (A) Starting position for sacral 
spine and posterior superior iliac 
spine. Standing upright with pelvis neutral
• (B) Hip flexion; the ilium (PSIS) 
should drop inferiorly
• (C) Starting position for sacral 
spine and ischial tuberosity. Standing upright with pelvis neutral
• (D) Hip flexion; Ischial tuberosity
should move inferior + lateral
(E) palpating position 
of sacrum in flexed sitting
(F)palpating PSIS for 
asymmetric movement on 
backward bending.

Question 9

Examiner palpating for sacral nutation
One thumb is on the PSIS, other thumb is parallel to it on the sacrum.
Examiner is feeling for:

Answer 9

(A) forward movement (nutation) of the sacrum that occurs early in
movement and (B) backward movement (counternutation) of the
sacrum, which normally occurs around 60° of hip flexion .

Question 10

Trendelenburg sign

Magee (pg. 680 – 681)

Answer 10

CLIENT:
• Balance on one leg then the 
other
THERAPIST:
• Observe 
TESTS FOR:
• Weak Hip Abductors (esp.Gluteus
Medius) or an unstable hip
POSITIVE IF:
• Pelvis on the opposite side 
(nonstance side) drops when the 
client stands on the affected leg

Question 11

STORK STANDING TEST

Magee (pg. 665)

Answer 11

CLIENT:
• Standing on one leg with other foot on
opposite knee, hip externally rotated
THERAPIST:
• Observe client
TESTS:
• A. Integrity of the joints of the pelvis
• B. Stability and proprioception of pelvis and
lower limb (w/ eyes open & closed)
POSITIVE IF:
• A. Pain (SI, Pubic, or hip jt’s) & or difficulty in
obtaining the test position
• B. Difficulties balancing on the one leg

Question 12

Flamingo test

Magee (pg. 638 – 639)

Answer 12

CLIENT:
• Stand on one leg
TESTS:
• Lesions in symphysis pubis or S.I. Joint
POSITIVE IF:
• Pain in symphysis pubis or S.I. Joint
indicates lesions in the painful structure
Clinical features:
• Consist of pain in the region of the pubis,
may radiate to the groin or lower abdomen
• Clicking may be present and indicates
instability. Local tenderness is the only
significant sign.

Question 13

Gillet’s (sacral fixation) Test
(AKA Ipsilateral posterior rotation test)
Magee (pg. 637 – 638)

Answer 13

CLIENT:
• Standing
• Flex hip when asked by therapist
THERAPIST
• One thumb on PSIS
• Second thumb parallel on sacrum
TESTS FOR:
• Hypomobile or “locked” S.I. Joint
POSITIVE IF: 
• S.I. joint on the side that is flexed 
moves minimally or up – is hypomobile
• Normal (-) = the test PSIS moves down 
or inferiorly

Question 14

Ipsilateral anterior rotation test

Magee (pg. 638)

Answer 14

CLIENT:
• Standing
• Extend hip when asked by therapist
THERAPIST
• One thumb on PSIS
• Second thumb parallel on sacrum
TESTS FOR:
• Hypomobile or “locked” S.I. Joint
POSITIVE IF: 
• S.I. joint on the test side moves down/
inferiorly
• Normal (-) = PSIS should move superior / 
lateral

Question 15

Ipsilateral prone kinetic test

Answer 15

On extension while lying in prone position, the posterior superior iliac spine and sacral crest
Normally should move superiorly and laterally.

Question 16

Active movements of the lumbar spine:

Answer 16

forward flexion Extension.
Side flexion
Rotation

Question 17

joint dysfunctionKemps/ Quadrant test

Answer 17

CLIENT:
Extend, side flex and rotate spine

THERAPIST:
Stand behind client, control movement holding
shoulder and occiput to support head
Apply overpressure

POSITIVE IF:
Symptoms are reproduced, causes maximum
narrowing of intervertebral foramen and closure
Of the facet joints

Question 18

Segmental instability tests – prone instability tests

Answer 18

The patient lies prone with the body on the examining table and legs over the edge and feet resting on the floor. While the patient rests in this position with the trunk muscles relaxed, the examiner applies posterior to anterior pressure to an individual spinous process of the lumbar spine.
Any provocation of pain is reported. Then the patient lifts the legs off the floor (the patient may hold table to maintain position) and posterior to anterior compression is applied again to the lumbar spine while the trunk musculature is contracted.

The test is considered positive if pain is present in the resting position but subsides in the second position, suggesting lumbo-pelvic instability. The muscle activation is capable of stabilizing the spinal segment.

Question 19

VALSALVA TEST

Answer 19

CLIENT:
Take a deep breath, hold it and bear down as if evacuating the bowels

POSITIVE IF:
Leads to symptoms in the sciatic
nerve distribution or other nerve involvement

INDICATES:
Intrathecal (fluid-filled space
 between the thin layers of tissue that
 cover the brain and spinal cord)
pressure

Question 20

Dural SLUMP TEST

purpose

Answer 20

Postulated neurobiomechanics that occur with slump movement.
The approximate points C6, T6, L4, and knee are where the neural tissue does not move in relation to the movements of the spinal canal.
It is important to understand, however, that movement of neurological tissue is toward the joint where movement was intiated.

Question 21

Dural SLUMP TEST

Sequence of subject postures

Answer 21

Sequence of subject postures in the slump test

Patient sits erect
Patient slumps lumbar and thoracic spine while examiner holds head in neutral
Examiner pushes down on shoulders while patient holds head in neutral
Examiner extends patient’s knee and dorsiflexes foot
Patient flexes head
Examiner carefully applies overpressure to cervical spine
Patient extends head. If symptoms are reproduced at any stage, further sequential movements are not attempted.

Question 22

Straight leg raise - “Lassegues’s” test

Answer 22

Client: Supine - Therapist: Passively move one hip into flexion, medial rotation and adduction making sure knee is in extension. Observe for signs and symptoms of neurological origin

Bragard’stest:
After having symptom, lower the leg about 10 degrees and Dorsiflex ankle

POSITIVE TEST:
(A) Radicular symptoms are precipitated on the same side with straight leg raising.
(B) The leg is lowered slowly until pain is relieved. The foot is then dorsiflexed (Braggard’s test), causing a return of symptoms

Question 23

Hyndman’s, Brudzinski’s sign, or Sotoo-Hall:

Answer 23

checks for irritation of the cervical spine and dura

Client is supine - Flex cervical spine –if pain is reproduced assess symptoms –local verses neurological

Question 24

BOWSTRING SIGN

Answer 24

THERAPIST:
Slightly flex knee after a positive straight leg raise test (20 deg), reducing symptoms.
Digital pressure in popliteal area
POSITIVE IF:
Radicular pain increases after digital pressure
INDICATES:
Tension/ pressure on sciatic nerve

Question 25

WELL LEG RAISING TEST

Answer 25

A) Movement of nerve roots occurs when the leg on the opposite side is raised.
(B) Position of disc and nerve root before opposite leg is lifted.
(C) When the leg is raised on the unaffected side, the roots on the opposite side slide slightly downward and toward the midline. In the presence of a disc lesion, this movement increases the root tension resulting in radicular signs in the affected leg, which remains on the table.

Question 26

MALINGERING TEST-Hoover test

Answer 26

CLIENT: Supine, lift one leg up with knee straight
THERAPIST: One had under each calcaneus
POSITIVE IF: A) Normally, attempts to elevate one leg are accompanied by downward pressure by the opposite leg. (B) When the “weak” leg attempts to elevate but the opposite (asymptomatic) leg does not “help,” at least some of the weakness is probably not genuine .
INDICATES: Client not really trying

Question 27

BABINSKI TEST

Answer 27

THERAPIST:
Run pointed object along plantar aspect of patient’s foot

POSITIVE IF:
Extension of great toe and abduction of others.

INDICATES:
Upper motor neuron lesion if positive bilaterally
Lower motor neuron lesion if present unilaterally

Question 28

BRUDZINSKI-KERNIG TEST

Answer 28

CLIENT:Supine, hands cupped behind head
Flex cervical spine (Brudzinki’s portion)
Actively flex hip on affected side until pain felt (Kernig portion)
Flex knee
POSITIVE IF:Pain goes away after flexing knee
INDICATES: Meningeal irritation, nerve root involvement, or dural irritation

Question 29

NACHLAS TEST

Answer 29

CLIENT: Prone 
THERAPAIST:
flex knee for 45-60 seconds
POSITIVE IF:
Unilateral neurological pain in:lumbar area, Hip, Posterior thigh

Pain anterior thigh = tight quadriceps, stretch femoral nerve
INDICATES:
L2-L3 nerve root lesion
There are two components to the nerve stretch: The uppermost part of the thigh is passively extended just short of producing lumbar spine extension.

By creating tension in the iliopsoas, the upper lumbar nerve roots are put under traction. The knee is then progressively flexed to increase femoral nerve tension by stretching the quadriceps femoris muscle.

Pain in the anterior thigh may be of muscular or nerve origin. A careful history should help to delineate the problem.