PT10112: LEC8 - LUMBOSACRAL SPINE
Ma’am Kristina Devora | Second Shift, A.Y. 2021-2022
COURSE OUTLINE
I.
II.
III.
Head / Face Special Tests
A. Tests for CN VII
1. Chvostek Test
B. Tests for Cervical Muscle Strength
1. Craniocervical flexion test
C. Tests for Neurologic Dysfunction
1. Jackson’s compression test
2. Shoulder depression test
3. Scalene cramp test
4. Valsalva test
5. Brachial plexus compression test
D. Tests for UMNL
1. Romberg’s test
2. Lhermitte’s Sign
E. Tests for Vascular signs
1. Static vertebral artery test
2. Hautant’s test
3. Barre’s test
4. Undergburg’s test
F. Tests for Cervical Instability
1. Transverse ligament stress test
2. Lateral/Transverse Shear Test
3. Rotational Alar Ligament Stress
Test
G. Tests for Upper Cervical Spine
Mobility
1. Cervical flexion rotation test
2. Test for 1st rib mobility
Lumbar Spine
Special Tests for Lumbar Spine
A. Tests for Neurologic Dysfunction
Reminder: All components that are marked with the
symbol asterisk (*) are found on previous MSK lec
transes.
NOTE: Additional information from Magee is
colored in red
HEAD/FACE SPECIAL TESTS
Results
●
●
●
(+) if facial muscles twitch
(+) for CN VII pathology
If specifically Bell’s Palsy,
House-Brackman Facial Nerve
Grading may be used
Synkinesis
● Marin-Amat Syndrome/ Inverse Marcus
Gunn
○ Eye closure for each jaw opening
○ The Marin-Amat syndrome, a specific
form of intrafacial synkinesis, describes
the contraction of the orbicularis oculi
muscle with the movement of the lower
facial muscles
■ It is thought to develop primarily as
a result of aberrant regeneration of
nerve fibers after traumatic injury
and can be a sequela of Bell’s palsy
● Marcus Gunn Syndrome
○ Eye closure for each jaw closure
CERVICAL SPINE SPECIAL TESTS
Tests for CN VII
Tests for Cervical Muscle Strength
Chvostek Test
Craniocervical Flexion Test
Position
Description
●
PT taps the parotid gland
(masseter)
Position
●
AXALAN | DE LOS REYES | ICO | PASCUA | PIZARRO | ROSITA | TAMAYO | TOLOSA | TY
The patient lies in supine with
knees bent (crook lying) with
head and neck in midrange, and
1
PT10112: LEC8 - LUMBOSACRAL SPINE
Ma’am Kristina Devora | Second Shift, A.Y. 2021-2022
an inflatable pressure sensor is
placed under the cervical spine
Description
●
●
●
Results
●
●
Test for deep cervical flexors
In hook lying, pressure sensor
(at 20 mmHg) is placed under
the cervical spine
Flex the head in five graded
segments of increasing
pressure (22, 24, 26, 28, 30
mmHg) and holds each for 10
seconds with 10-second rest.
(N) = can increase pressure up
to 26-30 mmHg without
activation of superficial
muscles
(+) if cannot maintain the
pressure at 26mmHg
downward pressure on the
affected shoulder
Results
●
Position
Sitting
Description
●
Pt sits and rotates head to
affected side then pulls the
chin down into the clavicle
Results
●
(+) pain = trigger points on
scalene
(+) radicular signs = plexopathy
or TOS
●
Valsalva Test
Position
Description
●
●
Results
Jackson’s Compression Test
●
●
Position
Description
●
Rotation + compression
Results
●
(+) if pain radiates into the arm,
indicating pressure on nerve
root
Shoulder Depression Test
Position
●
Test position is the mechanism
of injury
Description
●
●
For brachial plexus lesions
Laterally flex head to
contralateral side then apply a
(+) pain on contralateral side =
nerve root irritation
(+) pain on ipsilateral side =
dural adhesion or hypomobile
joint capsule
Scalene Cramp Test
Tests for Neurologic Dysfunction
● Foraminal Compression / Spurling’s Test*
● Distraction Test*
● Upper Limb Tension Test*
● Shoulder Abduction / Relief Test*
● Jackson’s Compression Test
● Scalene Cramp Test
● Valsalva Test
● Tinel’s for Brachial Plexus*
● Brachial Plexus Compression Test
*found in Lec 6 Trans
●
Effect of increased pressure on
spinal cord
Deep breath, hold while bearing
down as if moving bowels
(+) if with pain d/t increased
intrathecal pressure
​This increased pressure within
the spinal cord usually results
from a space-occupying lesion,
such as a herniated disc, a
tumor, stenosis, or
osteophytes.
Brachial Plexus Compression Test
Position
Description
●
Squeeze the plexus between
the thumb and fingers
Results
●
Pain at the site is not
diagnostic; the test is positive
only if pain radiates into the
shoulder or upper extremity.
AXALAN | DE LOS REYES | ICO | PASCUA | PIZARRO | ROSITA | TAMAYO | TOLOSA | TY
2
PT10112: LEC8 - LUMBOSACRAL SPINE
Ma’am Kristina Devora | Second Shift, A.Y. 2021-2022
It is positive for mechanical
cervical lesions having a
mechanical component.
●
●
●
●
Tests for UMNL
●
●
Romberg’s test
Lhermitte’s sign
●
●
Romberg’s Test
●
Position
Standing
●
Description
●
Results
●
Pt stands with eyes closed for
20-30 sec
●
●
(+) if excessive sway or loses
balance
●
●
Lhermitte’s Sign
Position
Long leg sitting
Description
●
Passive neck flexion and hip
flexion with knees extended
simultaneously
Results
●
(+) if sharp pain on spine =
meningeal irritation, cervical
●
Soto-hall test
○ Active head flexion
○ If the patient actively flexes the head to the
chest while in the supine lying position
●
●
Results
Hautant’s Test
Position
Sitting
Description
1.
2.
Static Vertebral Artery Test
Position
Description
●
Provocative Positions in Sitting:
Provocative Positions in
Supine:
Sustained full neck and head
extension
Sustained full neck and head
rotation
Sustained full neck and head
rotation with extensio
(HALLPIKE MANEUVER)
Unilateral PA oscillation of C1-2
facets
Simulated mobilization /
manipulation position
●
Tests for Vascular Signs
● Vertebral Artery / Cervical Quadrant Test*
● Static Vertebral Artery Test
● Hautant’s Test
● Barre’s Test
● Underburg’s Test
● Naffziger’s Test*
*found in Lec 6 Trans
Sustained full neck and head
extension
Sustained full neck and head
rotation (BARRE- LIEOU SIGN)
Sustained full neck and head
rotation with extension
(DEKLEYN’S)
Provocative movement
positions
Quick head movement in
provocative position
Head still with sustained trunk
movement
Head still with repeated trunk
movement
Results
●
●
In sitting, pt flexes shoulder to
900 (EO) → (EC) for 10-30 secs
Add extension and rotation to
the head (EO) → (EC) for 10-30
secs
For number 1, loss of arm
position = non-vascular
For number 2, loss of arm
position = vascular
Barre’s Test
Position
Standing
Description
●
AXALAN | DE LOS REYES | ICO | PASCUA | PIZARRO | ROSITA | TAMAYO | TOLOSA | TY
In standing patient raises
shoulder to 900 flexion, elbow
3
PT10112: LEC8 - LUMBOSACRAL SPINE
Ma’am Kristina Devora | Second Shift, A.Y. 2021-2022
●
Results
●
straight, forearm supinated,
palms up and eye closed
Hold the position for 10-20
secs
(+) if arm slowly falls with
forearm pronation
Underburg’s Test
●
Lateral/ Transverse Shear Test
Position
Supine
Description
●
●
Position
Standing
Description
●
●
Results
●
●
●
In standing patient raises
shoulder to 900 flexion, elbow
straight, forearm supinated,
palms up and eye closed
Pt marches in place with the
head in extension and rotation
to one side
(+) if arm slowly falls with
forearm pronation
​The test is considered positive
if there is dropping of the arms,
loss of balance, or pronation of
the hands
a positive result indicates
decreased blood supply to the
brain.
(+) for atlantoaxial
hypermobility
Results
●
For atlantoaxial instability due
to odontoid dysplasia
PT places radial side of 2nd
MCP against the transverse
process of axis → PTs hands
are pushed together
(+) excessive shear or motion
(minimal pain is expected)
Rotational Alar Ligament Stress Test
Position
Sitting
Description
●
Results
●
●
PT stabilizes with wide-pinch
grip
PT passively rotates the head
Normal if 20-300 rotation
occurred without movement of
C2
●
(+) excessive motion
Tests for Cervical Instability
●
●
●
●
●
Sharp-Purser Test*
Transverse Ligament Stress Test
Lateral / Transverse Shear Test
Lateral Flexion Alar Ligament Stress Test*
Rotational Alar Ligament Stress Test
*found in Lec 6 Trans
Transverse Ligament Stress Test
Position
Supine
Description
●
●
Results
●
PT supports the occiput while
placing the index finger in the
space between the occiput and
C2 spinous process
Head and C1 is carefully lifted
anteriorly (10-20 secs)
(+) if with soft endfeel, muscle
spasm, dizziness, nausea,
paresthesia, nystagmus or
lump sensation in throat
Tests for Upper Cervical Spine Mobility
Cervical Flexion Rotation Test
Position
Supine
Description
●
●
Results
●
PT fully flexes cervical spine
then rotattes the head to the
left and to the right
Normal rotation should be at
450
(+) if hypermobile or
hypomobile
Tests for 1st Rib Mobility
Position
AXALAN | DE LOS REYES | ICO | PASCUA | PIZARRO | ROSITA | TAMAYO | TOLOSA | TY
4
PT10112: LEC8 - LUMBOSACRAL SPINE
Ma’am Kristina Devora | Second Shift, A.Y. 2021-2022
Description
Results
●
PT palpates 1st rib as patient
takes deep breaths
●
PT palpates 1st rib as neck is
laterally flexed
●
Note when the rib is felt to
move up
●
LUMBAR SPINE
●
●
●
●
●
●
Low Back Pain
Lower Crossed Syndrome
Disc Herniation
○ Protrusion
○ Prolapse
○ Extrusion
○ Sequestrated
Spondylosis
○ Lumbar degenerative disc disease
Spondylolysis
○ Defect in pars interarticularis
Vertebral displacement
○ Spondylolisthesis
○ Retrolistehsis
●
●
●
●
SPECIAL TESTS FOR LUMBAR SPINE
Tests for Neurologic Dysfunction
●
Slump Test*
●
●
Modifications:
Sitting Root Test → pt actively extends the knee one
at a time
Bechterewis Test → pt actively extends both knees
● Straight Leg Raising Test*
● Prone Knee Bend Test*
● Brudzinski-Kernig Test*
Pt supine with hands cupped behind the
head
1) Active neck flexion
2) Active SLR
3) at Sx, pt actively bends the knee
○ Pain is at 1) & 2) and disappearance of Sx at
3) is a (+) → meningeal irritation, nerve root
involvement, dural irritation
Naffziger’s Test*
○ PT gently compress jugular vein for ~10s →
face flushes
○ Pt is asked to cough
○ (+) pain is a Sx → intrathecal pressure
Valsalva Maneuver*
○ Pt is asked to hold breath and bear down as
if evacuating the bowels
○ (+) pain is a Sx → intrathecal pressure
Babinski Test*
Oppenheim Test*
Gluteal Skyline Test*
○ Pt is relaxed in prone with head straight and
arms by the sides
○ PT stands at pt’s feeta and observes the
buttocks from the level of the buttocks
○ (+) if affected gluteus maximus appears flat
d/t atrophy, affected side shows less
contraction
○ (+) for inferior gluteal nerve or pressure on
L5, S1, or S2 nerve roots
Femoral Nerve Traction Test
○ Sidelying on the unaffected side with slightly
flexed hip and knee
○ PT extends the hip with the knee in extension
(slight flexion) → move the knee into full
flexion
Bowstring Test / Cram or Popliteal Pressure Sign
○ 1) PT performs SLR
○ At angle of Sx, PT slightly flexes pt’s knee →
Sx reduces
○ 3) PT applies pressure
○ (+) affectation of Sciatic nerve if radicular Sx
is reproduced
○ May be done in sitting → Sciatic Tension test
/ Deyerle’s Sign
○
*found in Lec 7 Trans
SPECIAL TESTS FOR SACROILIAC REGION
AXALAN | DE LOS REYES | ICO | PASCUA | PIZARRO | ROSITA | TAMAYO | TOLOSA | TY
5
PT10112: LEC8 - LUMBOSACRAL SPINE
Ma’am Kristina Devora | Second Shift, A.Y. 2021-2022
Tests for Neurologic Dysfunction
Prone Knee Bending (Nachlas) Test
Position
Prone
Description
●
Results
●
●
●
●
The patient lies prone, and the
examiner flexes the knee so
that the heel is brought to the
buttocks.
Normally, this is used to test for
a tight rectus femoris, an upper
lumbar joint lesion, an upper
spine nerve root lesion, or a
hypomobile sacroiliac joint.
If pain is felt in the front of the
thigh before full range is
reached, the problem is in the
rectus femoris muscle.
If the pain is in the lumbar
spine, the problem is in the
lumbar spine, usually the L3
nerve root, espe- cially if these
are radicular symptoms.
If the problem is a hypomobile
sacroiliac joint, the ipsilateral
pelvic rim (ASIS) rotates
forward, usually before the
knee reaches 90° flexion.
passively flexes the patient’s
hip with the knee extended.
Results
●
●
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●
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Although the Lasègue sign is
primarily considered a test of
the neurological tissue around
the lumbar spine, this test also
places a stress on the
sacroiliac joints.
Pain occurring after 70° is
usually indicative of joint pain.
However, in hypermobile
persons, joint pain is often not
experienced until after 120° of
hip flexion.
Therefore, it is more important
to watch for the production of
the patient’s symptoms than for
the actual ROM.
In addition, the ROM obtained
should be compared with the
unaffected side.
If the examiner then does a
passive bilateral straight leg
raising (SLR) test in a similar
fashion, pain occurring before
70° is usually indicative of
sacroiliac joint problems.
If, when doing SLR, the pain in
the sacroiliac joint is unaltered
or decreases, the examiner may
suspect an anterior torsion.
If the pain increases in the
sacroiliac joint, a posterior
torsion is possible.
If pain increases on the
opposite side, an anterior
torsion on the opposite side
should be suspected.
Straight Leg Raising (Lasègue’s) Test
Position
Supine
Description
●
With the patient in the supine
position, the examiner
AXALAN | DE LOS REYES | ICO | PASCUA | PIZARRO | ROSITA | TAMAYO | TOLOSA | TY
6
PT10112: LEC8 - LUMBOSACRAL SPINE
Ma’am Kristina Devora | Second Shift, A.Y. 2021-2022
○
○
○
●
●
Tension to sciatic nerve roots is released → >70°
Tension to sciatic nerve roots start → ~35°
Modifications:
● Hyndman’s Sign / Brudzinski’s Sign / Linder’s
Sign / Soto-Hall Test → SLR + Passive Neck
Flexion
● Bragard’s Test → SLR + Ankle DF
● Sicard’s Test → SLR + Big toe Extension
● Turyn’s Test → Big Toe extension only
●
●
In prone, PT stabilizes the spine and ribs at
around T12 level
PT pulls ilium posteriorly
(+) pain and excessive movement
Lateral Lumbar Spine Stability Test*
○ In sidelying, PT applies downward pressure
at around L3 level
○ (+) pain and excessive movement
Test for Anterior Lumbar Spine Instability*
○ In sidelying while hips flexed at 70°, PT
pushes posteriorly through the shaft of the
femur while PT palpates spinous processes
○ (+) excessive
Tests for Lumbar Instability
●
●
●
H and I Instability Test*
○ Test for muscle spasm and can be used to
detect instability
○ 2 Parts
■ “H”
■ Resting: Standing
■ Side flex as far as possible
■ Side flex then flex
■ Side flex then extend
■ “I”
■ Resting: standing
■ Flex (or extend) lumbar spine until hip
starts to move
■ Pt is guided into side bending
Specific Torsion Test
○ Used to stress specific levels of the lumbar
spine
○ Specific level must be rotated and stressed
Farfan Torsion Test*
●
Test for Posterior Lumbar Spine Instability*
○ In sitting pt’s elbows through the PT’s
body/shoulders → PT tries to pull the lumbar
spine to create lordosis as pt pushes with
elbows
○ (+) excessive movement (posterior shear of
upper segment)
●
Segmental Instability*
AXALAN | DE LOS REYES | ICO | PASCUA | PIZARRO | ROSITA | TAMAYO | TOLOSA | TY
7
PT10112: LEC8 - LUMBOSACRAL SPINE
Ma’am Kristina Devora | Second Shift, A.Y. 2021-2022
○
○
○
1) Pt is prone on the edge of the plinth with
LE on the floor while PT applies compression
2) Pt lifts legs off the floor while PT applies
compression
(+) if pain is elicited in 1)
●
●
●
●
Pheasant Test*
○ In prone, PT presses down the lumbar spine
then PT flexes the knee
○ (+) pain in the leg (hyperextension of the
spine d/t instability of segments)
●
●
Tests for Sacroiliac Joint Dysfunction
●
One Leg Standing Lumbar Extension Test
○ Pt stands on one leg then extends the spine
○ (+) spondylolisthesis / (+) stress fx
Quadrant Test
○ Pt stands on one leg then extends the spine
with rotation and lateral flexion
○ Overpressure may be applied
○ (+) facet joint disease
Schober’s Test*
Milgram’s Test*
○ In supine, pt lifts both LE simultaneously off
the plinth ~5-10 cm (2-4 in) for 30s
Yeoman’s Test*
○ 1) In prone, PT extends hip with the knee
extended
○ 2) PT then extends hip with knee flexed
○ (+) test if with pain on both tests in the
lumbar spine
McKenzie Side Glide Test*
○ PT grasps pelvis (pull) while shoulders
(push) are against the lower thorax
○ (+) if increased neurological Sx on the
affected side
AXALAN | DE LOS REYES | ICO | PASCUA | PIZARRO | ROSITA | TAMAYO | TOLOSA | TY
8
PT10112: LEC8 - LUMBOSACRAL SPINE
Ma’am Kristina Devora | Second Shift, A.Y. 2021-2022
○
Check for any pain
Tests for Malingering
●
Hoover’s Test
○ (+) if cannot lift the leg or no pressure on the
heel
●
Burns Test
○ Pt kneels on the chair and is asked to reach
the floor
○ (+) if pt can’t perform the task or
overbalances
Tests for Muscle Dysfunction
●
Beevor’s Sign
○ Pt flexes head against resistance, coughs or
attempts to sit up with hands behind the
head
○ (+) if umbilicus does not remain in the
middle
Tests for Intermittent Claudication
●
●
●
Stoop Test
○ Pt brisk walks (~50m/165ft) until pain is felt
on the buttocks or lower limb → bend
forward (pain relief)
○ (+) test for Neurogenic Claudication
○ Extension motion may bring back the Sx
Bicycle Test
○ Pt pedals on a bicycle while leaning
backwards until pain is felt on the buttocks
or lower limb → bend forward (pain relief)
○ (+) test for Neurogenic Claudication
○ Extension motion may bring back the Sx
Treadmill Test
○ 1) Treadmill at 1.2 mph [15 mins]
○ 2) Treadmill at own pace [15 mins]
OTHER TEST
● Sign of the Buttock
○ In supine, PT performs Passive SLR
○ At restriction, PT flexes the knee then further
flexes the hip
○ If hip flexion increases with knee flexed
■ (-) test → lumbar spine or hamstrings
○ If hip flexion is still restricted
■ (+) test → hip pathology (bursitis, tumor,
or abscess)
Tests for Sacroiliac Joint Involvement
AXALAN | DE LOS REYES | ICO | PASCUA | PIZARRO | ROSITA | TAMAYO | TOLOSA | TY
9
PT10112: LEC8 - LUMBOSACRAL SPINE
Ma’am Kristina Devora | Second Shift, A.Y. 2021-2022
Position
Side-lying
Description
●
●
●
Results
Pelvic Dysfunction
● Instability + Asymmetry = Pelvic Dysfunction
● Loss of stability of the pelvis (including SIJ)
is crucial in etiology of non-specific LBP
Richardson, et. al. (2002)
●
What type of Iliosacral Dysfunction?
○ Anterior / Posterior Rotation
○ Inflare / Outflare
○ Upslip / Downslip
●
Position
Supine
Description
●
●
Standing on one leg
Description
●
●
Results
●
●
●
When the patient is standing on
one leg, the weight of the trunk
causes the sacrum to shift
forward and distally (caudally)
with forward rotation. The ilium
moves
in
the
opposite
direction.
On the non–weight-bearing
side, the opposite occurs, but
the stress is greatest on the
stance side.
Pain in the symphysis pubis or
sacroiliac joint indicates a positive test for lesions in
whichever structure is painful.
The stress may be increased by
having the patient hop on one
leg.
This position is also used to
take a stress x-ray of the
symphysis pubis.
Pain indicates a positive test.
The pain may be caused by an
ipsilateral
sacroiliac
joint
lesion, hip pathology, or an L4
nerve root lesion.
Gaenslen’s test
Flamingo Test/ Maneuver
Position
The patient lies on the side with
the upper leg (test leg)
hyperextended at the hip.
The patient holds the lower leg
flexed against the chest.
The examiner stabilizes the
pelvis while extending the hip
of the uppermost leg.
●
Results
●
The patient is positioned so
that the test hip extends
beyond the edge of the table.
The patient draws both legs up
onto the chest and then slowly
lowers the test leg into
extension.
The other leg is tested in a
similar fashion for comparison.
Pain in the sacroiliac joints is
indicative of a positive test.
Gillet’s (Sacral Fixation) Test / Ipsilateral posterior
rotation test / Sacral Fixation Test
Position
Standing
Description
●
●
●
Gaenslen’s test
AXALAN | DE LOS REYES | ICO | PASCUA | PIZARRO | ROSITA | TAMAYO | TOLOSA | TY
While the patient stands, the
sitting examiner palpates the
PSISs with one thumb and the
other thumb parallel with the
first thumb on the sacrum.
The patient is then asked to
stand on one leg while pulling
the opposite knee up toward
the chest. This causes the
innominate bone on the same
side to rotate posteriorly.
The test is repeated with the
other leg palpating the other
PSIS.
10
PT10112: LEC8 - LUMBOSACRAL SPINE
Ma’am Kristina Devora | Second Shift, A.Y. 2021-2022
Results
●
●
●
●
If the sacroiliac joint on the
side on which the knee is flexed
(i.e., the ipsilateral side) moves
minimally or up, the joint is said
to be hypomobile, or “blocked,”
indicating a positive test.
On the normal side, the test
PSIS moves down or inferiorly
This test is similar to the test
performed during hip flexion in
active movement; the only
difference is the points of
palpation
during
the
movement.
(+) test of minimal movement
implying
hypomobile
or
“blocked” SI joint
Description
●
●
Results
Patrick test (FABER or Figure-4 Test)
Position
Supine
Description
●
●
Results
●
●
●
●
●
●
●
The patient lies supine, and the
examiner places the patient’s
test leg so that the foot of the
test leg is on top of the knee of
the opposite leg.
The examiner then slowly
lowers the knee of the test leg
toward the examining table.
A negative test is indicated by
the test leg’s knee falling to the
table or at least being parallel
with the opposite leg.
A positive test is indicated by
the test leg’s knee remaining
above the opposite straight leg.
If​​ positive, the test indicates
that the hip joint may be
affected, that there may be
iliopsoas spasm, or that the
sacroiliac
joint
may
be
affected.
Flexion, abduction, and external
rotation (FABER) is the position
of the hip at which the patient
begins the test.
The test is sometimes referred
to as Jansen’s test.
●
●
Position
If the lower PSIS becomes the
higher one on forward flexion,
the test is positive; it is that
side that is affected.
Because the affected joint does
not move properly and is
hypomobile, it goes from a low
to a high position.
This is believed to indicate an
abnormality in the torsion
movement at the sacroiliac
joint.
Supine-to-Sit (Long Sitting) Test
Position
Supine
Description
●
●
Piedallu’s Sign
The patient is asked to sit on a
hard, flat surface. This position
keeps the muscles (e.g.,
hamstrings) from affecting the
pelvic flexion symmetry and
increases the stability of the
ilia. In effect, it is a test of the
sacrum on the ilia.
The examiner palpates the
PSIS and compares their
heights.
If one PSIS, usually the painful
one, is lower than the other, the
patient is asked to forward flex
while remaining seated.
●
Sitting
AXALAN | DE LOS REYES | ICO | PASCUA | PIZARRO | ROSITA | TAMAYO | TOLOSA | TY
The patient lies supine with the
legs straight.
The examiner ensures that the
medial malleoli are level.
The patient is asked to sit up,
and the examiner observes
11
PT10112: LEC8 - LUMBOSACRAL SPINE
Ma’am Kristina Devora | Second Shift, A.Y. 2021-2022
whether one leg moves up
(proximally) farther than the
other.
Results
●
●
●
If so, it is believed that there is
a
functional
leg
length
difference resulting from a
pelvic dysfunction caused by
pelvic torsion or rotation.
It may also be caused by
spasm of the lumbar muscles
in the presence of lumbar
pathology.
(+) if leg moves farther →
pelvic dysfunction or lumbar
pathology (functional leg-length
discrepancy)
●
Results
Yeoman’s Test
Position
Prone
Description
●
●
Results
●
●
●
PT’s
one
thumb
palpates
the
PSIS while the
other palpates
the sacrum
Pt is instructed
to step back on
1
leg
→
anterior pelvic
rotation
(normal PSIS
moves
superiorly and
laterally)
(+) test of minimal
movement
implying
hypomobile or “blocked
joint”
Laguere’s Sign
The patient lies prone.
The examiner flexes the
patient’s knee to 90° and
extends the hip.
Pain localized to the sacroiliac
joint indicates pathology in the
anterior sacroiliac ligaments.
Lumbar pain indicates lumbar
involvement.
Anterior thigh paresthesia may
indicate a femoral nerve
stretch.
Position
Supine
Description
●
●
Results
In supine, PT
moves pt’s LE
in FABER
PT
should
stabilize
contralateral
pelvis
(+) if with pain in SI joint
Goldthwait’s Test
Position
Supine
Description
●
●
Results
Ipsilateral Anterior Rotation Test
Position
Description
Standing
●
In
standing,
AXALAN | DE LOS REYES | ICO | PASCUA | PIZARRO | ROSITA | TAMAYO | TOLOSA | TY
In
supine,
PT
places fingers in
interspinous
processes (L2-S1)
PT then passively
does SLR
(+) if pain is elicited
prior
to
interspace
movement → SI joint
(+) if pain is elicited
during
interspace
movement → Lumbar
Spine
12
PT10112: LEC8 - LUMBOSACRAL SPINE
Ma’am Kristina Devora | Second Shift, A.Y. 2021-2022
Tests for Limb Length
Functional Limb Length Test
Position
Standing
Description
●
●
Results
●
●
The patient stands relaxed
while the examiner palpates the
ASISs and PSIS, noting any
asymmetry.
The patient is then placed in
the “correct” stance (subtalar
joints neutral, knees fully
extended, and toes facing
straight ahead), and the ASIS
and PSIS are palpated with the
examiner noting whether the
asymmetry has been corrected.
If the asymmetry has ​been
corrected
by
“correct”
positioning of the limb, the leg
is structurally normal (i.e., the
bones have proper length), but
abnormal joint mechanics
(functional
deficit)
are
producing a functional leg
length difference.
Therefore, if the asymmetry is
corrected by proper positioning,
the test is positive for a
functional leg length difference.
Leg Length Test
Position
Supine
Description
●
●
●
Results
●
●
True leg length is measured by
placing the patient in a supine
position with the ASIS level and
the patient’s lower limbs
perpendicular to the line joining
the ASIS.
Using a flexible tape measure,
the examiner obtains the
distance from the ASIS to the
medial or lateral malleolus on
the same side.
The measurement is repeated
on the other side, and the
results are compared.
A difference of 1 to 1.3 cm (0.5
to 1 inch) is considered normal.
●
●
It should be remembered,
however, that leg length
differences within this range
may also be patho- logical if
symptoms result.
The leg length test should
always be performed if the
examiner suspects a sacroiliac
joint lesion.
Nutation (backward rotation) of
the ilium on the sacrum results
in a decrease in leg length—as
does counternutation (ante- rior
rotation) on the opposite side.
If the iliac bone on one side is
lower, the leg on that side is
usually longer.
PELVIC DYSFUNCTION
Instability
Asymmetry
Loss of stability of the pelvis (including SIJ) is
crucial in etiology of non-specific low back pain
Lower Crossed Syndrome
● Hyperactive postural muscles
○ Iliopsoas
○ Rectus femoris
○ Tensor fascia latae
○ Quadratus lumborum
○ Thigh adductors
○ Piriformis
○ Hamstrings
○ Lumbar erector spinae
● Inhibition and reflex weakness
○ Gluteus maximus
○ Gluteus medius
○ Gluteus minimus
○ Rectus abdominis
○ External oblique
○ Internal oblique
●
●
●
SACROILIAC JOINT DYSFUNCTION AND PAIN
Sacroiliac Joint
● Weight bearing joints that distribute weight from
the spine to the LE
● If the pt has a back sprain that hasn’t improved
after several months, it is important to look at the
SI joint
● Amterior Sacroiliac ligaments support the SI joint
anteriorly
● Posterior Sacroiliac ligaments support posteriorly
Sacroiliac Joint Dysfunction and Pain
AXALAN | DE LOS REYES | ICO | PASCUA | PIZARRO | ROSITA | TAMAYO | TOLOSA | TY
13
PT10112: LEC8 - LUMBOSACRAL SPINE
Ma’am Kristina Devora | Second Shift, A.Y. 2021-2022
Symptoms of SI joint dysfunction and Pain
○ Lower back, buttock, back of thigh, and knee
pain
○ Occasional groin pain
○ Difficulty and discomfort while sitting
Patient frequently changes position to
○
become comfortable
Tests Used to Determine the Presence of SI Joint Pain
(2 CONFIRMATORY + 1 RULE OUT)
● Finger Test - helpful in determining SI joint pain.
Pts usually point with 1 finger to 1 side, towards
the painful SI joint. If pt points to an exact area of
pain each time, pain is likely the SI joint.
● Faber Test - stretch the SI joint in order to
reproduce pain, press down gently but firmly on
the flexed knee and the opposite anterior superior
iliac crest, pain on the SI area indicates a
problem of the SI joint.
● Straight Leg Test - done to determine if a pt with
low back pain has an underlying herniated disc.
Not used to determine the presence of SI joint
pain.
Differential Diagnosis of SI Joint Pain
1. Trochanteric Bursitis
2. Piriformis Syndrome
3. Myofascial Pain
4. Lumbosacral Disc Herniation and Bulge
5. Lumbosacral Facet Syndrome
6. Lumbar Radiculopathy
7. Cluneal Nerve entrapment
Causes of SacroIliac Joint Pain
1. Leg length discrepancy
2. Mechanical dysfunction
3. Si joint infection
4. Ankylosing spondylitis
5. Crystal arthropathy
6. Pyogenic arthropathy
7. Post-spinal fusion
8. Stress fracture of sacrum
●
Malalignment
Pelvis
Rotations
●
●
Anteriorly Rotated (ASIS lower
than PSIS)
Posteriorly Rotated (ASIS higher
than PSIS)
Slips
●
●
Flares
●
●
Upslip (bony landmarks higher on
1 side)
Downslip (bony landmarks lower
on 1 side)
Outflare (ASIS farther from
umbilicus
Inflare (ASIS closer from
umbilicus)
Hip
Lateral Pelvic Tilt
(Pelvic Drop on Right
Leg Stance)
Lateral Pelvic Tilt
(Pelvic Hitch on Right
Leg Stance)
●
Weak right abductors
(+) Trendelenburg’s
Sign
Right hip adducted
●
●
Weak left adductors
Right hip abducted
●
●
SACROILIAC JOINT MOVEMENT
Sacroiliac Joint
● Composed of the sacrum articulating with the 2
innominates
Types of Movement
● Symmetrical
○ Occurs in the sagittal plane along the x-axis
○ Nutation
displacement
of
sacral
■ Anterior
promontory
■ Posterior displacement of PSIS
○ Counter-nutation
■ Posterior displacement of sacral
promontory
■ Anterior displacement of PSIS
● Asymmetrical
○ Occur in the transverse plane along the
y-axis
○ Sacroiliac torsion
■ Iliac on sacral: 2 innominates are
moving in the opposite direction
■ Right innominate: posterior rotation
● Axis of rotation pierces through the
right pubic symphysis
● Right ASIS moves posterior,
superior, and medially
■ Left innominate: anterior rotation
● Axis is through the pubic symphysis
● Left ASIS moves anterior, inferior,
laterally
■ Movement of sacrum: combination of
side-bending and rotation
● Right on right (direction on axis)
AXALAN | DE LOS REYES | ICO | PASCUA | PIZARRO | ROSITA | TAMAYO | TOLOSA | TY
14
PT10112: LEC8 - LUMBOSACRAL SPINE
Ma’am Kristina Devora | Second Shift, A.Y. 2021-2022
Sacrum turns right around the
right axis of rotation
○ Left sacral base → anterior
Right on left
○ Sacrum turns to the right
around the left axis of rotation
○ Right sacral base → posterior
Left on left
○ Right sacral base → anterior
Left on right
○ Right sacral base → posterior
○
●
●
●
AXALAN | DE LOS REYES | ICO | PASCUA | PIZARRO | ROSITA | TAMAYO | TOLOSA | TY
15