back special tests

Question 1

march test

Answer 1

purpose: si joint dysfunction

pt. pos: standing

Prac. pos: standing or sitting behind pt. with both thumbs over the SI joint

procedure: pt is instructed to alternately raise one knee to the chest and prac. will note the movement of SI joint

positive: no movement or unilateral asymmetry in movement

Question 2

Trendelenburg test

Answer 2

purpose: weakness in glute medius or involvement of superior gluteal nerve

pt. pos: standing

Prac. pos: sitting behind pt.

procedure: pt is instructed to alternately lift one knee to their test while prac. observes hip jolting out

positive: hip jutting laterally or pt is leaning to involved side

Question 3

heel and toe walking

Answer 3

purpose: neurological involvement/ motor function of lower extremity

pt. pos: standing

Prac. pos: standing next to pt.

procedure: have pt. walk on their toes and then walk on their heels

positive: inability to perform the procedure

Question 4

stork standing

Answer 4

purpose: check for proprioception

pt. pos: standing

Prac. pos: standing next to pt.

procedure: have the pt. lift one leg and check for balance

positive: inability to perform the test, unable to balance

Question 5

hip distraction test

Answer 5

purpose: apprehension due to an unstable hip or osteoarthritis or ligamentous issue

pt. pos: supine with test hip flexed to 30 degrees, slightly abducted and slightly externally rotated

Prac. pos: at foot of pt.; holding ankle with both hands

procedure: a distraction force is applied just to the point of the pt. beginning to move

positive: apprehension with distraction= unstable hip or ligamentous
relief of pain= osteoarthritis or leg calf perthes or OCD

Question 6

hoover test

Answer 6

purpose: malingering or lying pt.

pt. pos: lying on table

Prac. pos: at foot of pt. both heels of pt. cupped in prac. hands

procedure: pt is instructed to raise one leg

positive: failure of the opposite leg to push down on the prac. hand indicated a sub maximal effort

Question 7

SLR test

Answer 7

purpose: neurological involvement in lower extremity

pt. pos: supine with hip flexed

Prac. pos: standing next to pt. one hand maintaining knee extension and the other on the distal leg

procedure: hip is passively extended to the end of the range of motion. combination movements may be added such as the chin to the chest and/or dorsiflexion

positive: shooting pain, numbness, tingling. pain in the lumbar spine = then it would be indicative of bulging disc

Question 8

well SLR test

Answer 8

purpose: neurological involvement in the lower extremity

pt. pos: supine with hip flex

Prac. pos: standing next to pt. one hand maintaining knee extension and the other on the distal leg

procedure: the hip passively extended to the end of the range of motion. combination movement may be added such as the chin to the chest and/or dorsiflexion

positive: shooting pain, numbness, tingling down the non-test leg

Question 9

bowstring test

Answer 9

purpose: neurological involvement of tibial nerve or common perineal nerve

pt. pos: supine

Prac. pos: at foot of pt.

procedure: perform a SLR to the point of pain, flex the knee until pain is relieved then apply pressure to the popliteal fossa with the practitioner’s thumb

positive: reduced to eliminated pain with knee flexion that returns with popliteal pressure

Question 10

pelvic compression

Answer 10

purpose: SI joint dysfunction

pt. pos: supine

Prac. pos: standing next to pt. arms are crossed and placed on ASIS of pt.

procedure: downward and outward pressure is applied uniformly on ASIS

positive: posterior pain along the SI joint

Question 11

pelvic distraction

Answer 11

purpose: si joint dysfunction

pt. pos: supine

Prac. pos: next to pt. hands placed on superior portion of gluteus Maximus

procedure: prac. raises both hands, spreading the SI joint

positive: pain in the SI region

Question 12

FABER/ Figure 4/ Patrick’s test

Answer 12

purpose: SI joint dysfunction or tight hip flexors

pt. pos: supine with ankle crossed above opposite knee, flexion, abduction, and external rotation (FABER)

Prac. pos: standing next to pt. one hand on crossed knee, one hand on opposite asis

procedure: pressure is applied at the knee and asis simultaneously

positive: posterior pain= SI joint dysfunction, anterior pain= tight hip flexors

Question 13

Thomas test

Answer 13

purpose: tight hip flexors

pt. pos: supine with legs hanging off the table, knees flexed to 90 degrees

Prac. pos: standing next to pt.

procedure: pt is instructed to bring knee to chest and lean back onto table

positive: opposite leg lifts from table flexing at the hip

Question 14

Pubic symphysis

Answer 14

purpose: ascertain problems in the pubic symphysis or SI joint

pt. pos: supine

Prac. pos: standing next to pt.; heel of hand is moved from the umbilicus to the pubic symphysis

procedure: downward pressure is applied to the pubic symphysis

positive: pain in the pubic symphysis or SI joint, indicating pelvis involvement

Question 15

piriformis test

Answer 15

purpose: tight piriformis or tibial/ common peroneal nerve (sciatic nerve)

pt. pos: supine

Prac. pos: standing next to pt.

procedure: pt. knee is taken to the opposite shoulder and the foot is then internally rotated

positive: increased pain in the area of the piriformis or any neurological symptoms= nerve involvement

Question 16

FADIR

Answer 16

purpose: femoral acetabular joint impingement

pt. pos: supine

Prac. pos: standing next to pt. one hand on flexed knee and the other no the ankle of the same leg in a motorcycle grip

procedure: knee is taken into full flexion and moved by the prac. to opposite shoulder. leg is then taken into internal rotation

positive: deep pain, clicking or limited range of motion indicated the necessity of x-ray to confirm diagnosis

Question 17

babinski test

Answer 17

purpose: neurological deficit or impairment

pt. pos: supine or siting with legs extended

Prac. pos: at foot of pt.

procedure: a finger or hard object is run along the bottom of the foot from first toe to lateral foot towards heel

positive: toes should curl or do nothing. splaying or extension of the toes indicate a positive result

Question 18

Oppenheim test

Answer 18

purpose: neurological deficit or impairment

pt. pos: supine or sitting

Prac. pos: at foot of pt.

procedure: a finger or hard object is run along the rest of the tibia

positive: same as for babinski. toes should curl or do nothing. splaying or extension of the toes indicate a positive result

Question 19

milgram’s test

Answer 19

purpose: to determine muscular strain of the low back

pt. pos: supine

Prac. pos: at foot of pt.

procedure: pt is instructed to hold both legs in the air for 30 seconds

positive: inability to perform the procedure due to back pain

Question 20

Beevor’s sign

Answer 20

purpose: determine the presence of a neurological or muscular disorder of the abdomen/ lumbar spine

pt. pos: supine with hands behind head

Prac. pos: at foot or next to pt.

procedure: have pt perform a sit up

positive: the umbilicus should stay in a straight line. side to side movement is a positive

Question 21

springing test

Answer 21

purpose: check for hyper or hypo-mobility of an individual vertebrae

pt. pos: prone

Prac. pos: standing next to pt. the pisiform of the hand is placed on the spinous process of each vertebrae sequentially in the lumbar spine

procedure: anterior/ posterior movement in very small increments is initiated with differences noted in movements of each individual segment

positive: a level with extreme motion or lack of motion as compared to other levels

Question 22

active spinal extension

Answer 22

purpose: to determine muscular involvement of the low back

pt. pos: prone with hands behind the back

Prac. pos: next to pt.

procedure: have the pt. move into active spinal extension

positive: pain with movement or inability to complete maneuver

Question 23

sphinx position (done after active spinal extension)

Answer 23

purpose: to determine the possibility of a spondy (spondylosis, spondylolisis, spondylolisthesis)

pt. pos: prone with elbows on table

Prac. pos: next to pt.

procedure: have the pt. extend the spine using their arms on the able

positive: pain directly over the spine

Question 24

spondyloysthesis’s test

Answer 24

purpose: check for spondylolisthesis or slippage of the vertebrae

pt. pos: side lying with both knees flexed

Prac. pos: standing in front of pt. one hand under both knees the other hand on the lumbar spine

procedure: knees are taken into flexion and extension and the lumbar spine is palpated at each vertebral level

positive: vertebrae that does not line up with the others with flexion and extension

Question 25

Ober’s test

Answer 25

purpose: IT band syndrome

pt. pos: side lying on the table

Prac. pos: standing behind pt. one hand may be placed on the distal leg and the other could stabilize the pelvis

procedure: pt is instructed to let top leg hang over the back of the table

positive: inability to adduct; pain; asymmetry

Question 26

noble

Answer 26

purpose: IT band syndrome

pt. pos: side lying on table

Prac. pos: standing behind pt. one hand on the distal leg, one thumb on the IT band, 2-4 cm proximal to the knee

procedure: the knee is alternatively flexed and extended while the force is applied with the thumb proximal to the knee

positive: pain, particularly at 30 degrees of flexion

Question 27

femoral nerve traction test

Answer 27

purpose: determine involvement of the L2-L4 nerve roots or femoral nerve irritation

pt. pos: side lying

Prac. pos: standing behind pt., with top of pt’s foot on hip, one hand on the knee and the other on the PSIS for stabilization

procedure: the knee is passively flexed and the hip extended simultaneously

positive: pain, shooting pain, numbness, tingling