Lumbar Spine

Question 1

Bony Palpation

Answer 1

Lumbar spinous processes, sacral tubercles, iliac crest, PSIS

Question 2

Soft Tissue Palpation

Answer 2

Paraspinal muscles(palpate as a unit) superficial layer: Spinalis, Longissimus, Iliocostalis, Sciatic Nerve, Gluteus Maximus, Gluteus Medius, Hamstrings: Biceps femoris, semitendinosus, semimembranosus, and anterior abdominal muscles.

Question 3

Hoover Sign

Answer 3

Positive: Lack of counter-pressure on the healthy side.
Indicates: Lack of organic basis for paralysis(Malingering/hysteria). With organic hemiplegia, the patient will still exert downward pressure when attempting to raise the paralyzed leg.

Question 4

Straight Leg Raiser

Answer 4

Positive: Radiating pain and/or dull posterior thigh pain.
Indicates: Sciatic radiculopathy or tight hamstrings. Positive between 35-70 degrees indicates possible discogenic sciatic radiculopathy. Greater than 70 degrees indicates tight hamstrings.

Question 5

Goldwait Sign

Answer 5

Positive: Localized pain, low back or radiating pain down the leg.
Indicates: Lumbo-sacral or sacroiliac pathology. Pain occuring before the lumbar spinouses move indicates possible sacroiliac problem. Pain occurring after the lumbar spinouses move indicates possible lumbo-sacral problem.

Question 6

Bragard Sign

Answer 6

SLR on patient. Examiner lowers the raised leg (5 degrees) from the point of pain and sharply dorsiflexes patient’s foot.
Positive: Radiating pain in posterior thigh.
Indicates: Sciatic radiculopathy

Question 7

Buckling Sign

Answer 7

SLR
Positive: Pain in the posterior thigh with sudden knee flexion (buckle).
Indicates: Sciatic radiculopathy.

Question 8

Bowstring Sign

Answer 8

Positive: Pain in the lumbar region or radiculopathy.
Indicates: Sciatic nerve root compression, helps rule out tight hamstrings.

Question 9

Lasegue Test

Answer 9

Positive: Reproduction of sciatic pain before 60 degrees
Indicates: Sciatica

Question 10

Milgram Test

Answer 10

Positive: Inability to perform test and/or low back pain.
Indicates: Weak abdominal muscles or a space occupying lesion.

Question 11

Valsalva Maneuver

Answer 11

Positive: Radiating pain from the site of lesion (usually recreating the complaint in the cervical or lumbar area of the spine).
Indicates: Space occupying lesion (e.g. disc pathology)

Question 12

Bechterew Test

Answer 12

Positive: Reproduction of radicular pain or inability to perform the test due to tripod sign.
Indicates: Sciatic Radiculopathy

Question 13

Neri Bowing Test(Neri Sign)

Answer 13

Positive: Pain accompanied by flexion of the knee on the affected side and body rotation away from the affected side.
Indicates: Positive for a variety of low back pathologies. Hamstring tension on the pelvis may trigger the response..

Question 14

Anterior Innominate Test a.k.a Mazion Pelvic Maneuver a.k.a Advancement Sign

Answer 14

Positive: Radiating pain along the sciatic nerve, either unilateral or bilateral.
Indicates: Sciatic neuralgia, or radiculopathy, etc. possibly due to lumbar disc pathology.
Positive: low back pain (lumbar or pelvic regions)
Indicates: anterior (rotational) displacement of the ilium relative to the sacrum.

Question 15

Lewin Standing Test

Answer 15

Positive: Radiating pain down the leg causing flexion of the patient’s knee or knees.
Indicates: Gluteal, lumbosacral or sacroiliac pathologies

Question 16

Heel Walk

Answer 16

Positive: Inability to perform test
Indicates: L4-L5 disc lesion (L5 nerve root)

Question 17

Toe Walk

Answer 17

Positive: Inability to perform test
Indicates: L5-S1 disc lesion (S1 nerve root)

Question 18

Ely Heel to Buttock Test

Answer 18

Positive:  Inability to raise thigh
Indicates:  Iliopsoas spasm
Positive:  pain in the anterior thigh
Indicates:  inflammation of lumbar nerve roots.
Positive:  pain in the lumbar region
Indicates:  Lumber nerve root adhesions