Lower Back

Question 1

what are the lower limb tension tests

Answer 1

Sciatic nerve – LLTT
1. Perform the straight leg raising test (below)
Positive => radicular symptoms
Femoral nerve – LLTT
1. Patient lying prone – stand on same side as assessment side
2. Take patient’s ankle and passively flex knee brining ankle to buttocks
Positive => radicular symptoms in anterior thigh along femoral nerve distribution

Question 2

what are the findings of lower limb tension tests

Answer 2

L2 or L3 nerve root lesion
(+) Unilateral neurological pain in
lumbar area or posterior thigh

Question 3

what is the straight leg raise (SLR)

Answer 3

1. Patient lying supine
2. Hip is medially rotated and adducted – leg lifted by supporting foot
   around calcaneus (keeping knee straight)

Positive => pain (at varying degrees)

Question 4

what are the findings of SLR

Answer 4

Pain at 10-35 degrees → tight hamstrings
Pain at 35-70 degrees → IVD pressure on
sciatic nerve (usually lateral
herniation)
Pain at 70+ degrees → SI joint pain

Question 5

what is the Well leg raise

Answer 5

1. Patient lying supine
2. Examiner raises uninvolved leg
   Positive => back and sciatic pain on opposite side

Question 6

what are the findings for well leg raise

Answer 6

Further evidence of a space
occupying lesion – such as
herniated disc (usually medial)

Question 7

what is the Braggard’s test (sign)?

Answer 7

1. Patient lying supine or sitting
2. Examiner lifts leg off table (like SLR) to level of pain
3. Examiner then lowers the leg just below the level of pain and adds
   dorsiflexion of ankle stretching the sciatic nerve

Positive => pain radiating below knee

Question 8

what is the findings for Braggard’s test?

Answer 8

• Disc herniation
• Neural impingement

Question 9

what is the Bechterews Test?

Answer 9

1. Patient seated with flexed neck
2. Asked to extend on knee at a time
3. If no symptoms, ask patient to extend both legs simultaneously

Positive => symptoms in back or leg

Question 10

what is the finding of Bechterews test?

Answer 10

Sciatic nerve involvement

Question 11

what is the valsalva test?

Answer 11

1. Patient seated
2. Patient takes a deep breath and blows out with closed mouth (bear down)

Positive => back pain or pain down the legs

Question 12

what is the findings for valsalva test?

Answer 12

Space occupying lesion causing an
increase in intrathecal pressure

Question 13

what is the findings for belt test?

Answer 13

Sacroiliac syndrome

Question 13

what is the belt test?

Answer 13

1. Patient in standing position with examiner standing behind the patient
2. Ask patient to bend or flex forward until the lumbosacral pain is felt
3. Patient then returns to upright position
4. Examiner asks patient to bend forward again but with examiner
   supporting the patient’s sacrum with his or her thigh – guiding movement
   by grasping the ileum (pelvis immobilized

Positive => pain disappears

Question 14

what is the Gillet’s test/marching test

Answer 14

1. Patient standing
2. Squatting examiner palpates the PSIS with one thumb and the other
   thumb parallel with the first thumb on the sacrum
3. Ask patient to stand on one leg while pulling the opposite knee up
   towards the chest (causes innominate bone on same side to rotate
   posteriorly and sacrum to rotate to same side)
4. Repeat test with other leg palpating the other PSIS

Positive => if sacroiliac joint on the side on which the knee is flexed moves
minimally or up

Question 15

what is the findings of Gillet’s test/marching test

Answer 15

Joint is hypo-mobile; normally the
tested PSIS moves down or
inferiorly

Question 16

what is the kemp’s test?

Answer 16

1. Patient standing
2. Instruct patient to slowly extend, side bend, and rotate the thorax and
   lumbar spine to affected side (having patient run their fingertips of hand
   on affected side down the posterolateral aspect of the affected leg as far as
   possible)
3. Movement compresses intervertebral foramen, nerve root and facet joints

Positive => radiating pain or other neurological signs in affected leg (nerve
involvement) or localized pain (facet involvement)

Question 17

what is the findings for kemp’s test?

Answer 17

• Nerve involvement – radiating
  pain in affected leg
• Facet involvement – localized pain

Question 18

what is the piriformis test?

Answer 18

1. Patient lying on side; involved side up
2. Flex upper hip (testing side) 60-90
3. Flex knee 90
4. Examiner stabilizes hip with free hand; place downward pressure with
   other hand

Positive => pain in piriformis area or recreation of symptoms

Question 19

what is the findings for piriformis test?

Answer 19

Tight piriformis or piriformis
syndrome

Question 20

what is the brudzinski-kernig test?

Answer 20

1. Patient lying supine with hands cupped behind head
2. Patient flexes head onto chest
3. Patient raises extended leg actively by flexing the hip until pain is felt
4. When pain is felt, patient flexes knee to make pain disappear

Positive => if pain is felt and goes away with knee flexion

Question 21

what is the findings for brudzinski-kernig test?

Answer 21

Meningeal irritation
Dural irritation or dural
involvement

Question 22

what is the hoover test?

Answer 22

1. Patient lying supine
2. Examiner places one hand under each calcaneus
3. Patient asked to lift one leg off table, keeping the knees straight

Positive => if patient does not lift the leg or the examiner does not feel pressure
under opposite heal

Question 23

what is the findings for hoover test?

Answer 23

malingering

Question 24

what is the milgram’s test?

Answer 24

1. Patient lying supine
2. Actively lifts both legs up at the same time, off the table about 2-4 inches
   – hold this position for 30 seconds or symptoms are reproduced

Positive => if patient can’t hold for 30 seconds or symptoms are reproduced

Question 25

what is the findings for milgram’s test?

Answer 25

Lumbosacral pathology

Question 26

what is the single leg lumbar hyperextension test

Answer 26

1. Patient stands in straddle position with one lower limb extended behind
   the other
2. Patient stands on one leg and extends spine while balancing on the leg
3. Patient leans back as far as possible while examiner prevents patient from
   falling over
4. Repeat test with lower limb position reversed

Positive => pain in back and is associated with a pars interarricularis stress

Question 27

what is the findings for single leg lumber hyperextension test?

Answer 27

Spondylolysis and
spondylolisthesis

Question 28

what are the special test for lumbar disc herniation

Answer 28

• Straight leg raise (SLR)
• Well leg raise (opposite
  SLR)
• Braggard’s
• Bechterews
• Valsalva

Question 29

what are the special test for lumbar facet syndrome?

Answer 29

• Spurling’s
• Maximal foramen test
• Bakody’s
• Cervical distraction
• Shoulder depression
• Kemps

Question 30

what are the special test for lumbar sprain/strain

Answer 30

• Straight leg raise (SLR)
• Well leg raise
• Braggard’s
• Bechterews
• Belt test
• Marching test
• Kemps

Tests should be (-)

Question 31

what are the special test for sacroiliac joint dysfunction

Answer 31

• Belt test
• Marching test
• Patrick Faber’s test
• Pelvic rock test
• Gaenslen’s

Question 32

what are special test for pelvic instability?

Answer 32

• Belt test
• Marching test
• Patrick Faber’s test
• Pelvic rock test
• Gaenslen’s
• Yeoman’s

Question 33

what are the special test for piriformis syndrome

Answer 33

• Pace
• Piriformis length test
• Sign of the Buttock’s test
• Palpation

Question 34

what are the special test for lumbar spondylothesis

Answer 34

• Single leg lumbar
• hyperextension test