TESTS FOR LUMBAR SPINE

Pt. Name: Occupation: 1-STRAIGHT LEG RAISE Pain in the raised leg usually following the Distribution of sciatic nerve anywhere b/w 30-80 degrees
nerve.

Date: Diagnosis:

Age:

Remarks

Sciatic Nerve Compression or Hamstring Tightness now perform Braggrads test or Lasegue test to differentiate b/w sciatic irritation and hamstring tightness

2-BRAGGRADS TEST : Low er the raised leg a little below the point w here pain is felt and dorsiflex the foot to stretch the sciatic Recurrence of pain 3-SLR with neck flexion Pain with neck flexion Pain doesnt with neck flexion 4-Crossed SLR Pain in opposite leg 5-BILATERAL SLR Pain before 70 degree Pain after 70 degrees Lesion in Sacroiliac jt. Lesion in Lumbar Spine SOL( e.g. herniated disc), large intervertebral disc protrusion medial to nerve root. Suggest sciatic nerve irritation

Stretching of dura mater Lesion in hamstring area (hamstring Tightness) or sacroiliac or lumbosacral jts.

6-ERICKSONS TEST: (pt side lying w ith side being tested in contact w ith the bed; both hips and knees are extended w ith one leg on
top of the other. Examiner applies dow nward pressure over the greater trochanter.)

Pain over the sacroiliac area

the leg)

Sacroiliac pathology as in sacroiliitis

7-OBERS TEST: (Pt in side lying. Maximally abduct the hip and flex the knee w hile the hip is neutral or in slight extension then release Continued abduction even after letting go of the leg.
unaffected leg flexed while he extends the opposite leg.

Iliotibial band tightness

8-THOMAS TEST: (Pt in supine, place one hand under pts back, flex both hips and observe loss of lumbar lordosis, pt keep The hip cant be fully extended so that an Angle is formed b/w the thigh and the bed which is measured and represent the degree of hip flexion contracture some pts may attempt to correct this angle by arching the back so this should be noted by the examiner.
for 45 to 60 sec.)

Detect hip flexion contractures & also to evaluate range of hip flexion.

9-PRONE KNEE BENDING (Passively flexes the knee as far as possible so that the pts heel rest agains t the buttock maintained Unilateral Pain in lumbar area Pain in anterior thigh L2 & L3 Nerve Root Lesion Tight Quadriceps Muscles

10-Brudzinski test :( pt is supine, place his hands behind the head, and then actively flex the head onto the chest. The extended leg 2
is raise actively by flexing the hip until pain is felt. The pt then flexes the knee and the pain w ill disappear)

Pain in the back

Meningeal irritation, nerve root involvement Dural irritation. Meningeal irritation

Flexion of the hip and knee

11-Kernigs Test: ( pt is supine, flexes one of the pts hip and knee and then straightens it.) Pain at the back of the neck with or without resistance felt on extension Meningeal irritation

Pain at lumbosacral area

Disc pathology

12-Milgrams Test: (Used in disorders of the vertebral discs, Pt lies supine, ask the pt to keep both feet raised about tw o inches from
the table, w ith knees kept straight for about 30 sec.)

Pain in lumbosacral area

Increased Intrathecal pressure

13-Naffzigers Test: (Used in disorders of the vertebral discs, Pt lies supine; the examiner gently compresses the jugular veins for
approximately 10 seconds. The pts face w ill flush, then asked to cough).

Pain due to cough in LB

The spinal theca is compressed, leading to in Intrathecal pressure.

14-Femoral Nerve Traction Test :( pt lies n unaffected side w ith unaffected limb flexed slightly at the hip and knee. The pts

back should be straight, not hyper extended. The pts head should be slightly flexed. The examiner grasps the patients affected or painful limb and extends the knee w hile gently extending hip approximately 15 degrees. The pts knee then flexed on the affected side, this movt further stretches the femoral nerve.)

Pain radiate down ant. Thigh

Mid lumbar area(L2-L4) involvement

Pain in the groin & hip that radiates Along the anterior medial thigh

L3 nerve root problem

Pain extending to the midtibia

L4 nerve root involvement

15-Bowstring test or Cram test or Popliteal pressure sign :( The examiner carries out an SLR test, and pain
results. The knee is slightly flexed (20 degree), reducing the symptoms; the thigh remains in the same position. Thumb or finger pressure is then applied to the Popliteal area to reestablish the painful radicular symptoms)

Pain Tension/pressure on sciatic nerve 16-Sciatic Tension Test :( pt sit w ith the back straight w ithout tw isting & is then told not to move but to support or brace the body
w ith the arms. The knee of the affected limb is passively extended to the point of pain. It is then low ered slightly below the point of pain and held clasped b/w the examiners knee w hile the examiner presses the fingers of both hands into the popliteal space.)

Pain

Pressure or tension on sciatic nerve

17-Flip sign :( pt is in sitting; examiner extends the pts knee and looks for symptoms. The pt is then placed supine and a unilateral SLR
is performed for the sign to be positive both test must cause pain, if one of them is negative then there is a suspicion of problem in low er lumbar spine)

Pain in sciatic nerve distribution

Pressure or tension on sciatic nerve

18-Gluteal Skyline Test :( pt is relaxed in prone w ith the head straight and arms by the sides. The examiner stands at pts feet and
observes the buttocks from the level of the buttocks affected gluteal muscle w ill be flat as a result of atrophy. The pt is asked to contract the muscle. The affected side may show less contraction or no contraction)

No contraction or less contraction

Indicate damage to inferior gluteal nerve or pressure on the L5, S1 or S2 nerve roots

19-Stoop Test :( pt w alks briskly for 1 minute, pain w ill ensue in the buttock and low er limb w ithin a distance of 50 m.

To relieve the pain pt flexes forward. These symptoms may also be relieved w hen pt is sitting and forward flexing. If flexion does not relieve the symptoms, the test is negative. Extension may also be used to bring the symptoms back.)

Pain

Indicates intermittent claudication

20-Bicycle Test of Van Gelderen :( pt is seated n an exercise bicycle and is asked to pedal against resistance. .The patient
starts pedaling w hile leaning backw ard to accentuate the lumbar lordosis. If pain into the buttock and posterior thigh occurs followed by tingling in the affected lower extremity, the first part of the test is positive. The pt is then asked to lean forward while continuing to pedal. If the pain subsides over a short period of time, the second part of the test is positive; if the patient sits upright again, the pain returns.)

Pain

Indicates intermittent claudication

21-Burns Test :( pt is asked to kneel on a chair and then bend forward to touch the floor w ith the fingers) Overbalances or unable to perform Indicates malingering

22-Sign of the Buttock :( pt lies supine and the examiner performs a passive unilateral SLR test. If there is unilateral restriction the
examiner then flexes the knee to see w hether hip flexion es. If the problem is in the Lumbar spine, hip flexion w ill . This indicate negative sign for buttock test.)

Hip flexion doesnt .when knee is flexed The pt should also have noncapsular pattern of Hip.

Disease in Buttock (bursitis, tumor or abscess

Prepared by M Faisal Qureshi