Special Tests for Lumbar, Thoracic, and Sacral Spine ATHT 340 Dufrene

Kernig/Brudzinski Sign Position: Subject lies supine with hands cupped behind the head. Action: Subject is instructed to flex the cervical spine by lifting the head. Each hip is unilaterally flexed to no more than 90 degrees. The subject then flexes the knee to no more than 90 degrees. Positive Finding: The test is confirmed by increased pain with neck and hip flexion. The pain is relieved when the knee is flexed. The pain is indicative of meningeal irritation, nerve root impingement, or dural irritation that is exaggerated by elongating the spinal cord.

Valsalva’s Maneuver Test Position: Subject sits. Examiner stands next to subject. Action: Examiner asks the subject to take a deep breath and hold while bearing down, as if having a bowel movement. Positive Finding: Increased pain due to increased intrathecal pressure, which may be secondary to space-occupying lesion, herniated disk, tumor, or osteophyte in the cervical canal is a positive finding. Pain may be localized or referred to the corresponding dermatome.

Hoover Test Test Positioning: The subject relaxes in a supine position on the table while the examiner places both of the subject’s heels into the palm of the examiner’s hands. Action: The subject is asked to perform a unilateral straight leg raise. Positive Finding: The inability to lift the leg may reflect a neuromuscular weakness. A positive finding is also noted when the examiner does not feel increased pressure in the palm that underlies the resting leg.

Sitting Root Test Test Positioning: Subject sits with hip flexed to 90 degrees and the cervical spine in flexion. Action: Subject actively extends the knee. Positive Finding: Subject who arches backward and/or complains of pain in the buttocks, posterior thigh, and calf during knee extension demonstrates a positive finding for sciatic nerve pain.

Unilateral Straight Leg Raise Test Test Positioning: Subject is supine with both hips and knees extended. Examiner is standing with distal hand through subject’s heel and proximal hand on subject’s distal thigh to maintain knee extension. Action: Examiner slowly raises test leg until pain or tightness is noted. Examiner slowly lowers leg until pain or tightness resolves, then dorsiflexes the ankle and instructs subject to flex the neck. Positive Finding: Pain with dorsiflexion in lumbar area is indicative of dural pain. Pain with hip flexion greater than 70 degrees is indicative of lumbar involvement.

Bilateral Straight Leg Raise Test Test Positioning: Subject lies supine with both hips and knees extended. Examiner is standing with distal hand or forearm around or under subject’s heels and the proximal hand on subject’s distal thighs to maintain knee extension. Action: With subject relaxed, slowly raise legs until pain or tightness is noted. Positive Finding: Low back pain occurring at hip flexion angles less than 70 degrees is indicative of SI joint involvement. Low back pain occurring at hip flexion angles greater than 70 degrees is indicative of lumbar spine involvement.

Well Straight Leg Raise Test Test Positioning: Subject lies supine on table. Examiner places one hand on anterior aspect of uninvolved leg slightly superior to knee and the other hand around the heel of the ipsilateral calcaneus. Action: Examiner passively flexes subject’s uninvolved hip while maintaining knee in extended position. Positive Finding: Complaints of pain on the involved side indicate a positive test and may be related to vertebral disk damage.

Thomas Test Test Positioning: Subject lies supine with both knees fully flexed against chest and buttocks near the table edge. Examiner stands with one hand on subject’s lumbar spine or iliac crest to monitor lumbar lordosis or pelvic tilt. Action: Subject slowly lowers test leg until leg is fully relaxed or until either anterior pelvic tilting or an increase in lumbar lordosis occurs. Positive Finding: Lack of hip extension with knee flexion greater than 45 degrees is indicative of iliopsoas tightness. Full hip extension with knee flexion less than 45 degrees is indicative of rectus femoris tightness. Hip external rotation during any of the previous scenarios is indicative of IT band tightness.

Spring Test Test Positioning: Subject lies prone and examiner stands with thumb over the spinous process of a lumbar vertebra. Action: Apply a downward springing force through the spinous process of each vertebra to assess posterior-anterior motion. This action should be repeated for each transverse process to assess rotary motion. Positive Finding: Increases or decreases in motion at one vertebra compared to another are indicative of hypermobility or hypomobility, respectively.

Stork Standing Test Test Positioning: Subject stands on one leg with sole of nonweightbearing foot resting on the medial aspect of knee of weightbearing limb. Action: Subject maintains balance on one leg and simultaneously performs slight lumbar extension. Test is repeated bilaterally. Positive Finding: Complaints of pain in lumbar region may be related to the pars interarticularis region, which is sometimes associated with spondylolysis.

SI Joint Distraction Test Test Positioning: Subject lies supine. Examiner stands next to subject with arms crossed, places the heel of both hands on subjects anterior superior iliac spines. Action: Examiner applies outward and downward pressure with the heel of hands. Positive Finding: Unilateral pain at SI joint or in gluteal ligament region indicates either SI ligament sprain or SI joint dysfunction.

SI Joint Compression Test Test Positioning: Subject lies on his side. Examiner stands next to subject and places both hands directly over the subject’s iliac crest. Repeat bilaterally. Action: Examiner applies downward pressure. Positive Finding: Increased pain or pressure is indicative of SI joint dysfunction.

Gaenslen’s Test Test Positioning: Subject lies on the side of the uninvolved leg. With the involved leg in slight hyperextension, the subject then flexes the knee of the uninvolved side toward the chest. Action: Examiner stabilizes subject’s pelvis and further extends the involved leg. Positive Finding: Pain in SI region is a positive finding and may be associated with SI joint dysfunction.

FABER Test Test Positioning: Subject lies supine on table. Action: Examiner passively flexes, abducts, and externally rotates involved leg until foot rests on top of the knee of the noninvolved lower extremity. Examiner then slowly abducts the involved lower extremity, bringing the knee closer to the table. Positive Finding: Positive finding is revealed when the involved lower extremity does not abduct below the level of the noninvolved lower extremity. This may be indicative of iliopsoas, sacroiliac, or even hip joint abnormalities.

Long-Sitting Test Test Positioning: Subject lies supine with both hips and knees extended, and the examiner stands with thumbs on subject’s medial malleoli. Action: Examiner passively flexes both knees and hips and then fully extends and compares the position of the medial malleoli relative to each other. Subject then slowly assumes the long-sitting position, and malleolar position is re-assessed. Positive Finding: A leg that appears longer in supine position but shorter in long-sitting is indicative of an ipsilateral anteriorly rotated ilium. Conversely, a leg that appears shorter in supine position but longer in long-sitting is indicative of an ipsilateral posteriorly rotated ilium.