Lumbar Spine Provacative Tests

Front 1

Discogenic pain (HNP, annular tear)

Back 1

increased pain with sitting, forward flexion, lateral bending. pain may localize along the lumbar spine, or refer into the buttocks, occasionally into the lower extremity.

Front 2

Disc herniation with radiculopathy

Back 2

positive straight leg raise (from supine position, 35-70 degrees of elevation) - burning pain radiating into the foot. tenderness over the sciatic notch. follows the dermatome.

Front 3

Central Stenosis

Back 3

back pain is poorly localized. increased crampling/pain referred in the lower extremities with ambulation. improves with lumbar flexion - "shopping cart sign"

Front 4

Facet Pathology

Back 4

typically focused along the spine. can refer into hips or thighs, rarely below the knee. on exam, increased pain with standing in a "belt-like" pattern along the back

Front 5

Positive Facet Loading

Back 5

pain increased with extension/rotation of the spine with pressure applied over the facet

Front 6

SI Joint Pathology

Back 6

pain increases with getting out of a chair and rotation of the pelvic. it can refer from the gluteus into the hips and along the SI nerve root distribution. Pain orginiating from the SIJ does not exist above the L5 vertebral body. Tenderness over the SIJ is non-specific.

Front 7

Patrick's

Back 7

Confirmatory Tests for SIJ

patient in supine position. For the L SIJ. L ankle placed along the R knee. R hip is stabilized by examiner while pressure applied along L knee pushing it downward. + = pain over SIJ

Front 8

Yeoman's

Back 8

Confirmatory Tests for SIJ

prone for L SIJH. L knee is elevated while pressure applied along L ileum + = pain over SIJ

Front 9

Pelvic Shear

Back 9

Confirmatory Tests for SIJ

prone; palm over SIJ, pressure applied += pain over SIJ

Front 10

Waddell's Sign

Back 10

3/5

1. superficial tenderness - diffuse non-dermatomal with gentle palpation

2. simulation - pain in lumbar region w axial load or to body rotation with shoulder and pelvis in line

3. distraction testing

4. regional disturbance

5. overreaction