Lumbopelvic Special Tests PDF

Lumbopelvic Special Tests Adam Squires PT, DPT, Cert SMT, Cert DN Board Certified Specialist in Orthopedic Physical Therapy  Objectives Demonstrate understanding of and ability to perform lumbopelvic special tests.  Background Information Tests designed...

Lumbopelvic Special Tests Adam Squires PT, DPT, Cert SMT, Cert DN Board Certified Specialist in Orthopedic Physical Therapy  Objectives Demonstrate understanding of and ability to perform lumbopelvic special tests.  Background Information Tests designed to exam specific tissues Sometimes called “tissue-specific tests” Used to confirm or refute the working hypothesis established during history and general exam Hundreds of special tests across musculoskeletal care Cannot teach all of them Varying degrees of specificity and sensitivity Should never be used in isolation Part of the complete clinical picture Special Tests  Overview Nerve Intervertebral Joints SI Joint Stability/Motor Control Nerve 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 sitting in front of patient Action – Patient tucks chin to chest and slumps forward. Ankle dorsiflexion then knee extension is performed either actively or passively. Positive – Reproduces patient’s familiar symptoms Indicates – Nerve Mechanosensitivity Slump Test  Straight Leg Raise Position – Patient supine. Therapist standing on side to be tested Action – Keeping knee straight and ankle dorsiflexed, hip is passively flexed. Once symptoms or tension is felt, plantarflex ankle and monitor response. Positive – Reproduction of patient’s symptoms in DF and reduction in PF Indicates – Nerve Mechanosensitivity Straight Leg Raise  Crossed Straight Leg Raise AKA Well Leg Raise Test Position – Same as SLR Action – Same as SLR but to uninvolved LE Positive – Same as SLR Indicates – Space-occupying lesion (e.g. large disc herniation) Crossed Straight Leg Raise Joint Special Tests  Joint Special Tests Quadrant One-Leg Standing (Stork Standing) Lumbar Extension Test SI Joint Position and Pain Provocation https://creakyjoints.org/living-with-arthritis/symptoms/arthritis-in-back/  Quadrant Position – Patient standing. Therapist standing behind Action – Patient extends, laterally flexes, and rotates to side of pain. “Slide your hand down the back of your leg.” If no pain, therapist applies overpressure. Positive – Reproduction of patient’s symptoms. Indicates – Lumbar facet joint involvement Quadrant  One-Leg Standing (Stork Standing) Lumbar Extension Test Position – Patient standing with one leg in the air. Therapist standing behind patient. Action – Patient actively extends lumbar spine. “Lean back as far as you can without falling.” Positive – Reproduction of pain. Indicates – Pars interarticularis fracture One-Leg Standing (Stork Standing) Lumbar Extension Test  SI Joint Special Tests Pain provocation or joint position/movement tests Joint position/movement tests Gillet Test 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 patient and palpating bilateral PSIS Action – Patient lifts one knee up toward chest. Therapist assesses movement of PSIS. Positive – PSIS on ipsilateral side moves minimally or superiorly (normal motion is PSIS moves inferiorly) Indicates – Hypomobile or “blocked” SI joint Gillet (Stork) Test  Functional Limb Length Test AKA Supine to Sit Test Position – Patient supine with LEs extended. Patient standing at patient’s feet, palpating just inferior to the medial malleoli and assesses symmetry. Action – Patient sits up. Therapist continues to palpate medial malleoli and assesses movement on each side. Positive – Medial malleoli are not symmetrical or move from symmetrical to asymmetrical Indicates – Either anterior or posterior innominate (see next slide) Functional Limb Length Test  Fortin Finger Test Position – Patient standing. Therapist behind. Action – Ask the patient to point to the area of pain. Positive – Patient points slightly inferior and medial to the PSIS Indicates – SI Joint pain/pathology https://aleviospine.com/si-joint-pain/  Pain Provocation Tests Cluster of tests attempting to stress the SIJ 3/5 results in +LR of 4.29 Distraction (ASIS) Thigh Thrust Gaenslen’s – sometimes left out of cluster Compression (ASIS) Sacral Thrust  Distraction Position – Patient supine, LEs extended. Therapist standing to the side Action – Therapist applies posterior and lateral pressure to the patient’s ASIS bilaterally Positive – Reproduction of patient’s familiar pain Indicates – SIJ pathology  Distraction Laslett et al 2005 Diagnosing painful sacroiliac joints: A validity study of a McKenzie evaluation and sacroiliac provocation tests  Thigh Thrust Position – Patient supine with involved side hip flexed to 90 deg. Therapist standing on same side. Action – Therapist places hand under sacrum with fingers pointing to the spine. Force applied through the thigh toward the table Positive – Reproduction of familiar pain Indicates – SIJ Pathology  Thigh Thrust Laslett et al 2005 Diagnosing painful sacroiliac joints: A validity study of a McKenzie evaluation and sacroiliac provocation tests  Gaenslen’s Position – Patient supine with uninvolved side LE off plinth and involved side knee to chest. Therapist standing on the uninvolved side. Action – Therapist applies force to both limbs into further hip extension and hip flexion. Positive – Reproduction of familiar symptoms on the involved side Indicates – SIJ pathology  Gaenslen’s Laslett et al 2005 Diagnosing painful sacroiliac joints: A validity study of a McKenzie evaluation and sacroiliac provocation tests  Compression Position – Patient side-lying with involved side up. Therapist standing behind patient. Action – Force is applied through the pelvis toward the table Positive – Reproduction of familiar symptoms Indicates – SIJ pathology  Compression Laslett et al 2005 Diagnosing painful sacroiliac joints: A validity study of a McKenzie evaluation and sacroiliac provocation tests  Sacral Thrust Position – Patient prone. Therapist standing to the side. Action – Force applied through the sacrum toward the table Positive – Reproduction of familiar pain Indicates – SIJ pathology  Sacral Thrust Laslett et al 2005 Diagnosing painful sacroiliac joints: A validity study of a McKenzie evaluation and sacroiliac provocation tests Stability/Motor Control Special Tests  Stability/Motor Control Prone (Segmental) Instability Test Active Straight Leg Raise Aberrant motion Passive Lumbar Extension Test https://www.dmoose.com/blogs/workout-training/10-signs-of-weak-core-strength  Prone Instability Test Position – Patient prone with LEs off the edge of the plinth and resting on the floor. Therapist stands to one side. Action – Therapist applies force through the spinous process of the spine toward the floor. Force is released. Patient then lifts legs off the floor and the force is reapplied by the therapist. Positive – Pain with feet on the floor and less or no pain with feet lifted. Indicates – Instability that is reversed by muscle contraction Prone Instability Test  Active SLR Position – Patient supine with LEs extended. Therapist standing on one side. Action – Patient actively lifts one LE and puts it back down then repeats with the contralateral side. Therapist asks for any reproduction of pain or more difficulty with one side compared to the other. Leg lift is repeated while therapist provides compression to the pelvis. Positive – Less pain or easier to raise with compression of pelvis. Indicates – Motor control deficits/instability Active SLR  Aberrant Motion Position – Patient standing. Therapist standing. Action – Patient is asked to flex forward as far as possible then return to standing. Positive – Patient demonstrates abnormal movements while returning to standing position (e.g. thigh walking, deviation from midline, “catch” at mid-point of flexion). Indicates – Motor control impairments/dynamic instability Aberrant Motion https://www.ijssurgery.com/content/17/5/728  Passive Lumbar Extension Test Position – Patient prone. Therapist standing at patient’s feet Action – Therapist passively lifts and extends both LEs at the same time approximately 1 foot off the bed. While maintaining extension, therapist gently pulls the legs Positive – Pain in the lumbar region, heavy feeling in the low back. Indicates – Lumbar instability Passive Lumbar Extension Test  Objectives Demonstrate understanding of and ability to perform lumbopelvic special tests. Questions