LEWIN SUPINE TEST
POSITIVE: Inability to perform sit up
INDICATES: Ankylosing of the dorsolumbar spine, lumbar arthritis, degenerative disc with protrusion, SI or lumbosacral arthritis, and sciatica
FORRESTIER’S BOWSTRING SIGN
POSITIVE: Ipsilateral tightening and contracture of the paraspinal musculature (normally the contralateral musculature will contract)
INDICATES: Ankylosing Spondylitis (Marie Strumpell Disease), further evaluate
CHEST EXPANSION TEST
POSITIVE: Males = less than 2 inches expansion between maximum inhalation and exhalation Females = Less than 1 1/2 inches expansion between maximum inhalation and exhalation
INDICATES: Thoracic fixation, commonly found with Ankylosing conditions such as Ankylosing Spondylitis
AMOSS SIGN
POSITIVE: Localized thoracic or thoracolumbar pain
INDICATES: Ankylosing spondylitis, severe sprain, or intervertebral disc syndrome
MODIFIED SHOBER TEST
POSITIVE: Less than 5 cm of increase in the measured distance between the lower and upper marks. People with normal spinal mobility have an increase in the measured distance of 5 cm or more
INDICATES: Probable Ankylosing Spondylitis
STORK TEST (aka Single Leg Hyperestension Test)
POSITIVE: Pain in lumbar spine
INDICATES: Possible Spondylolysis or Facet syndrome
LIBMAN SIGN
POSITIVE: Response of pain
INDICATES: Is an indicator of the patient’s pain threshold. Can be indicator for unusually low threshold to pain, possible malingerer. (Can be used while interpreting palpatory findings during rest of exam anywhere in the body)
MANKOPF SIGN
POSITIVE: An increase in pulse rate by 10 or more beats/min. Is a positive (normal) sign. If no increase is noted or less than 10/min = No organic reason for pain (Negative test)
INDICATES: A negative test suggests malingering. Positive is normal. Patient with true pain will experience an increase of 10 beats per minute, which is equal to approximately a 10 percent or more increase in their pulse rate
BURNS BENCH TEST
POSITIVE: Response of pain in low back area, inability or unwillingness to do test
INDICATES: Lack of organic basis for low back pain (malingering). All stress is placed on posterior leg muscles
FLEXED-HIP TEST
POSITIVE: Patient complains of pain in the lumbar region and/or leg pain before any spinous process separation is felt by the examiner
INDICATES: Lack of organic basis for lower back pain (malingering), if patient complains of pain in the lumbar region and/or leg before any spinous process separation is felt by the examiner
FLIP SIGN
POSITIVE: Patient does not complain of pain
INDICATES: Lack of organic basis for lower back pain (malingering). The same degree of movement and location of pain should occur in either position, supine or seated.
AXIAL TRUNK-LOADING TEST
POSITIVE: Patient complains of pain in the lumbar region
INDICATES: Lack of organic basis for lower back pain (malingering). The axial loading may produce pain in the cervical region but should not produce pain in the lumbar region
TRUNK ROTATIONAL TEST (Simulated Trunk Rotation)
POSITIVE: Patient complains of low back pain
INDICATES: Lack of organic basis for pain (malingering). In this test, the whole spine is being moved as one unit, all movement occurs in the lower extremities, not in spinal segments.
MAGNUSON TEST
POSITIVE: Patient does not point to same site both times, significant difference in location of site of pain
INDICATES: Lack of organic basis for complaint (malingering). Patient with true pain will point to Same site of pain each time
SLUMP TEST
POSITIVE: Reproduction of patient’s pain
INDICATES: Peripheral vascular disease, intermittent vascular claudication, popliteal artery entrapment syndrome, atherosclerosis
BUERGER’S TEST
POSITIVE: Blanching of the foot
INDICATES: Reduced/poor circulation in lower extremity
BONY PALPATION: LUMBAR SPINE
- Lumbar Spinous Processes
- Sacral Tubercles
- Iliac Crest
- PSIS
RANGE OF MOTION: LUMBAR SPINE
- FLEXION: 25
- EXTENSION: 30
- LEFT LATERAL BENDING: 25
- RIGHT LATERAL BENDING: 25
- LEFT ROTATION: 30
- RIGHT ROTATION: 30
HOOVER SIGN
- POSITIVE: Lack of counter-pressure to opposite side
- INDICATES: Lack of organic basis for paralysis (Malingering/hysteria). With organic hemiplegia, the patient will still exert downward pressure when attempting to raise paralyzed leg
STRAIGHT LEG RAISER (SLR)
- POSITIVE: Radiating pain and/or dull posterior thigh pain
-
INDICATES: Sciatic radiculopathy or tight hamstrings.
- Positive between 35-70 degrees equals possible discogenic sciatic radiculopathy
- > 70 equals tight hamstrings
GOLDTHWAIT SIGN
- POSITIVE: Localized pain, low back or radiating pain down the leg
-
INDICATES: Lumbo-sacral or sacroiliac pathology
- Pain occuring after the lumbar spinouses move equals possible lumbo-sacral problem
- Pain occuring before the lumbars move equals possible sacroiliac problem
BRAGARD SIGN
- POSITIVE: Radiating pain in posterior thigh
- INDICATES: Sciatic Radiculopathy
BUCKLING SING (CIPRIANO)
- POSITIVE: Pain in the posterior thigh with sudden knee flexion (buckle)
- INDICATES: Sciatic Radiculopathy
BOWSTRING SIGN
- POSITIVE: Pain in the lumbar region or radiculopathy
- INDICATES: Sciatic nerve root compression, helps rule out tight hamstrings
LASEGUE TEST
- POSITIVE: Reproduction of sciatic pain before 60 degrees
- INDICATES: Sciatica
MILGRAM TEST
- POSITIVE: Inability to perform test and/or low back pain
- INDICATES: Weak abdominal muscles or space occupying lesion
VALSALVA MANEUVER
- POSITIVE: Radiating pain from site of lesion (usually recreating the complaint in cervical or lumbar area of the spine)
- INDICATES: Space occupying lesion (e.g. disc pathology)
BECHTEREW TEST
- POSITIVE: Reproduction of radicular pain or inability to perform correctly due to tripod sign
- INDICATES: Sciatic radiculopathy
NERI BOWING TEST (Neri Sign)
- POSITIVE: Pain accompanied by flexion of the knee on the affected side and body rotation away from the affected side
- INDICATES: Positive with a variety of low back pathologies. Hamstring tension on the pelvis may trigger the response
ANTERIOR INNOMINATE aka MAZION PELVIC MANEUVER (ADVANCEMENT SIGN)
- POSITIVE:
The inability to bend at the waist more than 45 degrees, because of either/or
- Radiating pain along the sciatic nerve, either unilateral or bilateral
- Low back pain (lumbar or pelvic regions)
-
INDICATES:
- Sciatic neuralgia or radiculopathy, etc., possibly due to lumbar disc pathology
- Anterior (rotational) displacement of the ilium relative to the sacrum
LEWIN STANDING TEST
- POSITIVE:
Radiating pain down the leg causing flexion of the patient’s knee or knees
- INDICATES:
Gluteal, lumbosacral or sacroiliac pathologies
HEEL WALK
- POSITIVE:
Inability to perform the test
- INDICATES:
L4-L5 disc lesion (L5 nerve root)
TOE WALK
- POSITIVE:
Inability to perform test
- INDICATES:
L5-S1 disc lesion (S1 nerve root)
ELY HEEL TO BUTTOCK TEST (Evans calls this Ely sign as an a.k.a.)
POSITIVE:
- Inability to raise the thigh
- Pain in the anterior thigh
- Pain in the lumbar region
INDICATES:
- Iliopsoas spasm
- Inflammation of lumbar nerve roots
- Lumbar nerve root adhesions
L4 NERVE ROOT
- DISC LEVEL: L3
-
MUSCLE TEST (1):
- Foot Dorsiflexion and Inversion: Tibialis Anterior (deep fibular/peroneal nerve)
- REFLEX: Patellar Tendon
- SENSATION: Medial aspect of leg, medial foot, medial aspect of big toe
L5 NERVE ROOT
- DISC LEVEL: L4
-
MUSCLE TESTS (4):
- Foot Dorsiflexion: Tibialis Anterior, Extensor Digitorum Longus (Deep Peroneal)
- Big Toe Dorsiflexion: Extensor hallucis longus (deep fibular/peroneal nerve)
- Toes 2, 3, 4 dorsiflexion: Extensor digitorum longus and brevis (deep fibular/peroneal nerve)
- Hip and Pelvis Abduction: Gluteus medius and minimus (superior gluteal nerve)
- REFLEX: NONE*
- SENSATION: Lateral leg, dorsum of foot, and middle third toes
S1 NERVE ROOT
- DISC LEVEL: L5
-
MUSCLE TESTS (3):
- Foot Plantarflexion: Gastrocnemius and Soleus (Tibial Nerve)
- Foot Plantar Flexion and Eversion: fibular/peroneus longus and brevis (superficial fibular/peroneal nerve)
- Hip Extension: Gluteus Maximus (Inferior gluteal nerve)
- REFLEX: Achilles
- SENSATION: Posterior aspect of the leg, lateral aspect of foot, and lateral aspect of little toe
SOFT TISSUE PALPATION: LUMBAR SPINE
- Paraspinal Muscles (palpate as a unit and individually) superficial layer
- Spinalis
- Longissimus
- Iliocostalis
- Gluteus Medius
- Gluteus Maximus
- Sciatic Nerve
- Hamstrings
- Biceps Femoris
- Semitendinosus
- Semimembranosus
- Anterior Abdominal Muscles
MINOR SIGN
+ : Knee flexion of the affected leg while supporting upper body weight (hand on back or thigh) on unaffected side
i : Sciatica, lumbosacral or sacroiliac joint lesion
BELT TEST (Supported Adam Test, Supported Forward Bending Test)
+ : Low Back Pain
i :
1) Pain while bending with the sacrum stabilized and unstabilized = Lumbar involvement
2) Pain during sacrum non-stabilized bending, and no pain during sacrum stabilized bending = pelvic involvment
MILGRAM TEST
+ : Inability to perform test and/or low back pain
i : Weak abdominal muscles or space occupying lesion
HEEL WALK
+ : Inability to perform test
i : L4-L5 disc lesion (L5 nerve root)
TOE WALK
+ : Inability to perform test
i : L5-S1 disc lesion (S1 nerve root)
KEMP TEST
+ :
1) Pain usually radicular, recreating existing sciatic pain
2) Pain - Local
i :
1) Disc Protrusion: - In medial disc protrusion, Kemps will be positive as the patient is leaning AWAY from the side of pain - In lateral disc protrusion Kemps will be positive as the patient is leaning INTO the side of pain
2) Localized pain may indicate lumbar spasm or facet capsulitis
STRAIGHT LEG RAISE (SLR)
+ : Radiating pain and/or dull posterior thigh pain
i : Sciatic radiculopathy or tight hamstrings. Positive between 35-70 degrees = possible discogenic sciatic radiculopathy > 70 degrees = tight hamstrings
LINDNER SIGN
+ : Pain along sciatic distribution or sharp, diffuse pain (leg) i : Sciatic radiculopathy
TURYN SIGN
+ : Pain in the gluteal region or radiating sciatic pain i : Sciatic Radiculopathy
BRAGARD SIGN
+ : Posterior thigh and leg pain i : Sciatic radiculopathy (usually from disc lesion)
SICARD SIGN
+ : Posterior thigh and leg pain i : Sciatic radiculopathy (usually from disc lesion)
BONNET SIGN
+ : Pain in the posterior thigh or leg i : Immediate pain is sciatic neuropathy from piriformis syndrome
FAJERSZTAJN TEST aka Well-Leg-Raising Test of Fajersztajn
+ : 1) Pain down affected leg 2) Decrease in pain down affected leg i : 1) Medial disc protrusion 2) Lateral disc protrusion
FEMORAL STRETCH TEST (Femoral Nerve Traction Test)
+ : Pain on the anterior portion of the thigh i : Traction on the femoral nerve indicating involvement of the 2nd, 3rd, and 4th lumbar nerve roots
BONY PALPATION: HIP AND PELVIS
ANTERIOR
- ASIS
- Iliac Crest
- Iliac Tubercle
- Greater Trochanter
POSTERIOR
- PSIS
- Ischial tuberosity
- Coccyx
SOFT TISSUE PALPATION: HIP & PELVIS
- Femoral Triangle Borders
- Sartorius
- Adductor Longus
- Inguinal Ligament
- Quadriceps Muscle (palpate as a unit and individually)
- Vastus Lateralis
- Vastus Medialis
- Vastus Intermedius
- Rectus Femoris
- Greater Trochanteric Bursa
- Gluteus Medius
- Gluteus Maximus
- Sciatic Nerve
- Cluneal Nerves
- Hamstrings
- Biceps femoris
- Semitendinosus
- Semimembranosus
RANGE OF MOTION:
HIP AND PELVIS
- Flexion 120
- Extension 30
- Abduction 45
- Adduction 45
- Internal Rotation 45
- External Rotation 45
- Flexion and Adduction
- Flexion, Abduction, and External rotation
LEG LENGTH DISCREPANCY
POSITIVE:
- Different Measurements
INDICATES:
- True = bony abnormality above or below level of trochanter difference (anatomical short leg).
- Apparent = pelvic Obliquity (Tilted pelvis)
ALLIS SIGN
POSITIVE:
- Difference in height and anteriority of the knees
INDICATES:
- If one knee is lower = ipsilateral congenital hip dislocation or tibial discrepancy (anatomical short leg)
- If one knee is anterior = ipsilateral congenital hip dislocation or femoral discrepancy (contralateral anatomical short leg)
THOMAS TEST
POSITIVE:
- Lumbar spine maintains lordosis (should flatten) and hip or leg flexes
INDICATES:
- Contracture of the hip flexors (iliopsoas)
ANVIL TEST
POSITIVE:
- Localized pain in long bone or in hip joint
INDICATES:
- Possible Fracture of long bones, or hip joint pathology
PATRICK TEST aka FABERE sign
POSITIVE:
- Pain in the hip region
INDICATES:
- Hip joint pathology
LAGUERRE TEST
POSITIVE:
- Pain in the hip joint
- Pain in the sacroiliac joint
INDICATES:
- Hip joint pathology
- Mechanical problem of the sacroiliac joint
GAENSLEN TEST
POSITIVE:
- Pain on the affected SI joint stressed into extension
INDICATES:
- General sacroiliac joint lesion, anterior sacroiliac ligament sprain, or inflammation of the SI joint
LEWIN - GAENSLEN TEST
POSITIVE:
- Pain on the affected SI joint stressed into extension
INDICATES:
- General sacroiliac joint lesion, anterior sacroiliac ligament sprain, or inflammation of the SI joint
HIBB TEST
POSITIVE:
- Pain in the hip region
- Pain in the buttock/pelvic region
INDICATES:
- Hip joint pathology
- Sacroiliac joint lesion
OBER TEST
POSITIVE:
Affected thgih remains in abduction (Normal biomechanics, the thigh/hip will adduct)
INDICATES:
Contraction of the iliotibial band or tensor fascia lata, (usually secondary to synovitis of the hip, secondary to trauma of the gluteus medius and maximus)
PELVIC ROCK TEST aka ILIAC COMPRESSION TEST
POSITIVE:
- Pain in either sacroiliac joint
INDICATES:
- Sacroiliac joint lesion
NACHLAS TEST
POSITIVE:
- Pain in the buttock and/or pain in the lumbar region
INDICATES:
- Sacroiliac joint lesion, or Lumbar pathology
YEOMAN TEST
POSITIVE:
- Pain deep in the SI joint
INDICATES:
- Sprain of the anterior sacroiliac ligaments
ELY SIGN (ELY TEST - CIPRIANO)
POSITIVE:
- Hip on side being tested will flex causing the buttock to raise off the table
INDICATES:
- Rectus Femoris or hip flexor contracture
ELY HEEL TO BUTTOCK TEST (cipriano)
POSITIVE:
- Inability to raise the thigh
- Pain in the anterior thigh
- Pain in the lumbar region
INDICATES:
- Iliopsoas spasm
- Inflammation of lumbar nerve roots
- Lumbar nerve root adhesions
TRENDELENBURG TEST
POSITIVE:
- High iliac crest on supported side and low crest on side of elevated leg
INDICATES:
- Weak gluteus medius muscle on the supported side