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Chapter 10: Lumbosacral Pathologies

Clinical Examination of the Lumbar Spine

Examination Map HISTORY

Past Medical History

Mental health status

History of the Present Condition

Location of pain

Radicular symptoms

Onset and severity of symptoms

FUNCTIONAL ASSESSMENT

Gait Observation

General movement

Posture

INSPECTION

Gait

Movement

Posture

General Inspection

Frontal curvature

Sagittal curvature

Skin markings

Inspection of the Lumbar Spine

Lordotic curve

Standing posture

Erector muscle tone

Faun's beard

Palpation

Palpation of the Lumbar Spine

Spinous processes

  • Step-off deformity

Paravertebral muscles

Palpation of the Sacrum and Pelvis

Median sacral crests

Iliac crests

Posterior superior iliac spine

Gluteals

Ischial tuberosity

Greater trochanter

Sciatic nerve

Pubic symphysis

JOINT AND MUSCLE FUNCTION ASSESSMENT

Goniometry

Flexion

Extension

Lateral bending

Rotation

Active Range of Motion

Flexion

Extension

Lateral bending

Rotation

Manual Muscle Tests

Flexion

Extension

Rotation

Pelvic elevation

Passive Range of Motion

Flexion

Extension

Rotation

Side gliding

JOINT STABILITY TESTS

Joint Play Assessment

Spring test

SELECTIVE TISSUE TESTS

Test for Nerve Root Impingement

Valsalva

Milgram

Kernig

Straight leg raise

Well straight leg raise

Slump test

Quadrant test

NEUROLOGICAL EXAMINATION

Lower quarter screen

REGION-SPECIFIC PATHOLOGIES AND RELATED SELECTIVE TISSUE TESTS

Spinal Stenosis

Intervertebral Disc Lesions

Femoral nerve stretch test

Tension sign

Segmental Instability

Erector spinae strain

Facet joint dysfunction

Spondylopathies

Spondylolysis

Spondylolisthesis

  • Single-leg stance test

Sacroiliac Dysfunction

Fabere sign

Patrick's test

Gaenslen's test

Long sit test

History

Table 10-1Ramifications of Spinal Pain Exhibited During the Activities of Daily Living
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Table 10-1 Ramifications of Spinal Pain Exhibited During the Activities of Daily Living
Activity Ramifications
Bending Pain may be initially worsened with flexion exercises.
Sitting Pain may be initially worsened with flexion exercises.
Rising From Sitting This motion causes changes in the forces within the disc. Sharp pain suggests derangement of the disc.
Standing The spine is placed in extension. Pain may be initially experienced with extension exercises.
Walking The amount of spinal extension increases as the speed of gait increases.
Lying Prone The spine is placed in or near full extension.
Lying Supine When lying supine on a hard surface, the amount of extension is maintained.
  When lying on a soft surface, the spine falls into flexion.

image Selective Tissue Test 10-1: Hoover Test

image

The Hoover Test is used to identify if a patient is actually exerting effort during the testing procedure. A positive test suggests that the patient is malingering.

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Patient Position Supine
Position of Examiner At the feet of the patient with the evaluator's hands cupping the calcaneus of each leg (A).
Evaluative Procedure The patient attempts an active straight leg raise (SLR) on the involved side.
Positive Test The patient does not attempt to lift the leg, and the examiner does not sense pressure from the uninvolved leg pressing down on the hand as should instinctively happen (B).
Implications The patient is not attempting to perform the test (i.e., ...

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