Purpose:
1. Adductor tightness
2. Acetabulum pain
3. SI pain
How to perform: Patient is placed into figure 4 position and in turn instructed to relax. Then the examiner places one hand on the medial side of the knee in the figure 4 position and the other hand on the opposite hip. The examiner then applies a downward force with both hands placed on knee and opposite hip. Patient is then asked where they feel pain.
(+): 1.Posterior joint pain
indicates possible SI dysfunction or sacroilitis
2. Leg in the figure 4 position maintains the level above extended leg
indicates possible adductor tightness
3. Posterior hip pain
indicates possible posterior hip impingement
(-): No anterior or posterior pain is felt as knee in figure 4 and opposite hip is pushed down, and/or the leg in the figure 4 position drops as the pt relaxes = Indicates no adductor tightness, no SI injury, no acetabulum related injury
Purpose: SI Joint
How to perform: Patient is supine and legs extended on the table. Examiner places arms in a crossed pattern on both ASIS. The examiner then pushes both ASIS outward in turn compressing the SI joint.
(+): recreation or increase of pain at SI joint = Indicates SI joint injury
(-): recreation or increase of pain at SI joint = Indicates SI joint injury
Purpose: SI joint
How to perform: Patient is supine and legs extended on the table. Examiner than places their right hand on the right ASIS and left hand on the left ASIS. Examiner will then place a dorsal lateral force to the ASIS distracting the SI joint on both sides.
(+): recreation or increase of pain at SI joint = Indicates SI joint injury
(-): no recreation or increase of pain at SI joint = Indicates no SI joint injury
Purpose: SI joint
How to perform: Patient is in supine position with 1 leg hanging off the side of the table. Other leg on the table, the patient brings the knee to the chest. You apply firm pressure to the knee flexed to the patient’s chest while appliying a counter pressure to the knee hanging off the table.
(+): Recreation of pain or patient’s symptoms = Indicates SI joint injury
(-): no recreation of pain or patient’s symptoms = No indication of SI joint injury
Purpose: SI joint
How to perform: Patient is prone. Knee is flexed to 90 degrees. The examiner then holds the distal femur and places the other hand on the posterior superior iliac spine. The hand holding the distal femur will passively move the thigh into extension. The hand that is on the posterior superior iliac spine will apply a ventrally directed force.
(+): recreation of pain or patient’s symptoms = Indicates Si joint injury
(-): no recreation of pain or patient’s symptoms = Indicates no Si joint injury
Purpose: Nerve Root Entrapment
How to perform: Patient is supine with legs extended on the table. Injured leg is then passively lifted. Patient is instructed to let examiner know when they feel the pain. Once the patient feels the pain. The examiner stops stops passively raising the leg and notes at what degree of flexion the pain was felt by the patient.
(+): recreation of pain as leg is passively lifted = Indicates possible nerve root entrapment
(-): recreation of pain = Indicates no nerve root entrapment
Purpose: Nerve Root Entrapment
How to perform: Patient is supine with legs extended on table. A passive single leg raise is performed till pain is felt. The leg raised will then have the knee passively bent till no pain is felt. Examiner then shoves their fingers into the popliteal fossa of the leg raised.
(+): recreation of pain as pressure is placed into the popliteal fossa = Indicates possible nerve root entrapment
(-): no recreation of pain as pressure is placed on the popliteal fossa = Indicates no possible nerve root entrapment
Purpose: Nerve Root Entrapment
How to perform: The patient is supine and extended. Have the patient single leg raise the uninjured leg.
(+): recreation of pain on the bad side = indicates possible nerve root entrapment
(-): no recreation of pain on the bad side = Indicates no nerve root entrapment
Purpose: Nerve Root Entrapment
How to perform: Patient is supine with legs extended. Examiner then passively single leg raises the injured side. The patient will tell the examiner when the the pain is felt. The examiner will then note when the pain is felt, then will slowly drop the raised leg until the patient doesn’t feel the pain. Examiner will hold the level the leg is at and then passively DF the foot of the raised leg.
(+): pain is felt as leg is passively raised, then goes away after the leg is lowered, then pain returns back for the patient after their foot is placed into passive DF = Indicates possible nerve root entrapment
(-): no pain is felt as leg is passively raised, then goes away after the leg is lowered, then pain returns back for the patient after their foot is placed into passive DF = Indicates no possible nerve root entrapment
Purpose: Nerve Root Entrapment
How to perform: Patient is supine with legs extended. Patient will then perform a double leg raise against the examiner applying resistance to of the legs as the patient is performing the double leg raise.
(+): recreation of pain = Indicates possible nerve root entrapment
(-): no recreation of pain = Indicates no nerve root entrapment
Purpose: Nerve Root Entrapment
How to perform: Patient is sitting on the edge of the table with hips in neutral. The patient is asked to slump their posture while still looking forward. The examiner will then passively flex the C-spine till head is tucked and also passively place the patient’s trunk in full flexion. Once the trunk is in full flexion and head is tucked the patient will be instructed to full extended 1 leg. Then after the leg is extended the examiner will then passively dorsiflex the extended leg’s foot.
(+): recreation of shooting pain or feeling of stingers felt by pt = Indicates possible nerve root entrapment
(-): No recreation of shooting pain or feeling of stingers felt by pt = Indicates no posible nerve root entrapment
Purpose: Malingering Patient
How to perform: Patient is supine with legs extended on the table. Examiner stands at the end of the table by their feet and will lift up both feet cupping the heels. The examiner will then instruct the patient to lift leg. While the patient lifts one leg, the examiner will then watch the opposite leg to see if they feel a push down from the opposite leg.
(+): no pressure felt by examiner on opposite foot as pt lifts other leg = Indicates patient is faking an injury
(-): pressure felt by examiner on opposite foot as pt lifts other leg = Indicates no malingering patient
Purpose: Meningeal irritation
How to perform: Patient is supine with legs extended. Examiner then takes one leg into a 90/90 position. With one hand under the achilles tendon and one hand in front of the knee. The examimer will then extend the leg they are holding in a 90/90 position.
(+): recreation of pain or increase in neurological symptoms = Indicates meningeal irritation
(-): no recreation of pain or increase in neurological symptoms = Indicates no meningeal irritation
Purpose: Meningeal irritation
How to perform: Patient is supine with legs extended on the table. The examiner will then passively lift the patient’s head watching to see if the knees and hips react to the head being passively lifted up.
(+): when head is passively lifted up, knees and hips flex to take pressure off of back = indicates meningeal irritation
(-): when patient’s head is passively lifted there is no flexion of knees and hips to take pressure off back = Indicates no meningeal irritation
Purpose: Spondylosis/Spondylolisthesis
How to perform: Patient is prone. Examiner then will palpate to find the point of pain on the facet. The examiner will use their thumb to do a bone mob on the facet which is the site of pain.
(+): recreation of pain = Indicates spondylosis or spondylolisthesis
(-): no recreation of pain = Indicates no spondylosis or spondylolisthesis
Purpose: Rib injury/Fx
How to perform: Patient is standing. Examiner to the side or front of the patient and with 1 hand in front of the patient and 1 hand on the back side of the patient. The examiner will apply a anterior posterior force of compression by the sternum and below the sternum.
(+): recreation of pain at site of compression = Indicates rib injury (fx, contusion, etc)
(-): no recreation of pain at site of compression = Indicates no rib injury
Purpose: Rib injury/fx
How to perform: Patient is standing in front of the patient and will have 1 hand on the left lateral side of the rib cage and 1 hand on the right lateral side of the rib cage. The examiner will then compress the rib cage inward. The examiner will go down the rib cage compressing the ribs inward to try and recreate any pain.
(+): recreation of pain at site of compression = Indicates rib injury (fx, contusion, etc)
(-): no recreation of pain at site of compression = Indicates no rib injury
Purpose: slipping rib syndrome
How to perform: Patient is supine with legs extended on the table and relaxed. The examiner will then ask the patient to lift up their shirt to expose the rib cage. The examiner will then take both hands to get under 1 side of the rib cage and pull the ribs up and towards the patient’s head.
(+): recreation of pain = Indicates slipping rib syndrome
(-): no recreation of pain = Indicates no slipping rib syndrome
Purpose: Bulging Disc
How to perform: Patient is sitting upward on the table. Examiner asks the patient to bear down to act as if they are moving their bowels to increase the intraabdominal pressure.
(+): recreation of pain and/or increase in neurological symptoms = Indicates possible bulging disc
(-): no recreation of pain and/or increase in neurological symptoms = Indicates no bulging disc
Purpose: Spondylosis/Spondylolisthesis
How to perform: The patient is standing with two feet on the floor. Examiner is behind patient and will palpate both PSIS. Then the examiner will instruct the patient to lift the opposite leg to 90 degrees and then extend their lumbar spine with the examiner support. If no positive is found, the examiner could ask the patient to lean towards the side of complaint after extending.
(+): recreation of pain or localized pain over the area of the complaint = Indicates spondylosis or spondylolisthesis
(-): no recreation of pain or localized pain over the area of the complaint = indicates no spondylosis or spondylolisthesis