Lumbopelvic Special Tests Overview

Lumbopelvic Special Tests

• These tests are designed to evaluate specific tissues
• They are sometimes called "tissue-specific tests"
• They are used to confirm or refute hypotheses from the patient history and general exam
• Hundreds of tests exist in musculoskeletal care
• Individual tests should not be used in isolation
• The tests should be part of a complete clinical picture

Objectives

• Demonstrate understanding of and ability to perform lumbopelvic special tests

Overview

• Nerve special tests
• Intervertebral joint special tests
• SI joint special tests
• Stability/motor control special tests

Nerve Special Tests

• Slump Test
• Straight Leg Raise
• Crossed Straight Leg Raise (Well Leg Raise)

Slump Test

• Position: Patient seated, therapist standing or seated in front.
• Action: Patient tucks chin to chest then slumps forward. Ankle dorsiflexion then knee extension is performed actively or passively.
• Positive: Reproduces patient's familiar symptoms
• Indicates: Nerve mechanosensitivity

Straight Leg Raise

• Position: Patient supine, therapist standing on side to be tested.
• Action: Keep the knee straight and ankle dorsiflexed while the hip is passively flexed. Once symptoms or tension is felt, plantarflex the ankle and monitor the response.
• Positive: Reproduction of the patient's symptoms in dorsiflexion and reduction in plantarflexion.
• Indicates: Nerve mechanosensitivity

Crossed Straight Leg Raise (Well Leg Raise Test)

• AKA Well Leg Raise Test.
• Position: Same as SLR but to the uninvolved leg.
• Action: Same as SLR
• Positive: Same as SLR
• Indicates: Space-occupying lesion (e.g., large disc herniation)

Joint Special Tests

• Quadrant
• One-Leg Standing (Stork Standing): Lumbar Extension Test
• SI Joint Position and Pain Provocation

Quadrant Test

• Position: Patient standing, therapist behind.
• Action: Patient extends, laterally flexes, and rotates to the side of pain; therapist slides hand down the back of the leg. If no pain, therapist applies overpressure.
• Positive: Reproduction of the patient's symptoms.
• Indicates: Lumbar facet joint involvement

One-Leg Standing (Stork Standing) Lumbar Extension Test

• Position: Patient standing with one leg in the air, therapist standing behind.
• Action: Patient actively extends the lumbar spine as far as they can without falling.
• Positive: Reproduction of pain.
• Indicates: Pars interarticularis fracture

SI Joint Special Tests

• Pain provocation or joint position/movement tests
  • Gillet
  • Functional Limb Length Test
  • Pain Provocation
  • Fortin Finger Test (point sign)
  • Laslett's Cluster - Thigh thrust, (ASIS) Distraction, Gaenslen's, (ASIS) compression, Sacral thrust

Gillet (Stork) Test

• Position: Patient standing, therapist seated or kneeling behind and palpating bilateral PSIS
• Action: Patient lifts one knee up towards chest; therapist assesses PSIS movement
• Positive: Ipsilateral PSIS moves minimally or superiorly (normal motion is inferior movement)
• Indicates: Hypomobile or "blocked" SI joint

Functional Limb Length Test

• AKA Supine-to-Sit Test
• Position: Patient supine with legs extended; therapist standing at feet palpating just inferior to medial malleolus and assessing symmetry.
• Action: Patient sits up; therapist continues to palpate medial malleoli and assess movement
• Positive: Medial malleoli not symmetrical or move from symmetrical to asymmetrical
• Indicates: Anterior or posterior innominate

Fortin Finger Test

• Position: Patient standing, therapist behind.
• Action: Patient points to area of pain
• Positive: Patient points slightly inferior and medial to the PSIS
• Indicates: SI joint pain/pathology.

Pain Provocation Tests

• Cluster of tests attempting to stress the SIJ
  • Distraction
  • Thigh Thrust
  • Gaenslen's (sometimes left out)
  • Compression
  • Sacral Thrust

Distraction Test

• Position: Patient supine, legs extended; therapist standing to the side.
• Action: Therapist applies posterior and lateral pressure to both ASIS bilaterally
• Positive: Reproduction of patient's familiar pain
• Indicates: SIJ pathology

Thigh Thrust Test

• Position: Patient supine, involved side hip flexed to 90 degrees; therapist standing on the same side
• Action: Therapist places hand under sacrum with fingers on spine; force is applied through the affected thigh toward the table
• Positive: Reproduction of familiar pain
• Indicates: SIJ pathology.

Gaenslen's Test

• Position: Patient supine with the uninvolved side leg off plinth; involved knee to chest, therapist standing on the uninvolved side.
• Action: Therapist applies force to both limbs into further hip flexion and extension.
• Positive: Reproduction of familiar symptoms on the involved side
• Indicates: SIJ pathology

Compression Test

• Position: Patient side-lying with involved side up, therapist standing behind.
• Action: Force is applied through pelvis toward the table
• Positive: Reproduction of familiar symptoms
• Indicates: SIJ pathology

Sacral Thrust Test

• Position: Patient prone; therapist standing to the side
• Action: Force is applied through the sacrum toward the table
• Positive: Reproduction of familiar pain
• Indicates: SIJ pathology.

Stability/Motor Control Special Tests

• Prone (Segmental) Instability Test
• Active Straight Leg Raise
• Aberrant Motion
• Passive Lumbar Extension Test

Prone Instability Test

• Position: Patient prone, legs off the edge of the plinth, resting on floor; therapist standing to the side
• Action: Therapist applies force through the spinous process toward the floor, release, patient lifts legs off floor; force is reapplied.
• Positive: Pain with feet on floor, less or no pain with feet lifted.
• Indicates: Instability reversed by muscle contraction.

Active Straight Leg Raise

• Position: Patient supine, legs extended; therapist standing on one side
• Action: Patient actively lifts one leg, repeats with other leg, therapist asks for any more difficulty on one side compared to the other, repeats leg lift with compression of pelvis.
• Positive: Less pain or easier to raise with compression of pelvis.
• Indicates: Motor control deficits, instability

Aberrant Motion

• Position: Patient standing; therapist standing.
• Action: Patient flexes forward as far as possible and then returns to standing position
• Positive: Abnormal movements during return to standing (e.g. thigh walking, deviation from midline, catch at midpoint of flexion).
• Indicates: Motor control impairments/dynamic instability

Passive Lumbar Extension Test

• Position: Patient prone; therapist standing at patient's feet.
• Action: Therapist passively lifts both legs approximately 1 foot off the bed at the same time. While maintaining extension, therapist gently pulls the legs.
• Positive: Pain in lumbar region, heavy feeling in low back
• Indicates: Lumbar instability