1. Thoracic and Lumbar Spine Special Tests and Pathologies

2. Clinical Evaluation Spring Test: Test Positioning: Action:
Subject is prone
Examiner stands with thumbs or hypothenar eminence over the spinous process of a lumbar vertebrae
Action:
Apply a downward “springing” force through the spinous process of each vertebrae to assess anterior-posterior motion
Positive Finding:
Increases or decreases in motion at one vertebrae compared to another (hypermobility or hypomobility)

3. Clinical Evaluation Nerve Root Impingement:
Narrowing of intervertebral foramen:
Stenosis
Facet joint degeneration
Herniated intervertebral disc

4. Clinical Evaluation

5. Clinical Evaluation Nerve Root Impingement Tests: Milgram Test:
Test Position:
Patient supine, examiner at feet of the patient
Action:
Patient performs a bilateral straight leg raise to the height of 2 to 6 inches and is asked to hold the position for 30 seconds
Positive Finding:
Patient unable to hold position, cannot lift the leg, or has pain with test
Implications:
Intrathecal or extrathecal pressure causing an intervertebral disc to place pressure on a lumbar nerve root

6. Clinical Evaluation Nerve Root Impingement Tests: Kernig’s Test:
Test Position:
Patient supine, examiner at side of patient
Action:
Patient performs a unilateral active straight leg raise with the knee extended until pain occurs
After pain occurs, the patient flexes the knee
Positive Finding:
Pain in the spine and possibly radiating into lower extremity
Pain relieved when patient flexes the knee
Implications:
Nerve root impingement secondary to bulging of the intervertebral disc or bony entrapment; irritation of dural sheath; irritation of meninges

7. Clinical Evaluation Nerve Root Impingement Tests:
Kernig/Brudzinski Test:
Patient actively flexes the cervical spine (lifts the head)
Hip unilaterally flexed (no more than 900)
Knee than flexed to no more than 900
(+) ↑ pain with neck and hip flexion; pain relieved when knee is flexed

8. Clinical Evaluation Nerve Root Impingement Tests:
Unilateral Straight Leg Raise Test (Lasegue Test):
Test Position:
Patient supine, examiner standing at tested side with the distal hand around the subject’s heel and proximal hand on subject’s distal thigh (anterior) – maintains knee extension
Action:
Examiner slowly raises the leg until pain/tightness noted or full ROM is obtained
Slowly lower the leg until the pain or tightness resolves, at which point dorsiflex the ankle and have subject flex the neck

9. Clinical Evaluation Straight Leg Raise Test: Positive Findings:
Leg and/or low back pain occurring with DF and or neck flexion is indicative of dural involvement and/or sciatic nerve irritation
Lack of pain reproduction with DF and/or neck flexion is indicative of hamstring tightness or SI pathology

10. Clinical Evaluation Nerve Root Impingement Tests:
Well Straight Leg Raising Test:
Can be used to differentiate between sciatic nerve irritation or a herniated intervertebral disc that is irritating the nerve root
Test Position:
Patient supine, examiner standing at unaffected side; one hand grasps under the heel while other is placed on anterior thigh to stabilize the leg in extension

11. Clinical Evaluation Well Straight Leg Raise Test: Action:
Examiner raises the leg by flexing the hip until discomfort is reported (knee kept in full extension)
Positive Finding:
Pain is experienced on the side opposite that being raised

12. Clinical Evaluation Nerve Root Impingement Tests: Slump Test:
Test Position:
Patient sits over edge of table; examiner is at side of patient
Action:
(1) Patient slumps forward along thoracolumbar spine, rounding the shoulders while keeping cervical spine neutral
(2) Patient flexes cervical spine; Clinician holds patient in this position
(3) Knee is actively extended
(4) Ankle is actively dorsiflexed
(5) Repeat on opposite side

13. Clinical Evaluation Slump Test: Positive Findings: Implications:
Sciatic pain or reproduction of other neurological symptoms
Implications:
Impingement of the dural lining, spinal cord, or nerve roots
Note: Patient performs ACTIVE knee extension and dorsiflexion

14. Clinical Evaluation Femoral Nerve Stretch Test:
Tests for nerve root impingement at L2, L3, L4
Test position:
Patient prone with a pillow under the abdomen; examiner at side of patient
Action:
Examiner passively extends hip while keeping knee flexed to 900
Positive test:
Pain in anterior and lateral thigh

15. Clinical Evaluation Single Leg Stance Test: Test position: Action:
Patient standing with body weight evenly distributed between the 2 feet; examiner stands behind pt.
Action:
Patient lifts one leg, then places the trunk in hyperextension; examiner may assist
Positive test:
Pain in lumbar spine or SI area

16. Clinical Evaluation Single Leg Stance Test: Implication: Comments:
Shear forces are placed on pars interarticularis by iliopsoas pulling the vertebrae anteriorly
Comments:
Unilateral fracture – pain when opposite leg raised
Bilateral fractures – pain with either leg being fractured

17. Clinical Evaluation Sacroiliac Joint Stress Test: Test position:
Subject supine; examiner stands next to subject and with arms crossed, places heel of both hands on the subject’s ASISs
Action:
Examiner applies outward and downward pressure with the heels of both hands
Positive finding:
Unilateral pain at SI joint or in gluteal/leg region is indicative of anterior SI ligament sprain

18. Clinical Evaluation Sacroiliac Joint Stress Test: Test position:
Subject side-lying; examiner stands next to patient and places both hands (one on top of the other) directly over the subject’s iliac crest
Action:
Apply downward pressure
Positive finding:
Increased pain indicative of SI pathology (possible involvement of posterior SI ligament)

19. Clinical Evaluation Sacroiliac Joint Stress Test: Test position:
Subject lying supine; examiner places both hands on lateral aspect of subject’s iliac crests
Action:
Apply inward and downward pressure
Positive finding:
Increased pain indicative of SI pathology (possibly involving posterior SI ligaments)

20. Clinical Evaluation Patrick or FABER Test: Test position: Action:
Subject supine
Action:
Examiner passively flexes, abducts, and externally rotates the involved leg until the foot rests on the top of the knee of uninvolved lower extremity; examiner slowly abducts the involved lower extremity towards the table
Positive test:
Involved lower extremity does not abduct below level of uninvolved side
SI pathology, iliopsoas tightness