Lumbar Spine Orthopedic Tests

Procedure Rationale, Findings

Bechterew’s Test - Active, seated - Test for lumbar radicular pain
- Extend one knee, then the other - ↑ traction of the sciatic nerve
knee, then both - (+) unable to perform due to radicualr pain, or perform
with leaning back: ↑ compression to the sciatic nerve or
lumbar nerve roots, disc protrusion

Slump Test - Active, seated, hands behind back - ↑ traction of dura

- Flex trunk, flex neck, extend one - ↑ pain: disc defect
leg, dorsiflex foot (affected side)
- Bilateral then with both leg extend

Kemp’s Test - Passive, seated - Test for lumbar radicular pain

- Stabilize the PSIS w/ one hand - When pt bends obliquely backward, the dural sac on the side
- Reach around to front of pt & of bending moves laterally
grasp shoulder w/ the other hand - (+) ↑ local pain: facet capsulitis, lumbar spasm
- Rotate, laterally flex, and extend - (+) ↑ radicular ipsilateral pain: lateral disc
the trunk - (+) ↑ radicular contralateral pain: medical disc
Turyn’s Test - Passive, supine - (+) ↑ pain: sciatic radiculopathy
- Dorsiflex great toe of affected side

Well Leg Raise Test - Passive, supine - Test for lumbar radicular pain
- Raise unaffected leg to the point - This test causes ipsilateral & contralateral stretching of the
of pain or 90° nerve roots, pulling laterally on dural sac
- (+) ↑ radicular pain on affected leg: medial disc protrusion

Straight Leg Raise Test - Passive, supine - Test for lumbar radicular pain
- Raise affected leg to the point of - ↑ stretch of sciatic nerve and spinal nerve roots at the L5-S2
pain or 90˚ - (+) ↑ pain at 0-35˚: priformis syndrome, SI joint restriction
- Place an inclinometer at the tibial- (+) ↑ radicular pain at 35-70˚: disc pathology
tuberosity - (+) ↑ pain at 70- 90°: lumbar joint problem
- (+) ↑ dull posterior thigh pain: tight hamstring
- Confirm with Bragard’s and Lasegue’s tests
Bragard’s Test - Passive, supine - Test for lumbar radicular pain
- Raise affected leg to the point of - ↑ traction of sciatic nerve
pain, then lower 5˚ and dorsiflex - (+) ↑ pain at 0-35˚: priformis syndrome, SI joint restriction
the foot - (+) ↑ radicular pain at 35-70˚: disc pathology
- (+) ↑ pain at 70- 90°: lumbar joint problem
- (+) ↑ dull posterior thigh pain: tight hamstring
Bonnet’s Test - Passive, supine - (+) radicular pain or paresthesia: sciatica, especially
- Straight leg raise w/ hip adducted piriformis syndrome
and internally rotated

Milgram’s Test - Active, supine - Test for Space-Occupying Lesion (SOL)

- Raise and hold legs for 3-6
inches off the table
- Hold for as long as possible
Hoover’s Sign - Active, supine
- Instruct pt to lift the affected leg
while you place one hand under
the heel on the unaffected side
Prone Lumbar Hyperextension Test - Active, prone
- Stabilize ankles and instruct pt to
attempt to extend trunk
- ↑ intrathecal pressure
- Normally, should be able to perform the test for > 30 s w/o
low back pain
- (+) low back pain: space occupying lesion
- Test for malingering low back pain
- (+) pt will not raise the affected leg & no posterior
pressure on the unaffected heel
- If pt is genuinely trying to raise the leg but cannot do so, you
should feel pressure from the unaffected heel
- (+) ↑ pain: lumbar sprain/strain
Pelvic Orthopedic Tests
Sitting Flexion Test
(Piedallu’s sign)
Procedure Rationale
- Active, seated - (+) PSIS raises superior as pt flex forward: SI restriction
- Place thumb on the superior part of
PSIS and tissue pull down
- Ask pt to bend forward

Anvil Test - Passive, supine, leg straight - Compression type blows to the hip joint
- Tap (strike) the heel - Test for hip fractures
- (+) ↑ pain: femoral head fracture

Straight Leg Raise Test - Passive, supine - Test for lumbar radicular pain
- Raise affected leg to the point of - ↑ stretch of sciatic nerve and spinal nerve roots at the L5-S2
pain or 90˚ - (+) ↑ pain at 0-35˚: priformis syndrome, SI joint restriction
- Place an inclinometer at the tibial - (+) ↑ radicular pain at 35-70˚: disc pathology
tuberosity - (+) ↑ pain at 70- 90°: lumbar joint problem
- (+) ↑ dull posterior thigh pain: tight hamstring
- Confirm with Bragard’s and Lasegue’s tests
Bonnet’s Test - Passive, supine - (+) radicular pain or paresthesia: sciatica, especially
- Straight leg raise w/ hip adducted piriformis syndrome
and internally rotated

Patrick’s Test (Hip FABER test)
- Passive, supine
- First flex the knee and press the
thigh into the acetabular cavity
- Then rest the heel on the opposite
knee. Stabilize the opposite side of
ASIS and press down the involved
side knee
- FABER (flexion, abduction, external rotation)
- Test for SI & acetabular dysfunction
- This test forces the femoral head into the acetabular cavity,
giving maximal congruence to the articular surfaces.
- (+) pain at the hip: inflammation of the hip or trauma

Laguerre’s Test (FABER in air)
- Passive, supine - Stressing the anterior aspect of the hip joint
- Flex the hip & knee to 90° - (+) pain at the hip: inflammation of acetabular joint
- Rotate the thigh outward & the knee
medially
- Press down on the knee w/ one
hand, and pull up on the ankle w/
the other hand

Thomas Test - Passive, supine - Test for hip contracture (a condition of soft tissue stiffness
- Bring unaffected side of the knee to that restrict joint motion)
the chest - (+) ↑ hip flexion or tightness of quads: contracture of hip
- Observe the hip flexion and palpate flexor (ex. iliopsoas), rectus femoris or restriction of hip joint
the affected side of quads
- Make sure that lumbar curve is
relatively flat on the table
Rectus Femoris Contracture Test - Passive, supine - Test for hip contracture
- Bring unaffected side of the knee to - (+) ↑ hip flexion, knee extension or tightness of quads:
the chest contracture of hip flexor, rectus femoris or restriction of hip
- Observe the hip flexion, knee joint
extension and palpate the affected
side of quads
- Make sure that lumbar curve is
relatively flat on the table
Ober’s Test #1 - Passive, side lying (affected side up) - Test for hip contracture
- Abduct leg and release it - (+) leg fails to descend smoothly: suspect contracture of
the TFL muscle or IT band

Ober’s Test #2 - Passive, side lying (affected side up) - (+) leg remains abducted: contracture of TFL and/or IT band
- Extend & slightly abduct leg, then
grasp ankle and flex the knee to 90˚
- The thigh is abducted and slightly
extended

Piriformis Test - Passive, side lying (affected side - (+) ↑ sciatic pain: piriformis syndrome
up)
- Flex the hip to 60° and flex the knee
fully. Stabilize the hip and push the
knee down

Prone Glide Test for SI Restriction - Passive, prone - (+) movement on opposite side: SI restriction
- Press down on SI joint of one side
and observe movement on the other
side
Yeoman’s Test - Passive, prone - (+) ↑ pain: inflammation of SI joint, or sprain of anterior
- Place the hand over the affected sacroiliac, iliofemoral or ischiofemoral ligament
side SI joint to stabilize the pelvis
- Flex the affected side knee and
extend the hip

Hibb’s Test - Passive, prone - (+) ↑ pain at SI join: inflammation of the SI joint
- Flex the knee and move the leg - (+) ↑ pain at the hip: inflammation of ischiofemoral ligament
outward (internal rotation of hip) - (+) lack of SI joint motion: SI restriction
- Also palpate the SI joint motion