Spine Special Tests

Question 1

Straight leg raise

Answer 1

The sciatic stretch test is used to identify sciatic nerve irritation.

Assessment
1. Position the patient supine on the clinical examination couch.

2. Holding the patient’s ankle, raise their leg by passively flexing the hip whilst keeping the patient’s knee fully extended.
3. The normal range of movement for passive hip flexion is approximately 80-90º.
4. Once the patient’s hip is flexed, dorsiflex the patient’s foot.

Interpretation
The sciatic stretch test is considered positive if the patient experiences pain in the posterior thigh or buttock region.

A positive test is suggestive of sciatic nerve irritation (e.g. secondary to lumbar disc prolapse).

Question 2

Femoral nerve stretch test

Answer 2

The femoral nerve stretch test is used to identify femoral nerve irritation.

Assessment
1. Position the patient prone on the clinical examination couch.

2. Flex the patient’s knee to 90º and then extend the hip joint.
3. Finally, plantarflex the patient’s foot.

Interpretation
The femoral nerve test is considered positive if the patient experiences pain in the thigh and/or inguinal region.

Question 3

Schobers test

Answer 3

Schober’s test can be used to identify restricted flexion of the lumbar spine, which may occur in conditions such as ankylosing spondylitis.

Assessment
1. Identify the location of the posterior superior iliac spine (PSIS) on each side.

2. Mark the skin in the midline 5cm below the PSIS.
3. Mark the skin in the midline 10cm above the PSIS.
4. Ask the patient to touch their toes to assess lumbar flexion.
5. Measure the distance between the two lines.

Interpretation
If a patient has normal lumbar flexion the distance between the two marks should increase from the initial 15cm to more than 20cm.

Reduced range of motion is associated with conditions such as ankylosing spondylitis.