Lumbopelvic Special Tests Overview
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Questions and Answers

Which test involves the patient lying supine with the therapist applying force to both limbs?

  • Compression
  • Thigh Thrust
  • Sacral Thrust
  • Gaenslen’s (correct)

    • What is a positive sign of the Distraction test regarding the indication of SIJ pathology?

  • Decreased flexibility in the lower back
  • Increased mobility in the hip joint
  • Improved range of motion
  • Reproduction of pain symptoms (correct)

    • In the Thigh Thrust test, what position is the patient's involved side hip maintained in?

  • Flexed to 90 degrees (correct)
  • Extension
  • Neutral
  • Abduction

    • During which test does the therapist stand behind the patient while applying force through the pelvis?

    <p>Compression (D)</p> Signup and view all the answers

    What structure is primarily involved in the tests described in the content?

    <p>Sacroiliac joint (C)</p> Signup and view all the answers

    Which of the tests involve the patient being in a prone position?

    <p>Sacral Thrust (D)</p> Signup and view all the answers

    Which test requires the therapist to apply posterior and lateral pressure to the ASIS bilaterally?

    <p>Distraction (C)</p> Signup and view all the answers

    In which position is the patient during the Gaenslen's test?

    <p>Supine (A)</p> Signup and view all the answers

    What does a positive result on the one-leg standing (stork standing) lumbar extension test indicate?

    <p>Pars interarticularis fracture (A)</p> Signup and view all the answers

    In the Gillet (stork) test, what is suggested if the PSIS on the ipsilateral side moves minimally or superiorly?

    <p>Hypomobile or blocked SI joint (A)</p> Signup and view all the answers

    What do asymmetrical medial malleoli indicate in the functional limb length test?

    <p>Anterior or posterior innominate (D)</p> Signup and view all the answers

    Where does a patient point to if the Fortin finger test indicates SI joint pain?

    <p>Slightly inferior and medial to the PSIS (D)</p> Signup and view all the answers

    Which test is not typically included in Laslett’s Cluster of SI joint pain provocation tests?

    <p>Gaenslen’s (A)</p> Signup and view all the answers

    What is indicated by three positive results in a cluster of SIJ pain provocation tests?

    <p>+LR of 4.29 (D)</p> Signup and view all the answers

    Which test is indicated by the reproduction of patient's symptoms due to lumbar facet joint involvement?

    <p>Quadrant Test (D)</p> Signup and view all the answers

    What does it mean if in the functional limb length test, the medial malleoli move from symmetrical to asymmetrical when the patient sits up?

    <p>Indicative of anterior or posterior innominate (D)</p> Signup and view all the answers

    What does a positive Sacral Thrust test indicate?

    <p>SIJ pathology (A)</p> Signup and view all the answers

    What symptom indicates a positive Prone Instability Test?

    <p>Pain lessens with feet lifted (D)</p> Signup and view all the answers

    In which test does the therapist apply compression to the pelvis to assess motor control deficits?

    <p>Active Straight Leg Raise (B)</p> Signup and view all the answers

    What is indicated by a positive Passive Lumbar Extension Test?

    <p>Lumbar discomfort and heaviness (A)</p> Signup and view all the answers

    In the Aberrant Motion test, what kind of motion indicates motor control impairments?

    <p>Thigh walking and deviation from midline (C)</p> Signup and view all the answers

    What happens during the Active SLR test to indicate instability?

    <p>Pain decreases with compression (D)</p> Signup and view all the answers

    What action is performed by the therapist in a Prone Instability Test?

    <p>Applying force through the spinous process (D)</p> Signup and view all the answers

    Which test is conducted with the patient in a standing position to identify dynamic instability?

    <p>Aberrant Motion (C)</p> Signup and view all the answers

    Which special test assesses nerve mechanosensitivity by having the patient slump forward, tuck their chin to their chest, and then extend their knee?

    <p>Slump Test (C)</p> Signup and view all the answers

    During a Straight Leg Raise test, what action confirms a positive result indicating nerve mechanosensitivity?

    <p>Reproduction of symptoms in dorsiflexion and reduction in plantarflexion (A)</p> Signup and view all the answers

    Which special test helps identify a space-occupying lesion, such as a large disc herniation?

    <p>Crossed Straight Leg Raise (C)</p> Signup and view all the answers

    What is the primary purpose of lumbopelvic special tests?

    <p>To confirm or refute a working hypothesis developed during the patient examination (B)</p> Signup and view all the answers

    Which special test involves the patient extending, laterally flexing, and rotating to the side of pain?

    <p>Quadrant (C)</p> Signup and view all the answers

    During the Straight Leg Raise test, the therapist should monitor the patient's response while performing which action?

    <p>Passive flexion of the hip with the knee extended and ankle dorsiflexed (D)</p> Signup and view all the answers

    Which statement accurately reflects the use of special tests in musculoskeletal care?

    <p>They should be used as part of a comprehensive clinical picture (C)</p> Signup and view all the answers

    Besides Slump Test and Straight Leg Raise, which test also evaluates nerve mechanosensitivity?

    <p>Crossed Straight Leg Raise (Well Leg Raise) (C)</p> Signup and view all the answers

    Flashcards

    Lumbopelvic Special Tests

    Tests designed to assess specific tissues in the lumbopelvic region.

    Nerve Mechanosensitivity

    A condition indicated by reproduction of familiar symptoms during nerve special tests.

    Slump Test

    A nerve special test indicating mechanosensitivity through a specific seated position and movement.

    Straight Leg Raise

    A nerve special test performed with the patient supine to assess nerve mechanosensitivity in the leg.

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    Crossed Straight Leg Raise

    Test for nerve mechanosensitivity indicating a space-occupying lesion; performed on the uninvolved leg.

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    Joint Special Tests

    Tests designed to assess specific joints for mobility and pain provocation.

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    Quadrant Test

    A joint special test involving extension, lateral flexion, and rotation to the side of pain.

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    One-Leg Standing Test

    A joint special test (Stork Standing Lumbar Extension) assessing stability and pain in a standing position.

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    Sacral Thrust

    Force applied through the sacrum towards the table to assess SIJ.

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    Positive Response

    Reproduction of familiar pain during sacral thrust.

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    SIJ Pathology

    Indicated by pain response during sacral thrust test.

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    Prone Instability Test

    Tests instability by assessing pain when legs are on vs off the floor.

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    Active Straight Leg Raise (SLR)

    Assesses motor control by lifting legs with compression to pelvis.

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    Aberrant Motion

    Abnormal movements when returning to standing after flexion.

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    Passive Lumbar Extension Test

    Tests lumbar pain by lifting legs passively while prone.

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    Motor Control Deficits

    Indicated by difficulty in leg raises or abnormal movements.

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    Posterior and Lateral Pressure

    Therapist applies pressure to the patient's ASIS; positive if pain reproduces.

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    Thigh Thrust Test

    Patient supine; hip at 90 degrees. Therapist applies force through thigh; positive if pain reproduces.

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    Gaenslen’s Test

    Patient supine with one leg off plinth and other knee to chest; therapist pulls limbs; positive if pain occurs.

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    Compression Test

    Patient side-lying with affected side up. Therapist applies downward force; positive if pain occurs.

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    Sacral Thrust Test

    Patient prone; therapist stands to the side; applies force to sacrum; positive if pain reproduces.

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    Sacroiliac Joint Pathology

    Indicated by reproduction of familiar pain during various tests.

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    ASIS

    Anterior Superior Iliac Spine; area where pressure is applied in tests.

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    Laslett et al Study

    Research validating sacroiliac provocation tests for diagnosing pain.

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    Gillet Test

    Test assessing PSIS movement when lifting a knee; indicates SI joint mobility.

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    Functional Limb Length Test

    Analysis of symmetry between medial malleoli when sitting up; indicates innominate issues.

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    Fortin Finger Test

    Patient points to pain near the PSIS; indicates SI joint pathology.

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    Pain Provocation Tests

    Cluster of tests stressing SI joint to assess pain; identifies joint pathology.

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    Distraction Test

    Patient is supine, trying to ascertain SI joint pain through distraction forces.

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    Study Notes

    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

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    Lumbopelvic Special Tests PDF

    Description

    This quiz focuses on understanding and performing lumbopelvic special tests, essential for evaluating specific tissues in musculoskeletal care. Participants will review various nerve and joint special tests, enhancing their clinical skills and knowledge. Master these tests for comprehensive patient assessment!

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