Test INTERPRETATION/WHAT TISSUE STRUCTURE DOES THIS TEST

LOAD? For you to complete

Squat test Use to test the ankle, knee and hip joints for mobility or there lack of

Lumbar Kemps The aim of this test is to decrease the IVF and impact the facets by
test creating extension and rotation in the lumbar spine. (If procedure
reproduces pain in the leg, neurogenic claudication is indicated. If the
pain is local, the facets may be responsible)

Djerine’s triad Intra-abdominal pressure is increased and the patient is asked sneeze
(Valsalva, cough, and cough. If low back and or leg and thigh pain increases on valsalva
sneeze) could suggest intervertebral disc herniation.

Flip or While the patient is sitting they actively extend their leg. Then place
Bechterew’s test them supine and do unilateral straight leg raises. Positive for both
tests may indicate sciatic nerve. Only one positive may indicate lower
lumbar issues.

Straight leg The patient in the supine position and the knee extended, the
raising test (SLR) examiner flexes the hip until the patient complains of pain or
tightness. A unilateral straight leg raise is full at 70 where sciatic
nerve is completely stretched (primarily the L5,S1 and S2 nerve
roots). Thus, pain after 70 is probably joint pain from the lumbar area
or sacro-iliac joints. The test will cause traction in the sciatic nerve,
lumbosacral nerve roots, and dura mater. Adhesions within these
areas may result from herniation of the intervertebral disc, or
extradural or meningeal irritation.

Pain comes from the dura mater nerve root, adventitial sheath of the
epidural veins or the synovial facet joints. The test is positive if pain
extends from the back down into the leg in the sciatic nerve
distribution

Well straight leg (Same as straight leg raising test – supine)

raising test If the well leg is lifted and the patient complains of pain on the
(WSLR) opposite side, 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. The test causes
stretching of the ipsilateral as well as the contralateral nerve root,
pulling laterally on the dural sac

Braggard’s test (Same as straight leg raising test – supine)

If pain is present lower leg until pain subsides then dorsiflex foot, if
pain increases with dorsiflexion it indicates stretching the dura mater
of the spinal cord

Bowstring’s test (Same as straight leg raising test – supine)

The examiner caries out a straight leg raising test, and pain results.
The knee is slightly flexed, reducing the symptoms; the thigh
remaining in the same position. Thumb or finger pressure is then
applied to the popliteal area to re-establish the painful radicular
symptoms.

Indicates tension or pressure on sciatic nerve

Bonnet’s test (Same as straight leg raising test – supine, however induce internal
rotation at 45 degrees)

Internal rotation stretches the piriformis muscle. Leg pain may result
from sciatic nerve irritation or compression from a contracted
piriformis muscle. (External rotation may also effect siatic nerve
through contraction of piriformis)

Kernigs test Same as straight leg raising test – supine, but patient flexes head into
chest (done until pain is felt). Patient then flexes knee and pain
disappears. Pain is a positive sign, and may indicate the meningeal
irritation, nerve root involvement or dural irritation.

Sign of the The examiner performs a passive unilateral straight leg raising test. If
buttock there is unilateral restriction, the examiner then flexes the knee to see
whether hip flexion increases.

If problem is in the lumbar spine, hip flexion will increase (negative

sign)
 If hip flexion does not increase when the knee is flexed, it is a positive
sign. Indicating disease in the buttock, such as bursitis, tumour or
abscess (will exhibit a non-capsular pattern of the hip)

Slump test Seated position with hands behind there back. Then place patient into
full flexion preventing neck flexion. Overpressure is applied to
maintain lumbar and thoracic flexion. Cervical spine is then flexed.
Maximum dorsiflexion is induced and the patient is asked to extend
the leg.

If leg can’t be extended till neck flexion is released then the test is
considered positive for increased tension in the neuro-meningeal tract

Milgrams test The patient lies supine, and simultaneously actively lifts both legs off
the examining table 5 to 10 cm, and holds this position for 30 sec.
(Positive if the patient can’t hold for the time or symptoms are
reproduced in affected limb.)

This test increases intrathecal pressure, and if pain is reproduced,

may indicate a space-occupying lesion (eg intervertebral disc)

Sacral thrust The patient lies prone on a flat table, so that the symphysis pubis is
(Springing the on an unyielding surface. The operator applies the heel of his hand to
sacrum) the apex of the sacrum and springs firmly over it.

While springing, the other fingers palpate over the SI joint. It is

primarily a subjective test, relying on the patient’s sensation of pain.

SIJ distraction

SIJ compression

Thigh thrust

Gaenslen Place the patient in a supine position, with both their legs drawn onto
their chest. Shift the patient to the side of the couch, so that one
buttock extends over the edge of the table while the other remains on
it. Allow the unsupported leg to drop over the edge, while the
opposite leg remains flexed.
Nachlas test Patient lies prone and knee is placed into maximal flexion (insuring
(prone knee there is not hip rotation). Should be maintained for 40-60 sec, if not
bending possible at 90 degrees test with passive hip extension with knee
flexion should be undertaken.

Shooting pains in front of thigh and leg indicate L2-3 nerve root lesion.
Can also indicated stretching of anterior thigh musculature (tight
rectus femoris may cause anterior torsion of ilium with knee flexion –
causing sacroiliac or lumbar pain). Test stretches femoral nerve.

Ely’s test Patient prone with knee passively flexed while foot is being pushed to
opposite shoulder. Positive test indicated either L2-4 lesion or tight
rectus femoris

Yeoman’s test Patient prone while pelvis is stabilized and the hip is extended using
patients flexed knee while the other knee is extended. Positive test
indicated pain in lumbar spine and sacroiliac joints

Lumbar Patient is prone in a slightly extended position. Gradual downwards

springing test force is applied with heel of hand to each lumbar vertebra.

Pain felt on the brisk release of contact is to be recorded with level.

Stoop test Patient stands in forward flexion - Assesses neurogenic intermittent

claudication.

Patient with neurogenic intermittent claudication walks briskly for 1

minute, pain will ensue in the buttock and lower limb within a distance
of 50 – flexing will relieve the pain as well as sitting and flexing
forward. No relief with flexion is a negative test (extension may be
used to bring back symptoms)

Hoover test Patient lies supine. Examiner hands are placed under each calcaneus
with legs relaxed. Patient then raises one leg while keeping the knee
locked and the leg straight.

Inability to lift leg and no presence of pressure under the opposite

calcaneus means the are malingering. However if lifted limb is weaker
pressure under the heel the normal heel with increase to increased
effort on the other leg (two sides should be compared)

Trendelenberg’s Patient is asked to stand and flex one knee to 90 degrees while
test standing on the other. Normally pelvis on other side should rise – if it
does that indicates positive test.

Test assesses stability of hip and ability of hip abductors to stabilize

the pelvis and femur. Pelvis dropping on opposite sides suggests
weak gluteus Medius or unstable hip joint of affected side (e.g. hip
dislocation)

Patrick Fabere Fabere = Flexion, abduction and external rotation) Patient is supine,
test leg is placed so foot of the test leg on top of the knee of the opposite
leg. Leg if slowly lowered to test abduction.

Negative is leg falls below table or is parallel with opposite straight

leg. Positive if this isn’t possible indicating either hip joint issues,
iliopsoas spasms or lesion in sacro-iliac joint.

Thomas test Patient is supine (assess for excessive lordosis – usually present with
tight hip flexors). Patients hip is then flexed bringing the knee to the
chest to flatten lumbar.

Assess for hip fracture or contracture of the hip. If there is no flexion

contracture, the hip being tested (the straight leg) will remain on the
examining table. If a contracture is present, the patient’s straight leg
will rise off the table.

If the lower limb is pushed down onto the table, the patient may
exhibit an increase in lordosis, again this result indicates a positive
test

Test for true leg Patient must have a square pelvis level or balanced with the lower
length limb. Legs should be 15-20cm apart or parallel to each other.
Examiner uses tape to measure distance between ASIS and lateral
malleolus or ASIS and umbilicus. If one leg is shorter a true short leg
can be determined by measuring from greater trochanter to the lateral
malleolus. If there is a difference from this procedure, the following
should be measured:

a). From the greater trochanter of the femur to the knee joint line on
the lateral aspect (for femoral shaft shortening)
b). From the knee joint line on the medial side to the medial malleolus
(for tibial shaft shortening)

Ober’s test Patient lying on their side with lower leg flexed at the hip using knee
 for stability. Examiner passively abducts and extends patients upper
leg with knee straight or flexed at 90 degrees. Then slowly lowers
upper limb.

Ober’s test assesses the tensor fasciae latae (iliotibial band) for
contracture. If a contracture is present, the examiner stabilises the
pelvis at the same time to stop the pelvis from falling backward

Pelvic Rock test With the patient supine, place your hands on the iliac crests with the
thumbs on his ASIS’s and your palms on the iliac tubercles. Then,
forcibly compress the pelvis toward the midline of the body.

Homer pheasant Patient is prone, pressure is placed on posterior aspect of lumbar

test spine. Legs are then passively flexed at the knee to reduce IVF size
(position should be maintained for around 5 minutes).

Pain in legs from hyperextension of spine suggests unstable spinal

segments and neurogenic claudication. (Achilles reflex may be
checked before and after to determine change in nerve function)

Schober test Testing the movement of the sacro-iliac joints during forward flexion
(assessing the separation/lengthening 5cm above and 10cm below
the PSIS – S2)

Bicycle test of Patient seated on bicycle and asked to pedal against resistance while
Van Felderen leaning backwards to accentuate lumbar lordosis.

Pain in buttock and posterior thigh followed by tingling in affected

lower extremity that will be considered positive.
Patient then asked to lean forward and pedal, if pain subsides that
again is positive for neurogenic claudication.
The Gait Cycle Review

1. Describe the gait cycle.

Defined as a method of locomotion involving the use of the two legs, alternatively,
to provide both support and propulsion, with at least one foot being in contact
with the ground at all times

2. The stance phase is 40% of the gait cycle and the swing phase is 60%. True
or false.
False – the stance phase is 60% and the swing phase is 40%

3. What are the definitions of the following terms?

a. Stride Length – the distance between two successive placements of
the same foot
b. Step Length – the distance between the point of initial contact of one
foot and the point of initial contact of the opposite foot
c. Step width – the mediolateral space between the two feet
d. Foot angle – the angle made by the long axis of the foot from the heel
to 2nd metatarsal and the line of progression of gait
e. Cadence – the rate at which a person walks, expressed in 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

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 (evertors)

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 supinators

11. List 4 causes for limited knee flexion.

Sciatic nerve issues
Weak semitendinosis, 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 minimis muscles (supplied by superior gluteal nerve L4-S1
so could be related to issues with this nerve)
(Trendelenburg gait)
Complete the following table:

Peripheral Nerve Motor Sensory Reflex

Spinal accessory Shoulder

elevation/scapular Base of neck,
adduction extending laterally
over shoulder
Suprascapular Abducts humerus 0- Lateral shoulder
and axillary nerve 15 degrees,
externally rotates
humerus
Axillary nerve Adducts and Lateral aspect
externally rotates of arm
humerus, abducts
humerus beyond 15
degrees
Lateral pectoral Pulls shoulder
nerve forward

Musculocutaneous Flexes and Lateral biceps

nerve supernates arm and antebrachium
forearm, flexes and
adducts forearm
Radial nerve Elbow/wrist thumb
and finger extension

Median nerve Pronates and flexes

forearm, flexes wrist
and abducts hands,
flexes
metacarpophalange
al and proximal
interphalangeal
joints
Ulnar nerve Medial 1 ½
fingers