Test INTERPRETATION/WHAT TISSUE STRUCTURE DOES THIS TEST

LOAD? For you to complete

Squat test Testing ankles, knees and hips for pathology. Be cautious with elderly
and do not perform on pregnant women.

Lumbar Kemps Neurgenic claudication indicated if pain is reproduced during

test extension ipsilateral rotation with lateral flexion in the ipsilateral IVF

Djerine’s triad Testing for IVD herniation -low back pain/thigh pain
(Valsalva, cough,
sneeze)

Flip or Two phases to this test, sitting passive knee extension, followed by
Bechterew’s test passive single straight leg raise. If both are +ve then sciatic nerve
distribution suspected. If only one produces pain then look to the
llumbar spine

Straight leg Passive test – unilateral +ve pain at 70 degrees hip flexion in nerve
raising test (SLR) roots commonly L5, S1, S2

Well straight leg Space-occupying lesion in +ve pain down leg which is not passively
raising test raised
(WSLR)

Braggard’s test If pain is present during SLR then examiner reduces flexion until no
pain and dorsi flexes the ankle +ve pain in dura mater of spinal cord

Bowstring’s test SLR pain, flex knee with thigh position maintained, practitioners
thumbs on popliteal tissue to reproduce sciatic nerve tension

Bonnet’s test Passive – hip flexion to 45 degrees flexion with internal rotation +ve
pain sciatic nerve irritation

Kernigs test Active test – similar to SLR. Active flexion of neck with active flexion
of leg at hip. +ve pain during movement = meningeal irritation, nerve
root or dural irritation

Sign of the Passive – unilateral SLR, looking for restriction. Performed again with
buttock knee flexed to compare. +ve = no change in range bursitis, tumour or
abcess, -ve = change in range during flexed knee hip flexion which
indicates lumbar involvement

Slump test Testing neuromeningeal tract – passive test

Milgrams test Supine position, active flexion of extended leg for 30sec +ve IVD
space occupying lesion

Sacral thrust Lumbar-Sacral junction lesion L5-S1 or anywhere in the sacrum.

(Springing the Pathology of the Sacraltuberous and Sacralischial ligaments.
sacrum)

SIJ distraction

SIJ compression

Thigh thrust Testing the SIJ +ve = pain. Patient is supine, examiner passively
flexes the hip to 90 degrees. Examiner uses one hand to palpate SIJ
of tested side whilst using body to thrust down through the knee and
hip.

Gaenslen Ipsilateral SIJ lesion, hip pathology, L4 nerve root lesion. +ve = pain in
SIJ

Nachlas test Tight rec fem muscle before full PROM prone hip extension with knee
(prone knee flexion, radicular pain L3 nerve root lesion.
bending

Ely’s test +ve = L2-L4 and/or tension in rec fem on flexion of knee to opposing
buttock in supine position.

Yeoman’s test +ve = SIJ or Lumbar spine pain during extension or either hips (knee
flexed) with stabilised pelvis

Lumbar Gradual pressure centrally and unilaterally applied with brisk release.
springing test Pain is noted as +ve at vertebral level
Stoop test Neurogenic Claudication relationship to posture and walking. Walking
briskly for 1min, pain in buttocks and lower leg will appear. Patient
flexes forwards to relieve pain or sits and forward flexes. -ve if flexion
does not relieve pain. Extension may also bring symptoms back.

Hoover test Malingering. +ve if no pressure if felt through examiners hands from
the calcaneus of the leg not being actively lifted by the patient.

Trendelenberg’s +ve if opposite pelvis does not rise during hip flexion of tested side.
test Indicates instability of pelvis – gluteus medius on opposite side or hip
joint on affected side.

Patrick Fabere Iliopsoas shortening or SIJ lesion. +ve if knee does not touch table or
test does not finish parallel to opposite thigh.

Thomas test Shortened iliopsoas (psoas ++) and/or rec fem. +ve if knee extends
for rec fem or thigh is not touching the table for iliopsoas shortening.

Test for true leg Measure form umbilicus to lateral malleolus. Then from greater
length trochanter to lateral malleolus. If there is difference ascertain if it is
tibial (medial side of knee joint line to medial malleolus) or if it is
femoral shortening (Greater trochanter to lateral knee joint line).

Ober’s test ITB & Gluteus Medius restriction in particular. +ve = knee held of table
through contracture of tight muscles.

Pelvic Rock test Or “Squish” test, testing posterior sacroiliac ligaments, +ve = pain.
Patient is supine, examiner places hands on ASIS’s and Iliac Crest’s
and forcibly compresses towards midline at 45 degree angle.

Homer pheasant Aim is to decrease the IVF for up to 5min. +ve pain in hyperextension
test of spine, indicates unstable spine segment and neurogenic
claudication. Achilles reflex can also be checked.

Schober test Lumbo-pelvic movement in flexion/extension between two measured

points. S2 – 10cm above & 5cm below. -ve increased measurement
during flexion and decreased measurement during extension

Bicycle test of Patient cycles in trunk extension to increase lumbar lordosis, pain in
Van Felderen buttocks and thigh followed by tingling = +ve part 1. Patient then leans
 forward whilst still peddling if the pain diminishes = +ve. Neurogenic
Claudication.

The Gait Cycle Review

1. Describe the gait cycle.

a. Method of locomotion using legs alternatively to provide support and
propulsion, with one foot in contact with the ground at all times. The
cycle is the time interval between the exact same repetitive events of
walking - left foot contacting floor through cycle back to left foot on floor
again.
b. Two phases
i. Stance phase = 62% cycle
ii. Swing phase = 38% cycle

2. The stance phase is 40% of the gait cycle and the swing phase is 60%. True
or false.
3. What are the definitions of the following terms?
a. Stride Length
i. The linear distance in plane of progression in foot-to-floor
contact of the same foot to the ground through the cycle, usually
about 144cm.
b. Step Length
i. The distance between successive contact points on opposite
feet, usually about 72cm.
c. Step width
i. Distance between the two feet, usually about 5-10cm.
d. Foot angle
i. Or Fick’s angle, usually 12-18 degrees measured from midline
to 2nd phalanx
 e. Cadence
i. Normally about 90-120 steps per minute, cadence is heel strike
to toe off showing changing weight distribution.
4. When examining the motion in the sagittal plan, which joint undergoes the
most angular motion?
a. Ankle joint (Tibiotalar)
5. Describe the typical gait for a post-stroke patient.
a. Ataxic Gait – poor balance and broad base which leads to a lurch or
stagger with all movements exaggerated.
6. At what phase of the gait cycle do the quadriceps activate?
a. Swing phase
7. At what phase of the gait cycle do the hamstring muscles activate?
a. Stance phase
8. List the 7 principles of gait assessment.
a. Arm Swing
b. Base of Gait
c. Heel Strike
d. Time spent on each leg
e. Posture of Trunk
f. Toe Walking
g. Heel Walking
h. Tandem Walking
9. List 2 causes for excessive inversion (supination)

a. Tight Tibialis anterior (supplied by deep fibular nerve L4)

Tight Tibialis posterior (supplied by tibial nerve L4-5)
b. Or weak pronators (evertors)
10. List 3 causes for excessive eversion.
a. Tight Fibularis longus and brevis (supplied by superficial fibular nerve
L5-S1)
Fibularis tertius also assists in eversion (supplied by deep fibular nerve
L4)
b. Or weak supinator’s

11. List 4 causes for limited knee flexion.

a. Sciatic nerve issues

b. 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.

a. 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

a. Weak glute Medius and minimus muscles (supplied by superior gluteal

nerve L4-S1 so could be related to issues with this nerve)

b. (Trendelenburg gait)

This would be a good time to reinforce with you the evaluation of the
peripheral nerves, too, which would involve the SMR and NTT (nerve
tension tests)
Complete the following table:

Peripheral Nerve Motor Sensory Reflex

Spinal accessory Shoulder Brachial plexus none

elevation/scapular symptoms possible
adduction because of
(Cranial XI; C3, C4)
drooping shoulder.
Shoulder aching.

Suprascapular Supraspinatus, Top of None

and axillary nerve infraspinatus (arm shoulder from
lateral rotation). clavicle to
SSN: C5-C6 spine of
Deltoid, teres minor scapula. None
AN: C5-C6 (arm abduction) Pain in
posterior
shoulder
radiating into
arm.

Deltoid Area
Anterior
shoulder pain
Lateral pectoral Pectoralis Major, None None
nerve Pectoralis Minor.

LPN: C5-C6
Musculocutaneous Coracobrachialis, Lateral biceps
nerve Biceps, Brachialis antebrachium
(Elbow Flexion)
MCN: C5-C7
Radial nerve Elbow/wrist thumb Dorsum of Triceps
and finger hand
RN: C5-C8, T1 extension

Median nerve Pronator teres, Palmer None.

wrist flexors aspect of
(lateral half of thumb,
MN: C6-C8, T1
flexor digitorum index,
profundus), middle, and
Palmaris longus, half of ring
Pronator finger.
Quadratus, Flexor Dorsal
Pollicis Longus aspect of
and Brevis, index,
Opponens Pollicis, middle, and
 Lateral two possibly half
Lumbricals of ring
finger.
Ulnar nerve Flexor digiti Medial 1 ½ ?
minimi, abductor fingers
UN: C7-C8, T1 digiti minimi,
opponens digiti
minimi, adductor
pollicis, interossei,
medial two
lumbricals,
palmaris brevis