Lab #3 : Spine : Functional Testing Carlos Leon-Carlyle # Mike Bois # Bruce Monkman # Loriana Costanzo #

Milgram Test  Patient lies supine on a table with their legs straight. Have them raise their legs about two inches off the table and hold as long as they can.  This maneuver stretches the iliopsoas muscle and anterior abdominal muscles. It also increases the intrathecal pressure.

Milgram Test (Continued)  If the patient can hold this position for thirty seconds without pain, intrathecal pathology may be ruled out.  If the patient cannot hold this position, lift their legs, or experiences pain as they attempt the maneuver, intrathecal or extrathecal (herniated disc) pathology may be present. Another possibility is that there is pathologic pressure on the theca itself (wrapping of the cord).

Straight Leg Raising Test  Patient lies down in the supine position on a table.  Clinician lifts the patient’s leg upward by supporting his foot around the calcaneous. The knee should remain straight, so the clinician places their free hand on the anterior aspect of the knee to prevent this.  Raise the patient’s leg to approximately 80 degrees.

Straight Leg Raising Test (Continued)  If straight leg raising is painful:  Lower the leg slightly, then dorsiflex the foot to reproduce sciatic pain.  If there is a reaction to the dorsiflexion of the foot, then ask the patient to locate the source of the pain as closely as possible on their body.  If no pain is present, then the patient is most likely experiencing tight hamstrings which simply require stretching.

Well Leg Straight Leg Raising Test  Patient lies supine and raises their uninvolved leg.  If back or sciatic pain is present on the opposite side, then there is further evidence of a space- occupying lesion such as a herniated disc in the lumbar area.

Hoover Test  This test is used to determine whether the patient is really trying to raise their leg.  Perform in conjunction with the straight leg raising test.  When a patient is genuinely trying to raise their leg, they put downward pressure on the calcaneus of their opposite leg to gain leverage.  If no downward pressure is felt, then they are probably not really trying.

Kernig Test  Patient lies supine on a table with both hands behind their head.  The patient forcibly flexes their head onto their chest.  If the patient complains of pain in the cervical spine, lower back, or down the legs, this may indicate a meningeal irritation, nerve root involvement, or irritation of the dural coverings of the root.  If there is pain, have them locate it as precisely as possible.