Thoracic and Lumbar Spine
Special Tests and
Pathologies
Clinical Evaluation
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Spring Test:
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Test Positioning:
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Action:
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Subject is prone
Examiner stands with thumbs or hypothenar eminence over the
spinous process of a lumbar vertebrae
Apply a downward “springing” force through the spinous
process of each vertebrae to assess anterior-posterior motion
Positive Finding:
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Increases or decreases in motion at one vertebrae compared to
another (hypermobility or hypomobility)
Clinical Evaluation
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Nerve Root
Impingement:
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Narrowing of
intervertebral foramen:
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Stenosis
Facet joint degeneration
Herniated intervertebral
disc
Clinical Evaluation
Clinical Evaluation
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Nerve Root Impingement Tests:
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Milgram Test:
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Test Position:
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Action:
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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:
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Patient supine, examiner at feet of the patient
Patient unable to hold position, cannot lift the leg, or has pain
with test
Implications:
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Intrathecal or extrathecal pressure causing an intervertebral disc
to place pressure on a lumbar nerve root
Clinical Evaluation
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Nerve Root Impingement Tests:
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Kernig’s Test:
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Test Position:
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Action:
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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:
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Patient supine, examiner at side of patient
Pain in the spine and possibly radiating into lower extremity
Pain relieved when patient flexes the knee
Implications:
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Nerve root impingement secondary to bulging of the
intervertebral disc or bony entrapment; irritation of dural sheath;
irritation of meninges
Clinical Evaluation
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Nerve Root
Impingement Tests:
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Kernig/Brudzinski Test:
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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
Clinical Evaluation
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Nerve Root Impingement Tests:
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Unilateral Straight Leg Raise Test (Lasegue
Test):
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Test Position:
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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:
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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
Clinical Evaluation
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Straight Leg Raise
Test:
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Positive Findings:
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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
Clinical Evaluation
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Nerve Root Impingement Tests:
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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:
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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
Clinical Evaluation
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Well Straight Leg
Raise Test:
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Action:
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Examiner raises the leg
by flexing the hip until
discomfort is reported
(knee kept in full
extension)
Positive Finding:
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Pain is experienced on
the side opposite that
being raised
Clinical Evaluation
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Nerve Root Impingement Tests:
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Slump Test:
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Test Position:
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Patient sits over edge of table; examiner is at side of patient
Action:
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(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
Clinical Evaluation
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Slump Test:
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Positive Findings:
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Sciatic pain or
reproduction of other
neurological symptoms
Implications:
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Impingement of the
dural lining, spinal cord,
or nerve roots
Note: Patient performs ACTIVE knee
extension and dorsiflexion
Clinical Evaluation
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Femoral Nerve Stretch Test:
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Tests for nerve root
impingement at L2, L3, L4
Test position:
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Action:
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Patient prone with a pillow under
the abdomen; examiner at side of
patient
Examiner passively extends hip
while keeping knee flexed to 900
Positive test:
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Pain in anterior and lateral thigh
Clinical Evaluation
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Single Leg Stance Test:
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Test position:
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Action:
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Patient standing with body weight evenly distributed
between the 2 feet; examiner stands behind pt.
Patient lifts one leg, then places the trunk in
hyperextension; examiner may assist
Positive test:
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Pain in lumbar spine or SI area
Clinical Evaluation
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Single Leg Stance Test:
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Implication:
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Shear forces are placed on
pars interarticularis by
iliopsoas pulling the
vertebrae anteriorly
Comments:
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Unilateral fracture – pain
when opposite leg raised
Bilateral fractures – pain
with either leg being
fractured
Clinical Evaluation
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Sacroiliac Joint Stress Test:
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Test position:
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Action:
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Subject supine; examiner stands
next to subject and with arms
crossed, places heel of both
hands on the subject’s ASISs
Examiner applies outward and
downward pressure with the
heels of both hands
Positive finding:
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Unilateral pain at SI joint or in
gluteal/leg region is indicative of
anterior SI ligament sprain
Clinical Evaluation
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Sacroiliac Joint Stress Test:
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Test position:
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Action:
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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
Apply downward pressure
Positive finding:
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Increased pain indicative of SI
pathology (possible involvement
of posterior SI ligament)
Clinical Evaluation
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Sacroiliac Joint Stress Test:
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Test position:
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Action:
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Subject lying supine; examiner
places both hands on lateral
aspect of subject’s iliac crests
Apply inward and downward
pressure
Positive finding:
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Increased pain indicative of SI
pathology (possibly involving
posterior SI ligaments)
Clinical Evaluation
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Patrick or FABER Test:
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Test position:
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Action:
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Subject supine
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:
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Involved lower extremity does not
abduct below level of uninvolved
side
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SI pathology, iliopsoas tightness