Introduction

iPod Spine: Lumbar Instability and Sacro-Iliac Joint Dysfunction

Students participated in this Blog: Brittany West, Dmitri Raetki-Solntev

Research Advisers: DR. Hamdy Radwan, Dr. Emma White


Welcome to our blog! This blog is designed to assist physical therapy students, teachers and practicing physical therapists. This blog was developed by physical therapy students and faculty of Winston Salem State University, physical therapy department. This blog provides detailed information and steps for administration of lumbar spine and sacro-iliac (SI) special tests.

Extensive clinical experience and a literary review were conducted to support the use of these tests. Detailed information is available regarding the procedure, alternative names, position of both patient and therapist, and references to use for future research by
 viewers. Videos can be accessed to view the tests in action.

Such statistical parameters as sensitivity (true positive), specificity (true negative) and likelihood ratio (LR) are also at your disposal. You will find the information about each test identifying in what cases the test is considered positive (+) or negative (-).
We hope that you will use and find this blog helpful. Enjoy it!!!
 
Below is the list of special tests discussed in this blog:  

 1.      Sacral Thrust Test

 2.      Compression Test

 3.      Distraction Test

 4.      Thigh Thrust Test

 5.      Lumbar Instability Test

 6.      Gaenslen’s Test

 7.      Patrick’s Test (FABER)

 8.      One Leg Standing Lumbar Extension Test

 9.      Straight Leg Raise Test

 10.  Slump Test

Gaenslen’s Test

Purpose: The test can help distinguish between lumbar spine involvement and SI joint dysfunction.

Patient/Therapist Position: Pt is supine with crease of knee at edge of table. The leg being tested is hyperextended at the hip so that it hangs over the table while the other leg is flexed at the hip and knee.
Procedure: Once the pt is in the proper position; the pt actively holds the non-tested leg into hip flexion during which time the PT stabilizes the pelvis and applies passive pressure to the tested leg, in order for it to stay on the table. The PT applies overpressure so that the tested hip is put into further extension and adduction.

*Note- Unaffected side/leg should always be tested first.

Interpretation: + indication when pain is reproduced with comparable symptoms.  This positive test is indicative of SI joint, pubic synthesis instability and/or L4 nerve root lesion.


Statistics: Sensitivity 31-37%, Specificity 71-77% , +LR 1.84 to 2.21 , -LR .65 to .66

References:

Therrien, Jason and Finley, Katie. “Gaenslen’s Test”. http://www.physio-pedia.com/Gaenslen_Test. Web 2012.

P. van der Wurff, et. Al. “Clinical tests of the sacroiliac joint. A systematic methodological review. Part 1: Reliability.” Man Ther. Volume 5, Number 1, February 2000. Pgs. 30–36.

Patrick’s Test (FABER) Test

Purpose: To assess for pathological conditions of hip joint, iliiopsoas spasm, or sacroiliac joint dysfunction.

Patient/Therapist Position: Pt is lying supine, untested leg is lying straight, tested leg is brought into hip flexion, abduction and external rotation by PT.


Procedure: The PT stabilizes contralateral (straight) leg’s ASIS. The PT then tries to passively lower the tested leg to the table. 1

Interpretation: + indication when pain is reproduced with comparable symptoms and/or when the tested leg's knee remains above the leg that is straight out.

*Note- Unaffected side should always be tested first.

Statistics: Sensitivity 82%, Specificity N/A , +LR .46, -LR N/A

References:

Magee, David and Sueki, Derrick. Orthopedic Physical Assessment Atlas and Video: Selected Special Tests and Movements. Musculoskeletal Rehabilitation Series. 2011.

Maslowski E, et. Al. “The diagnostic validity of hip provocation maneuvers to detect intra-articular hip pathology.” American Academy of Physical Medicine and Rehabilitation. Volume 2, Number 3. March 2010. Pgs. 174-181

One-Leg Standing (Stork Standing)

Patient/Therapist Position: Patient positioned supine resting on the table. Therapist is positioned on the opposite side of the tested SI Joint.

Procedure: Therapist flexes patients hip on the involved side to 90 degrees and applies direct downward force through the femur while stabilizing sacrum. Repeat 4-5 thrusts, 3-4 sets.

Interpretation: + with local SI Joint pain on suspected side

Statistics: Sensitivity .96, Specificity .88, +LR 2.80, -LR .18

References:

 Laslett M., et al, :Diagnosis of Sacroiliac Joint Pain: Validity of individual provocation tests and composites of tests. Manual Therapy 10 (2005) 207–218

 Stuber J., Specificity, sensitivity, and predictive values of clinical tests of the sacroiliac joint: a systematic review of the literature. J Can Chiropr Assoc 2007; 51(1)
 

Straight Leg Raise Test (Lasegue’s Test)

Purpose: To assess for impingement of the dura and spinal cord nerve roots of the lower lumbar spine. The test targets the sciatic nerve, tibial nerve, sural nerve, common peronal nerve and nerve root (disc prolapse).

Patient/Therapist Position and Procedure: Basic SLR; Pt is lying supine with leg straight. PT then flexes hip until pt complains of pain or tightness in the lower back or radicular pain down the posterior portion of the tested leg. PT then lowers leg (which should slowly relieve pain). If no comparable symptoms occur the PT can proceed to next SLR modification.

*Note- Unaffected leg should always be tested first.


Interpretation: + indication when pain is reproduced with comparable symptoms, radicular pain in posterior portion of tested leg, and if the pain is relieved when the PT lowers the tested leg.


Statistics: Sensitivity 33%, Specificity 87% , Reliability 0.93, Validity 98%

References:

Magee, David and Sueki, Derrick. Orthopedic Physical Assessment Atlas and Video: Selected Special Tests and Movements. Musculoskeletal Rehabilitation Series. 2011.

Capra, Francesco, Vanti, Carla, et. Al. “Validity of the Straight-Leg Raise Test for Patients with Sciatic Pain with or without Lumbar Pain Using Magnetic Resonance Imaging Results as a Reference Standard.” Journal of Manipulative and Physiological Therapeutics. Volume 34, Number 4. May 2011. Pgs. 231-238.

Slump Test

Purpose: To assess for movement restriction/impingement of the dura and spinal cord and/or nerve roots. Modifications test for cervical and lumbar nerve roots, sciatic nerve, obturator nerve and femoral nerve impingements.
Patient/Therapist Position and Procedure: Pt is seated on edge of table, feet hanging off the table. Pt is instructed to “slump” over into thoracic and lumbar flexion. Pt has hands behind his/her back. Pt is asked to keep neck and head in neutral (no flexion). If there are no reproduction of neurological symptoms, the PT progresses to the slump test modifications.

*Note- Unaffected leg should always be tested first.


Interpretation: + indication when pain is reproduced with comparable symptoms; if pt is unable to extend (affected) knee due to pain and then the pain is relieved when overpressure of the cervical spine is released the pt actively extends their neck.

Statistics: Sensitivity 84%, Specificity 83%

References:

Magee, David and Sueki, Derrick. Orthopedic Physical Assessment Atlas and Video: Selected Special Tests and Movements. Musculoskeletal Rehabilitation Series. 2011.

Javid Majlesi, MD, Halit Togay, MD, et. Al.  “The Sensitivity and Specificity of the Slump and the Straight Leg Raising Tests in Patients with Lumbar Disc Herniation.” JCR: Journal of Clinical Rheumatology. Volume 14, Number 2, April 2008. Pgs. 87-92.

Lumbar Instability Test (Prone Instability Test)

Patient/Therapist Position: Patient positioned prone with legs off the table while toes touch the floor. Patient is to be relaxed prior to testing. Therapist is positioned on either side of the table. Therapist places hands at suspected involved segment.

Procedure: Patient is asked to lift feet of the floor 2-3 inches and extent hips towards the ceiling. Therapist applies direct downward force to the segment.

Interpretation: + with pain diminishing during procedure

Statistics: Sensitivity .72, Specificity .58, +LR 1.7, -LR .48

References:

 Ozgocmen s. et al, : The value of sacroiliac pain provocation tests in early active sacroiliitis. Clin Rheumatol (2008) 27:1275–1282 DOI 10.1007/s10067-008 0907-z

 Laslett M., et al, :Diagnosis of Sacroiliac Joint Pain: Validity of individual provocation tests and composites of tests. Manual Therapy 10 (2005) 207–218