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Lumbar Spine Special Tests

PT Special tests for the lumbar spine
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Straight Leg Raise (SLR)
Purpose: neural tension test
Procedure: Pt. lies supine with knee extended. Examiner lifts entire leg to flex the hip until pt. c/o pain or tightness in back or posterior leg.
+ Result: 1) pain primarily in back, indicates anterior disc herniation or central lesion 2) pain primarily in leg, indicates lateral lesion
Bragard's Test
Purpose: neural tension test
Procedure: Pt. supine as examiner performs SLR, then drops leg back down slightly until symptoms are relieved. Pt. then asked to DF ankle.
+ Result: increased pain, indicating stretching of dura mater of spinal cord or lesion of spinal cord
Lindner's Sign
Purpose: neural tension test
Procedure: Pt. supine as examiner performs SLR, then drops leg back down slightly until symptoms are relieved. Pt. then asked to flex the neck.
+ Result: 1) symptoms reproduced in lumbar region, leg or arm, indicating stretching of dura mater of spinal cord or lesion of spinal cord 2) if pain does not increase, lesion is within lumbosacral or sacroiliac joints
Slump Test
Purpose: neural tension test
Procedure: Pt. seated on edge of table with hands behind back. Test is performed in progressive step: 1) pt. slumps forward into thoracic and lumbar flexion 2) cervical spine and head are flexed 3) ankle is DF 4) knee is extended
+ Result: 1) positioning increases symptoms 2) when pressure from cervical spine flexion is released, knee is able to extend further or symptoms decrease.
Well Leg Raise
Purpose: tests for space occupying lesion (often disc protrusion)
Procedure: Pt. lies supine with knee extended. Examiner lifts entire leg to flex the hip until pt. c/o pain.
+ Result: pain occurs on CL side of lifted leg, indicating medial disc protrusion
Bowstring Test
Purpose: neural tension test of sciatic nerve
Procedure: Pt. supine as examiner carries out SLR to pain. Examiner maintains position while flexing the knee 20 degrees (reducing symptoms), then uses thumb to apply pressure to popliteal area (increases radicular symptoms)
+ Result: radicular symptoms occur, indicating sciatic nerve involvement
Bechterew's Test
Purpose: less provocative neural tension test; test for malingering
Procedure: Pt. seated on side of table and asked to extend one knee, then the other and finally both knees together.
+ Result: symptoms increase in affected leg
Quadrant Test
Purpose: tests for facet joint dysfunction
Procedure: Pt. stands with examiner standing behind and supporting shoulders while pt. extends spine. Overpressure is applied into extension while pt. side flexes and rotates toward painful side. Movement is continued until limit of range is reached or symptoms are produced.
+ Result: symptoms are produced, indicating facet joint dysfunction
Prone Knee Flexion
Purpose: neural tension test of femoral nerve
Procedure: Pt. lies prone while examiner passively flexes knee so that the pt's heel rests on butt (without hip rotation)
+ Result: UL neurological pain in lumbar area, buttock or posterior thigh, indicates L2 or L3 nerve root lesion
McKenzie Side Glide
Purpose: tests for joint dysfunction
Procedure: Pt. stands with examiner standing to one side and grasping pt's pelvis with both hands. Examiner places shoulder against pt's lower thorax (using shoulder to block) and pulls pelvis toward herself. Position is held for 10 - 15 seconds. Repeat on opposite side
+ Result: increased neurological symptoms on affected side, indicates joint dysfunction
Stork Standing
Purpose: tests for pars interarticularis stress fracture (spondylolisthesis)
Procedure: Pt. stands on one leg and extends spine while balancing. Test repeated on opposite leg.
+ Result: pain in back, indicating fracture; if UL, standing on IP leg will cause more pain
Prone Lumbar Instability Test
Purpose: tests for lumbar instability syndrome
Procedure: Pt. lies prone with hips on edge of table and feet on floor. Pt. asked to lift legs together off of floor.
+ Result: hyperextension of spine causes pain in leg, indicating spinal instability