Schober’s Test GORP OMNICS

Introduction

• Schober’s test is classically used to determine if there is a decrease in lumbar spine range of
motion (flexion),

Procedure

• Patient is standing,
• Examiner marks the L5 spinous process by drawing a horizontal line across the patients back.
• A second line is marked 10 cm above the first line.
• Patient is then instructed to flex forward as if attempting to touch his/her toes, examiner
remeasures distance between two lines with patient fully flexed.
• Patient then comes back into extension and measurement is taken.

Modified Schober Test

• Patient is standing, examiner marks both posterior superior iliac spine (PSIS) and then draws a
horizontal line at the centre of both marks
• A second line is marked 5 cm bellow the first line.
• A third line is marked 10 cm above the first line.
• Patient is then instructed to flex forward as if attempting to touch his/her toes, examiner
remeasures distance between the top and bottom line.

Positive Schober’s Test

• Less than 5cm increase in length with forward flexion :

• Decreased lumbar spine range of motion, ankylosing spondylitis

Clinical Notes

• This test is almost exclusively associated with Ankylosing Spondylitis, but may also be positive
due to a decrease in lumbar range of motion due to pain or congenital anomalies or segmental
fusion.
Kemps Test GORP OMNICS

Introduction

• Kemp’s Test is a useful examination to differentiate between Lumbar nerve root

compression and local lumbar spine sprain/strain
• Kemp’s test is a test to assess the lumbar spine facet joints (zygapophyseal joints).
• The aim of this test is to decrease the IVF and impact the facets by creating extension and
rotation in the lumbar spine.
• It is a provocative test to detect pain , which can be local, referred or radicular

Procedure :

• Patient seated, examiner stabilises lumbar spine with one hand and supports patient’s
contralateral shoulder with the other hand.
• Patient leans away from examiner then is twisted into forward flexion and eventually brought
back into lateral flexion and extension.
o Modifications
• Kemp’s Test can also be performed with the patient standing in an upright position. Take care that
the patient does not lose balance.
• You can apply downward pressure on the patients shoulders to increase pressure on the facet
joints.

Positive Kemp’s Test

• There are two signs to show a positive kemp’s test.

• Leg pain: Typically indicates nerve root compression, radiculopathy.
• Local lower back pain: Local lesion (sprain/strain, facet syndrome, meniscoid entrapment)

Interpretation
• Local lower back pain on the tested side usually indicates a facet cause, while radiating pain into
the leg is more suggestive of nerve root irritation.
• Pain on the contralateral side can suggest a lumbar strain or sprain.
Slump Test GORP OMNICS

Introduction
• The slump test places tension on the entire spinal cord and peripheral nerves of the upper and
lower extremities.
• It can therefore assess a space-occupying condition/lesion of the cervical and lumbar spinal regions
as well as thoracic outlet syndrome (TOS).
• Slump Test is often used to produce symptoms of radiculopathy/disc herniation in patients with
lower back pain.

Procedure
• The patient is seated on the edge of the examining table with the legs supported, the hip is in the
neutral position and the hands behind the back
• The patient is asked to slump so that the lumbar and thoracic spine go into full flexion.
• The examiner maintains the patient’s chin in neutral position to prevent head and neck flexion.
• The examiner then uses one arm to apply over-pressure and maintain flexion of the lumbar and
thoracic spine.
• While this position is held the patient is then asked to flex the cervical spine and head as far as
possible.
• The examiner then applies over-pressure to maintain flexion in all three parts of the spine using the
same arm to maintain over-pressure in the cervical spine.
• With the other hand, the examiner then holds the patient’s foot in maximum dorsiflexion. While
the examiner holds these positions, the patient is asked to actively straighten the knee as much as
possible.
• The test is repeated with the other leg, and then with both legs together.

Positive Slump Test

• The client should either experience a reproduction of the upper or lower extremity symptoms that
they have been experiencing or a high level of pain during the procedure.
• If the patient is unable to fully extend the knee because of pain, the examiner releases the pressure
on the cervical spine and the patient actively extends the neck.
• If the knee extends further and the symptoms decrease with neck extension, then the test is
considered positive for increased tension in the neuromeningeal tract.
Djerine’s Triad (Valsalva, cough and sneeze) GORP OMNICS

Introduction

• Djerine’s Triad is a three-part test for determining nerve compression which 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 (Intrathecal pressure
test)

Procedure

• Patient is sitting erect

• The first part is the Valsalva maneuver.
• This is accomplished by having the individual sit erect, head up with forearms flexed to 90° with
fist clenched.
• Then the individual is requested to take a deep breath and hold it while bearing down as if having a
bowel movement.
• The individual should note if they experience sharp pain at the spine and report to the practitioner,
at what segmental level it was experienced.
• The second part of this test is accomplished by having the individual replicate a cough while sitting
erect.
• they should report if they notice any sharp pain and at the spinal level it occurs.
• The third part of this test is achieved by inducing the individual to sneeze.
• However, because the violent action of sneezing could worsen a compromised annulus, we
recommend that this third and final part of Dejerine’s triad not be performed.

Positive Djerine’s Triad Test

• Spine and/or extremity pain is a positive finding indicating the possibility of a space-occupying
lesion associated with the thecal sac.
• Additionally, pain experienced at a specific segmental level from one or more of these manoeuvres
would be a positive concomitant for more specialized testing in the extended exam or by
diagnostic imagery.
Flip or Bechterew’s Test GORP OMNICS

Introduction

• Bechterew’s Sitting Test is a useful orthopaedic examination for patients with lower back pain to
reproduce radiculopathy.
• Bechterew’s Sitting test is mainly used to assess radiculopathy in the lower limb. The test can also
reproduce local pain lumbar spine pain or hamstring muscle pain.
• The Bechterew’s test uses hip flexion and knee extension to provoke pain with nerve root/sciatic
tension.

Procedure

• Patient seated, attempts to extend knee one side at a time actively

• The examiner look for symptoms
• Patient then attempts to extend both knees at the same time

Positive Bechterew’s Sitting Test

• 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.
• Leg pain: Radiculopathy, intervertebral foramen encroachment, space-occupying lesion, nerve root
tension
• Local pain: Lumbar ligament sprain/ muscle strain
Straight Leg Raise (SLR) GORP OMNICS

Introduction
• The Straight Leg Raise is a test to help determine whether a patient with low back pain has an
underlying herniated disk.
Procedure
• Patient is supine
• Each leg is tested individually with the normal leg being tested first.
• The examiner places one hand under patient’s ankle & other hand over patient’s knee (to insure
knee stays extended during action).
• The Examiner then proceeds to passively elevate the straight leg.
• The examiner flexes the hip until the patient complains of pain or tightness in the back or back of
the leg.
Interpretation

• If symptoms are primarily back pain, it is most likely the result of a disc herniation applying
pressure on the anterior theca of the spinal cord, or the pathology causing the pressure is
more central. "
• If pain is primarily in the leg, it is more likely that the pathology causing the pressure on
neurological tissue(s) is more lateral
• Neurologic pain which is reproduced in the leg and low back between 30-70 degrees of hip flexion
is suggestive of lumbar disc herniation at the L4-S1 nerve roots.
• Pain at less than 30 degrees of hip flexion might indicate acute spondyloithesis, gluteal abscess,
disc protrusion or extrusion, tumour of the buttock, acute dural inflammation, a malingering
patient, or the sign of the buttock.
• Pain at greater than 70 degrees of hip flexion might indicate tightness of the hamstrings, gluteus
maximus, or hip capsule, or pathology of the hip or sacroiliac joints

Positive Straight Leg Test

• The test is positive if pain extends from the back, down into the leg in the sciatic nerve
distribution.
Well Straight Leg Raise Test (aka Crossed Straight leg Raise test) GORP OMNICS

Introduction

• To test for the presence of a disc herniation.

Procedure

• Same as the straight leg raise

• Patient is supine
• Each leg is tested individually with the normal leg being tested first.
• The examiner places one hand under patient’s ankle & other hand over patient’s knee (to insure
knee stays extended during action).
• The Examiner then proceeds to passively elevate the straight leg.

Positive Well Straight Leg Test

• A positive test is considered when the patient reports reproduction of pain in the involved limb at
40 degrees of hip flexion or less in the uninvolved limb.

Indications

• 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 GORP OMINICS

Procedure

• Test should follow a Straight Leg Raise

• If pain is present while performing the SLR, the examiner carefully drops the leg back slightly
until there is no pain or tightness, and then performs dorsiflexion on the foot.
• Affected leg is lowered to angle just below the production of pain, examiner then dorsiflexes the
foot

Interpretation

• Leg pain or reproduction of SLR test symptoms: Radiculopathy, interventricular foramen

encroachment, space-occupying lesion, nerve root tension, sciatica
• Local back or hamstring pain or calf pain: Sprain/strain

Clinical Notes

• Dorsiflexion of the foot may increase sciatic nerve root tension resulting in radicular symptoms.
• Pain that increases with ankle dorsiflexion, indicates stretching of the dura mater of the spinal cord
Bonnet’s Test GORP OMNICS

Introduction

• This test uses the external rotation mechanics of the piriformis muscle to determine if the
piriformis tension has a role in the patients pain

Procedure

• Patient Position: Supine

• Description: The patients extended leg is comfortably lifted 45° and internally rotated.

Interpretation

• Rationale: Internal rotation stretches the piriformis muscle.

• Leg pain may result from sciatic nerve irritation or compression from a contracted piriformis
muscle.
• Similarly, SLR with external rotation may be performed.
• This may also affect the sciatic nerve via contraction of the piriformis muscle.
Bowstring’s test GORP OMNICS

Introduction

• Bowstring Sign is often used to apply pressure on the sciatic nerve and reproduce radicular pain,
indicating lumbar root compression or sciatic nerve tension (sciatica
Procedure

• Patient supine, examiner flexes patient’s hip with knee slightly flexed until the patient complains
of pain or tightness;
• examiner then back off slightly and applies pressure with thumbs on hamstring muscles
• If no pain is elicited, examiner then proceeds to apply pressure to the popliteal fossa (traction on
the sciatic nerve).
• Patient is instructed to repeat motion of touching toes.

Positive Bowstring Sign

• Leg pain: Radiculopathy, interventricular foramen encroachment, space-occupying lesion, nerve

root tension, sciatica
• Local Back or Hamstring Pain: Consider local muscle strain or ligamentous sprain

Interpretation
• Bowstring Sign can be used to differentiate between radiculopathy, sciatica and local muscular
and/or ligamentous sprain.
• The test is an indication for tension or pressure on the sciatic nerve.
Milgram’s Test GORP OMNICS

Introduction
• The test increases subarachnoid pressure and is positive when the patient is unable to hold the
position for 30 seconds without pain, indicating pathology within or outside the spinal cord
sheath, such as a herniated disc.

Procedure

• Patient supine,
• Patient simultaneously actively lifts both legs off the examining table 5 to 10 cm, and holds this
position for as long as possible
• If patient can hold position for 30 sec intrathecal pathology can be ruled out

Positive Milgram’s Test

• The test is positive if the limbs or affected limb cannot be held for 30 seconds, or symptoms are
reproduced in the affected limb
Sign of the Buttock GORP OMNICS

Introduction

• Importance of the Test: When performing a SLR, a pathology in the hamstrings, sciatic nerve,
buttock, or hip may cause limitations.
• If the knee is flexed, the stress is taken off the hamstrings and sciatic nerve (because they cross
the knee), so remaining limitation is due to pathology of the hip or buttock.

Procedure

• Patient supine
• The examiner performs a passive straight leg raising test.
• If the SLR is positive, the end-feel is usually spasm or capsular, but definitely painful.
• Return the patient to neutral.
• Passively flex the patient's hip, but this time the examiner then flexes the knee to see whether
hip flexion increases.
• Assess for if further hip flexion was achieved. If no change in range of motion, the pathology is
within the hip or buttock, and not the hamstrings or sciatic nerve.

Positive Sign of the Buttock Test

• To be positive, the Sign of the Buttock must have all present: restriction of SLR concurrently with
limited hip flexion and a non-capsular pattern of restriction of hip joint ROM.
• If hip flexion does not increase when the knee is flexed, it is a positive sign of the buttock test,
and indicates disease in the buttock, such as bursitis, tumour or abscess.
Belt or Supported Adam’s Test GORP OMNICS

Introduction

• Belt Test is a useful examination to differentiate between Lumbar spine pathology and Sacroiliac
(SI) joint pathology.

Procedure
• Standing patient is instructed to bend forward and touch toes with knees straight and return to
standing.
• If pain is present in the low back, the examiner then stabilises the patient’s pelvis with hands and
patient’s sacrum with examiner’s lateral thigh.
• Patient is instructed to repeat motion of touching toes.
• By supporting the patient’s pelvis & sacrum the examiner should effectively prevent motion at
the sacroiliac joint, thus eliminating it as a potential pain generator during supported forward
flexion.

Positive Belt or Supported Adam’s Test

• Pain with both supported & unsupported flexion- Lumbar spine pathology
• No pain with support, pain without support- Sacroiliac joint pathology
Squat Test GORP OMNICS

Procedure

• Patient Position: Prone

• The examiner instructs the patient to squat down as far as possible, bounces two or three times
and returns to the standing position.

Positive Squat Test

• This action will quickly test the ankles, knees and hips or any pathological condition.
• If the patient can fully squat and bounce without signs and symptoms, these joints are in all
probability free of pathology related to the complaint.
• It must be remembered that this test should be used only with caution and should not be done
with patients suspected of having arthritis in the lower limb joints.
• If this test is negative there is no need to test the peripheral joints with the patient in the lying
position.
Kernig’s/ Brudzinki’s test GORP OMNICS

Indications

• The mechanics of the Kernig/Brudzinski test are similar to those of the straight leg raising test
except that the movements are done actively by the patient.
• Brudzinski’s neck sign is one of three medical signs, that may occur in meningitis/meningeal
disease.
• Kernig’s Sign leg sign, is often used to produce a sign of meningitis.
• The examination can also be used to reproduce radiculopathy in root compression, or nerve tension
(sciatic nerve).

Procedure

• Patient supine, examiner passively flexes patient’s head & neck onto the chest.
• Simultaneously the examiner flexes patient’s hip to 90° with knee flexed.
• Examiner then extends patient’s knee until pain is felt
• The patient then flexes the knee, and the pain will disappear.

Positive Kernig’s Sign

• Leg pain: Radiculopathy

• Increased resistance : Hamstring tightness
• Involuntary flexion of the opposite knee and hip: Meningitis