Squat test Test the ankles, knees and hips or any

pathological condition

Lumbar Kemps If this procedure reproduces pain in the

test leg, neurogenic claudication is
indicated. If the pain is local, the facets
may be responsible with pain not
extending below the knee

Djerine’s triad A three-part test used to reproduce

(Valsalva, cough, symptoms of nerve compression which
sneeze)
can arise from osseous foraminal
encroachment, disc protrusion
(bulging),
prolapse (herniation) or severe
sprain/strain of the spine. It
accomplishes
this by increasing the pressure of the
cerebral spinal fluid.

Flip or Testing for impingement of the sciatic

Bechterew’s test nerve. For the sign to be positive, both
tests must cause pain in the sciatic
nerve distribution. If only one test is
positive, the examiner should be
suspicious of problems in the lower
lumbar
spine.

Straight leg The straight leg raise is used to place

raising test (SLR) tension on the sciatic nerve to aid in
diagnosis of the presence of nerve root
compression of the lower lumbar
nerve roots. The basis of this test is that
the pain is reproduced due to
stretching of the lower lumbar and
sacral roots when the leg is flexed.
Well straight leg The well straight leg test causes
raising test stretching of the ipsilateral and
(WSLR)
contralateral nerve root, thereby
causing a lateral pulling motion on the
dural sac. It is an indication of a space-
occupying lesion (eg. herniated disc).
It is usually indicative of a rather large
intervertebral disc protrusion,
usually medial to the root nerve root.

Bragard’s test Pain that increases with ankle

dorsiflexion, indicates stretching of the
dura
mater of the spinal cord. Used to
discriminate between nerve or muscle
aetiology of lower back pain
Bowstring’s test This is a provocation test used to test
for tension or pressure on the sciatic
nerve by increasing the stress on it

Bonnet’s test This test stretches the Piriformis muscle

to test for tightness of the muscle or
other discomforts of the sciatic nerve as
it passes through or under the
Piriformis muscle
Kernig’s test This test tests for irritation that could
possibly indicate meningeal irritation,
nerve root involvement or dural
irritation by stretching the spinal cord
and
its overlying meningeal casing
Sign of the This test helps to determine whether
buttock the buttocks pain has its origin in the
buttock as a local lesion or is referred
from the hip, sciatic, nerve or
 hamstring muscles. The sign of the
buttock is part of a combination of
findings which indicates serious gluteal
pathology posterior to the axis of
flexion and extension of the hip. It is
designed to reveal 7 signs rather than a
single one.

Slump test This test is used to evaluate the

dynamics of the neural structures of the
central and peripheral nervous system
from the head, along the spinal cord
and the sciatic nerve tract and its
extensions into the foot. During the
slump
test the neural structures within the
vertebral canal are slowly and
progressively put on maximum stretch
Milgram’s test This test increases intrathecal pressure,
and if pain is reproduced, may
indicate a space-occupying lesion (eg.
intervertebral disc).

Sacral thrust This test’s purpose is to apply an

(Springing the anterior shear force to both sacroiliac
sacrum
joints since the ilia are fixed by the
examination bench. The test causes a
rotational shift of the SI joints
SIJ distraction This test stresses the anterior sacroiliac
ligaments.

SIJ compression The sacroiliac joint (SIJ) Compression

Test or “Approximation Test” is a
pain provocation test which stresses the
SIJ structures, in particular, the
posterior SIJ ligament.
Thigh thrust The posterior pelvic pain provocation
test is a pain provocation test used
to determine the presence of sacroiliac
dysfunction by creating a
posterior shearing force to the SIJ
through the femur.

Gaenslen’s The test functions by stressing the

tissues on the posterior side of the
pelvis
and creating motion at the sacroiliac
joint. Specifically, Gaenslen's test can
indicate the presence or absence of a
SIJ lesion, pubic symphysis
instability, hip pathology, or an L4
nerve root lesion. It can also stress the
femoral nerve.

Nachlas test This test is a neural tension test used to

(prone knee stress the femoral nerve and the
bending test)
mid lumbar (L2-L4) nerve roots. It also
causes a stretch of rectus femoris
which, when pulled taunt, causes a
pulling force to be placed on its
attachments. This pulls on the anterior
inferior iliac spine (AIIS), causing
anterior tilt of the pelvic bone on that
side. Because that pelvic bone moves
and the other pelvic bone does not
because it is stabilized against the
table,
motion is introduced into the SIJs.

Ely’s test This test is used to assess rectus femoris

for spasticity or tightness. It also
puts tension on the femoral nerve and
nerve roots L2- L4, during flexion of
 the knee
Yeoman’s test This test also stretches the SI joint – hip
joint and psoas muscle – and via the
latter also puts tension on the lumbar
spine.

Lumbar This test is designed to test each

springing test segments mobility relative to the next,
to
check for hypomobile, normal and
hypermobile spinal segments.
Therefore,
ligaments and IVD would be the mains
tissues being stretched and
compressed
Stoop test This test is used to determine if
neurogenic intermittent claudication is
present, which is typically exacerbated
when the spine is extended. Flexing
forward once symptoms are present is
designed to take pressure off the
neural structures exacerbated by
posture-related compression, which
causes
the neural and microvascular
compromise of the cauda equina and
lumbosacral nerve roots.

Hoover test This test is designed to check for

malingering. Since involuntary
extension of
the "normal" leg occurs when flexing
the contralateral leg against
resistance, the extensor muscles of the
counterbalancing leg should be
contracting and pulling the extending
leg down while attempting to elevate
 the other leg.

Trendelenburg’s This test is used to indicate weakness in

test the hip abductor muscles on the
stance side: gluteus medius and gluteus
minimus.

Patrick Fabere The FABER (Patrick’s) Test which stands

test for: Flexion, Abduction and
External Rotation of the leg. These
three movements combined result in a
clinical pain provocation test to assist in
diagnosis of pathologies at the
hip, lumbar and sacroiliac region.

Thomas test This test is used to measure the

flexibility of the hip flexors, which
includes
the iliopsoas muscle group, the rectus
femoris, pectineus, gracillis as well as
the tensor fascia latae and the
sartorius.

Test for true leg This test is used to measure if one leg is
length shorter than the other, the examiner
can determine if a true short leg is
present by measuring from the greater
trochanter to the lateral malleolus on
both legs.

Ober’s test This test assesses a tight, or inflamed

Tensor Fasciae Latae (TFL) and
Iliotibial band (ITB) for contracture
Pelvic Rock test This test is designed to compress the
joint surfaces of the SI joints to check
for stability of the SI joint
Homer pheasant A clinical test designed to help lumbar
test spinal stenosis by differentiating
neurological pain from axial back and
leg pain. This test is used to
hyperextend the lumbar spine to
diagnose an unstable spinal segment.

Schober test This test is used to check the amount of

flexion occurring in the lumbar spine

Bicycle test of This test is used to determine if

Van Felderen neurogenic intermittent claudication is
present, which is typically exacerbated
when the spine is extended. Flexing
forward once symptoms are present is
designed to take pressure off the
neural structures exacerbated by
posture-related compression, which
causes
the neural and microvascular
compromise of the cauda equina and
lumbosacral nerve roots.
The van Gelderen bicycle test is also
used to stress the LE vascular
system without causing any central
canal or foraminal stenosis that could
be
misinterpreted as intermittent
neurogenic claudication.

The Gait Cycle Review

1. Describe the gait cycle.
• the word gait refers to the manner or style of walking, rather than the
actual walking
process
• the gait cycle is the time interval between the exact same repetitive events of
walking
• the defined cycle can start at any moment, but it is generally begun when one
foot contacts
the ground
• if it starts with the right foot contacting the ground, then the cycle ends when the
right foot
• gait is the medical term to describe human locomotion, or the way that we walk
• interestingly, every individual has a unique gait pattern
2. The stance phase is 40% of the gait cycle and the swing phase is 60%.
True or false.
• False
o Stance phase is the part of the cycle when the foot is in contact with the
ground. It comprises 62% of the cycle, beginning with initial foot strike and
ending with toe-off
o Swing phase occurs when the foot is in the air and comprises 38% of the
cycle, beginning with toe-off and ending with second (ipsilateral) foot strike
3. What are the definitions of the following terms?

a. Stride Length
• The distance between 2 successive heel strikes
of the same foot
b. Step Length
• The distance between 2 successive heel strikes
of two different feet
c. Step width
• The lateral distance between the heel centres of
two consecutive foot contacts
d. Foot angle
• The angle in degrees from straight forward to the second toe

e. Cadence
• The number of steps per minute
4. When examining the motion in the sagittal plan, which joint undergoes the
most angular
motion?
• Ankle joint (tibiotalar)
5. Describe the typical gait for a post-stroke patient.
• Ataxic gait – Lurch or stagger, and all movements are exaggerated. Gait is
irregular, jerky
and weaving
6. At what phase of the gait cycle do the quadriceps activate?
• Swing phase
7. At what phase of the gait cycle do the hamstring muscles activate?
• Stance phase
8. List the 7 principles of gait assessment.
• Arm Swing
• Base of Gait
• Heel Strike
• Time Spent on Each Leg
• Posture of Trunk
• Toe Walking
• Heel Walking
• Tandem Walking
1. Variability – A measure of
inconsistency and arrhythmicity of stepping
and of arm
movements
2. Guardedness – Hesitancy,
slowness, diminished propulsion, and
lack of commitment in
stepping and arm swing
3. Staggering – Sudden and
unexpected laterally directed partial losses
of balance
4. Foot contact – The degree to which
the heel strikes the ground before the
forefoot
5. Hip Rom – The degree of loss of
hip range of motion seen during a gait cycle
6. Shoulder extension – A measure of
the decrease of shoulder range of motion
7. Arm – Heel strike synchrony – the extent to which the contralateral
movements of an
arm and leg are out of phase
9. List 2 causes for excessive inversion (supination)
• Tight Tibialis anterior (supplied by deep fibular nerve L4)
• Tight Tibialis posterior (supplied by tibial nerve L4-5)
• Or weak pronators (everters)
10. List 3 causes for excessive eversion.
• Tight Fibularis longus and brevis (supplied by superficial fibular nerve L5-S1)
• Fibularis tertius also assists in eversion (supplied by deep fibular nerve L4)
• Or weak inverters
11. List 4 causes for limited knee flexion.
• Sciatic nerve issues
• Weak Semitendinosus, Semimembranosus or Biceps femoris
• Other pathologies affecting the L5-S2 nerve roots (disc herniation, vertebral body
degeneration)
• Tight Quadriceps muscles (L2-4)
12. List 2 causes for excessive hip flexion.
• Tight iliacus and psoas muscles (femoral nerve supplied by L1-4)
• Weak gluteus maximus muscles (inferior gluteal nerve supplied by L5-S1)
• Or Weak hamstring muscles
13. List 2 causes for contralateral pelvic drop
• Weak glute Medius and minimus muscles (supplied by superior gluteal nerve L4-
S1 so could
be related to issues with this nerve) (Possible Trendelenburg gait)

Peripheral Nerve Motor Sensory Reflex

Spinal accessory Shoulder elevation/scapular No cutaneous distribution None

C3 - C4 adduction

Suprascapular and S - Abducts humerus from 0 S - none None

axillary nerve to 15 degrees, externally A - Deltoid area
C5 – C6 posterior rotates humerus. A –
cord Abducts humerus beyond
15 degrees, Adducts and
externally rotates humerus

Lateral pectoral Pulls shoulder forward No cutaneous distribution None

nerve
C5 - C6

Musculocutaneous Flexes and supinates Lateral aspect of forearm Biceps

nerve forearm
C5 – C7 lateral cord

Radial nerve Elbow/wrist thumb and Dorsum of hand (lateral Triceps

C5 – T1 posterior finger extension two
cord thirds)
Dorsum and lateral aspect
of
thumb
Proximal two-thirds of
dorsum
of index, middle, and half
of
ring finger

Median nerve Thumb flexion and Palmer aspect of hand None

C6 – T1 opposition, flexion of with thumb, index,
 digits 2 and 3, wrist middle, and lateral half
flexion and abduction, of ring finger.
forearm pronation Dorsal aspect of distal
third of index, middle,
and lateral half of ring
finger

Ulnar nerve Finger adduction and Dorsal and palmer None

abduction other than aspect of little and
thumb; thumb adduction; medial half of ring
flexion of digits 4 and 5; finger
wrist flexion and
adduction