Hip and Lower back Special Tests

Piriformis Tightness Test

 

Steps

• Athlete is side–lying with the test leg being the uppermost leg

• Athlete's test leg is flexed at the hip to about 60° & the knee flexed

• Examiner stabilizes the hip with one hand & applies a downward pressure to the knee

Positive Test
Piriformis muscle pain; buttock pain; sciatica pain
 

Positive Test Implications
Piriformis tightness (piriformis muscle pain); piriformis muscle pinching the sciatic nerve (buttock pain and sciatica pain)

Patrick's Test (Faber Test or Figure–Four Test)

Steps

• Athlete is supine with the foot of the involved side crossed over the opposite thigh (figure–4 position) & the leg resting in the full external rotation

• Examiner has one hand on the opposite ASIS & the other hand on the medial apsect of the flexed knee

• Examiner applies overpressure at the knee & ASIS

Positive Test
Inability to lower the flexed thigh down to the level of the leg on the table; hip joint pain; Sacroiliac pain
 

Positive Test Implications
Ilipsoas tightness; hip pathology (groin or inguinal area pain); sacroiliac joint pathology (pain during application of overpressure in the SI area)

Trendelenburg's Test

Steps

• Athlete stands with the feet evenly distributed (i.e. approximately shoulder–width apart from each other)

• Examiner sits or kneels behind the athlete

• Examiner slightly lowers the athlete's shorts so that the examiner may palpate the right & left PSIS and/or iliac crests

• Examiner instructs the athlete to flex the hip thereby lifting the right (and then the left knee) while observing the pelvis

Positive Test
The PSIS or iliac crest on the same side as the leg lifted will drop in relation to the contralateral side
 

Positive Test Implications
Contralateral (i.e., stance leg) gluteus medius (hip abductor) weakness or decreased innervation of the same muscles

Clinical Discrimination Between Femoral & Tibial Leg Length Discrepancy Test

Steps

• Athlete is lying supine with his/her hip flexed to 45° & knee flexed to 90° and both feet lined up next to each other (line up medial malleoli and 1st MTP joints)
• Examiner holds teh athlete's feet to the table and instructs the athlete to raise the pelvis up off the table and then lower the pelvis back to the table
• Examiner observes the patient from the side (viewing both tibial tubercles) for anterior positioning of one knee compared to the other
• Examiner observes the patient from the front (viewing the top of both patellae) for height differences of one knee compared to the other

Positive Test
Anterior positioning and/or height differences of one knee compared to the other

Positive Test Implication
Femoral length difference (lateral view–increased anterior position); tibial length difference (front view–increased height difference)

Gaenslen's Test

Steps

• Athlete is supine, lying close to the side of the table
• Examiner allows the near leg to hang over the side edge of the table
• Examiner instructs the athlete to actively flex the other leg to his/her chest & hold
• Examiner stabilizes the athlete & applies pressure to the near leg, forcing it into hyperextension

Positive Test
Pain in the SI region

Positive Test Implications
SI joint dysfunction

SI Compression Test

Steps

• Athlete is supine
• Examiner applies pressure to spread the ASIS

Positive Test
Pain arising from the SI joint

Positive Test Implications
SI pathology

SI Distraction Test

Steps

• Athlete is in the side–lying position
• Examiner is positioned behind the athlete with both hands over the lateral aspect of the pelvis
• Examiner applies downward pressure through the anterior portion of the ilium, spreading the SI joints

Positive Test
Pain through the SI joint

Positive Test Implications
SI pathology

Ely's Test

Steps

• Athlete lies prone with the knees extended
• Examiner passively flexes the athlete's knee

Positive Test
The hip on the same side passively flexes as the examiner flexes the knee

Positive Test Implications
Rectus femoris tightness

Thomas's Test

Steps

• Athlete is supine with his/her knees bent at the end of the table
• Examiner places one hand between the lumbar lordotic curve & the tabletop
• Examiner passively flexes one of the athlete's legs to his/her chest, allowing the knee to flex during the movement
• Examiner observes the involved leg for movement

Positive Test
The knee of the leg on the table cannot flex past 90° (i.e. the knee of the leg on the table will extend as the examiner flexes the contralateral hip); the involved leg (i.e. the leg on the table) rises up off the table (i.e. the contralateral hip to the one being moved will flex)

Positive Test Implications
Rectus femoris tightness (the knee extends as the examiner flexes the hip); iliopsoas tightness (the leg on the table will rise off of the table)

Oppenhiem Test

Steps

• Run metal edge of neurlogic hammer, or fingernail along the tibial crest

Positive Test
Great toe extension with flexion and splaying of the lateral four toes

Positive Test Implications
Upper motor neuron lesion

Bowstring Test

Steps

• Subject begins supine with legs extended
• Examiner performs a passive straight leg raise on the involved side
• If radiating pain is reported, the examiner then flexes the subjects knee until symptoms are reduced
• The examiner then applies pressure to the popliteal area in attempt to reproduce the radicular pain

Positive Test
Reproduction of radicular pain with popliteal compression

Positive Test Implications
Sciatic nerve pathology

Babinski Test

Steps

• Run metal edge of neurlogic hammer, or fingernail along the tplantar surface of the foot from the calcaneus, along the lateral border of the foot to the forefoot

Positive Test
Great toe extension with flexion and splaying of the lateral four toes

Positive Test Implications
Upper motor neuron lesion

Slump Test

Steps

• Subjects sits at end of table and leans forward while the examiner holds the head and chin upright
• Examiner then flexes the subjects neck and assesses for any changes in symptoms
• If no changes are noted the examiner passively extends one of the subjects knees
• Again, note symptomatic changes
• If no changes are noted, the examiner passively dorsiflexes the subjects ankle while the knee remains extended
• Subject is then returned to original position and the test is repeated for the opposite leg

Positive Test
A complaint of sciatic–type pain or any reproduction of symptoms is indicative of a positive test

Positive Test Implications
Sciatica or dural irritation

Seated Straight Leg Raise Test

Steps

• Subject sitting with hip flexed to 90° & hands grasping table on each side
• Subject actively extends knee

Positive Test
1) Subject breaks tripod or subject is unable to fully extend knee
2) Subject arches back & or complains of pain in buttocks, posterior thigh and calf

Positive Test Implications
1) Tight hamstrings
2) Sciatic nerve irritation

Single Straight Leg Raise Test

Steps

• Subject begins supine with both knees extended
• Examiner stands at subject’s side with distal hand cupping heel and proximal hand around subjects thigh (anteriorly) to maintain knee extension
• With subject relaxed the examiner slowly raises the test leg until tightness is noted
• The examiner slowly lowers the leg until the pain or tightness resolves, then dorsiflexes the ankle and instructs the subject to flex the neck

Positive Test & Implications
Leg and/or low back pain occurring with dorsiflexion and/or neck flexion indicates dural involvement
A lack of pain reproduction with dorsiflexion and/or neck flexion indicates either hamstring tightness, possible lumbar spine or sacroiliac involvement
If latter is determined, proceed to the bilateral straight leg raise test

Malinger's Rotational Test

Steps

• With the subject standing the examiner asks the patient to perform trunk rotation while the examiner stabilizes the patient’s pelvis
• Examiner notes any pain from the patient
• The examiner again asks the patient to perform trunk rotation. However, this time the examiner rotates the pelvis along with the spine
• Examiner notes any complaint of pain

Positive Test
Patient complains of pain during both of the above

Positive Test Implications
Patients complaints are not consistent with test findings

Kernig Test

Steps

• Subject supine with hands cupped behind head
• Subject is instructed to flex cervical spine by lifting head
• Each hip is unilaterally flexed to no more than 90, with knee fully extended
• The opposite leg should remain on the table

Positive Test
Increased pain with both hip and neck flexion and pain is relieved when knee is allowed to flex

Positive Test Implications
Meningeal irritation, nerve root impingement, dural irritation aggravated by spinal cord elongation

Hoover Test

Steps

• Subject is supine while examiner cups both heels of the patient with their hands
• Subject is asked to perform a unilateral straight leg raise

Positive Test
1) Inability to raise leg
2) A positive finding is also noted when the examiner does not feel pressure in the palm of the hand underlying the resting leg

Positive Test Implications
1) neuromuscular weakness
2) lack of effort by subject