You are on page 1of 8

DOWNING TEST

This is a key test to determine sacro-iliac joints (SIJ) dysfunctions. Practitioners should use it
systematically as it is the most reliable to assess the pelvis. Novice osteopaths should make it
usual in their practice.

Contraindications: arthrosis, arthritis, hip prosthesis and laxity/flaccidity.

OSTEOPATHIC GENERAL RULE:


Regarding osteopathic dysfunction, during mobilization: we can always go towards the
dysfunction but not towards the correction.

This test includes 2 maneuvers and should be bilaterally performed:

A) 1st maneuver: lengthening


Aim:

To temporarily lengthen a lower limb by mobilizing the SIJ forwards,


making sure the practitioner inhibits the coxofemoral joint.

Results:

If lengthening is possible within the joint limits (about 1.5cm or 0.6


inch), this means the SIJ tested is free of posterior limitation.
If lengthening is impossible or below the joint limits (about 1.5cm or
0.6 inch), the practitioner can suspect a posterior limitation of the tested
ilium over the sacrum.

B) 2nd maneuver: shortening


Aim:

To temporarily shorten a lower limb by mobilizing the SIJ backwards,


making sure the practitioner inhibits the coxofemoral joint.

Results:

If shortening is possible within the joint limits (about 1.5cm or 0.6


inch), this means the SIJ tested is free of anterior limitation.
If shortening is impossible or below the joint limits (about 1.5cm or 0.6
inch), the practitioner can suspect an anterior limitation of the tested
ilium over the sacrum.

SARL IRFOR Modle dpos.

LOWER LIMB LENGTHENING TEST

Positions

Patient supine, practitioner at the patients feet looking at this face in the first
place. Using his thumbs placed under the medial malleolus and/or under the
heels, he evaluates both lower limbs length. Then, he faces the contralateral
knee to the SIJ to evaluate.

Technique

1- Using his caudal hand, the practitioner grabs the patients contralateral lower
limb, just above the ankle, and performs a light hip flexion + adduction.
2- The practitioner places his cephalic hand in the contralateral popliteal fossa,
thumb at 90, his fore arm parallel to the femur, elbow towards the symphysis
pubis. He then induces a lateral rotation of the contralateral hip and can add a
light traction in case of excessive stiffness.
3- The practitioner replaces the lower limb on the table, knee extended, and
back to the very initial position.

Results

1- The practitioner evaluates the gain of length of the SIJ / lower limb tested by
using his thumbs placed under the medial malleolus and/or under the heels.
2- Eventually, the practitioner performs a global reset maneuver, doubleflexing knee and hip on the tested side, his sternum applying extra pressure on
the leg to cancel the possible lower limb lengthening.

LOWER LIMB LENGTHENING TEST

SARL IRFOR Modle dpos.

LENGTHENING MANEUVER BIOMECHANICS

During the lengthening maneuver, flexion / adduction / lateral rotation of the hip cause a
tension of the iliofemoral ligament (aka Bertin ligament or Y-shaped or Welckers Z) and of
the anterior joint capsule and consequently bolts it.
This maneuver prevents all movement in the hip joint and allows us to mobilize forwards the
short horizontal part of the auricular L-shaped SIJ.

Iliofemoral Ligament

Greater
trochanter

Pubofemoral ligament

Lesser trochanter

Lateral rotation and adduction of the lower limb bolts the hip.

SARL IRFOR Modle dpos.

LOWER LIMB SHORTENING TEST

Positions

Patient supine, practitioner at the patients feet looking at this face in the
first place. Using his thumbs placed under the medial malleolus and/or
under the heels, he evaluates both lower limbs length. Then, he moves close
to the SIJ to evaluate, facing the feet.

Technique

1- Using his caudal hand, the practitioner grabs the patients ipsilateral
lower limb, just above the ankle, and performs a maximal hip abduction +
extension.
2- With his cephalic hand, the practitioner grabs the distal tip of the femur.
He then induces a knee flexion, maintaining abduction / extension of the
hip. On top of these, he performs a medial rotation of the hip. He can add a
light traction in case of excessive stiffness.
3- The practitioner replaces the lower limb on the table, knee extended, and
back to the very initial position.

Results

1- The practitioner evaluates the loss of length of the SIJ / lower limb tested
by using his thumbs placed under the medial malleolus and/or under the
heels.
2- Eventually, the practitioner performs a global reset maneuver, doubleflexing knee and hip on the tested side, his sternum applying extra pressure
on the leg to cancel the possible lower limb shortening.

DOWNING SHORTENING MANEUVER

SARL IRFOR Modle dpos.

SHORTENING MANEUVER BIOMECHANICS

During the shortening maneuver, extension / abduction / medial rotation of the hip cause a
tension of the ischiofemoral and iliofemoral ligaments (aka Bertin ligament or Y-shaped)
and of the posterior joint capsule and consequently bolts it.
This maneuver prevents all movement in the hip joint and allows us to mobilize the short
horizontal part of the auricular L-shaped SIJ.

Sacrospinous ligament

Posterior
iliofemoral
ligament

Greater
trochanter

Posterior
ischiofemoral
ligament
Lesser
trochanter

Medial rotation and abduction of the lower limb bolts the hip.
SARL IRFOR Modle dpos.

Linea aspera

RESULTATS DU TEST DE DOWNING

1- If lengthening and shortening are identical on one side: no iliac dysfunction on


this side.
2- If lengthening and shortening are identical on both sides: no iliac dysfunctions on
both sides.
3- If lengthening is impossible and shortening possible: 1st degree causative
posterior iliac.
2nd degree adaptative dysfunction allows minimal lengthening, inferior to the
shortening.
4- If shortening is impossible and lengthening possible: 1st degree causative anterior
iliac.
2nd degree adaptative dysfunction allows minimal shortening, inferior to the
lengthening.
5- If lengthening is impossible on both sides and shortening possible: bilateral
posterior iliacs.
6- If shortening is impossible on both sides and lengthening possible: bilateral
anterior iliacs.
7- If on one side, lengthening is impossible and shortening possible and the opposite
on the other side: iliac posterior torsion on one side and iliac anterior torsion on
the other side.
8- If lengthening and shortening are impossible on one side or on both sides:
permanent loss of mobility on one or both sides (i.e. degenerative arthrosis).
Note:
In case of genetically different length of lower limbs, the practitioner has to take this
difference into consideration when the maneuvers are performed and lengths assessed.
Note:
A 1st degree causative dysfunction (total loss of mobility) is to be manipulated in the
first place using preferably a direct technique
Note:
A 2nd degree adaptative dysfunction (partial loss of mobility) is to be manipulated using
isometric or Sutherlands techniques. Very often, it signs a mechanical / muscular
pattern (ascending or descending).

SARL IRFOR Modle dpos.

DOWNING TEST RECAP BOARD

RIGHT SIDE

LEFT SIDE

ILIAC DYSFUNCTION

Lengthening:
Shortening:

++
++

Lengthening:
Shortening:

++
++

BILATERAL ILIACS

Lengthening:
Shortening:

++
0

Lengthening:
Shortening:

++
0

BILATERAL 1st DEGREE

Lengthening:
Shortening:

++
0

Lengthening:
Shortening:

++
++

ANTERIOR RIGHT ILIAC

Lengthening:
Shortening:

++
0

Lengthening:
Shortening:

0
++

ANTERIOR RIGHT ILIAC

Lengthening:
Shortening:

0
++

Lengthening:
Shortening:

0
++

BILATERAL

Lengthening:
Shortening:

++
++

Lengthening:
Shortening:

0
++

POSTERIOR LEFT ILIAC

Lengthening:
Shortening:

0
++

Lengthening:
Shortening:

++
0

ANTERIOR LEFT ILIAC

Lengthening:
Shortening:

+
+

Lengthening:
Shortening:

+
+

REDUCED ILIACS

Lengthening:
Shortening:

+++
+++

Lengthening:
Shortening:

+++
+++

Lengthening:
Shortening:

+++
0

Lengthening:
Shortening:

+
++

SARL IRFOR Modle dpos.

NORMALITY

ANTERIOR ILIACS

NORMAL LEFT ILIAC

POSTERIOR LEFT ILIAC

POSTERIOR ILIACS

NORMAL RIGHT ILIAC

POSTERIOR RIGHT ILIAC

MOBILITY

ILIACS HYPER
MOBILITY

ANTERIOR RIGHT ILIAC


2

nd

DEG POST LEFT ILIAC

SARL IRFOR Modle dpos.