Special tests of the spine, pelvis, and temporomandibular joint

Special tests spine and pelvis

Cervical spine

• Vertebral artery test
  • Patient supine with head supported and over the edge of the mat; therapist passively extends head/neck and holds it for 30 seconds, progress to passively rotate and side-bend with extension — holding each position for 30 seconds
    • Tests the integrity of the vertebrobasilar vascular system
  • Positive: symptoms of dizziness, dysphagia, diplopia, ataxic gait, nystagmus- red flag, and the therapist does not progress with any movements of the cervical spine
    • Vertebral artery test should always be performed before cervical spine mobilization- if not performed, this is considered sub-standard care and can be life-threatening

• Flexion rotation test
  • Patient in supine with maximal flexion of neck performed with rotation to left and right
    • Provocative test for atlantoaxial dysfunction or cervicogenic headache
    • Positive: reproduction of headache symptoms or loss of 10 degrees of mobility when comparing left and right rotation (when compared to each side)

• Spurling’s test (foraminal compression)
  • Patient sitting with head laterally bending towards the involved side while the therapist applies pressure straight down
    • Confirms cervical root dysfunction
  • Positive: pain and paresthesia in a dermatomal pattern of the cervical root

• Cervical compression test
  • Patient sitting and neck passively moved into lateral flexion and rotation to the non-painful side, followed by extension. Repeat the painful side.
    • Identifies intervertebral foramen and/or facet dysfunction
  • Positive: pain and paresthesia in a dermatomal pattern of cervical root or localized pain in the neck if facet dysfunction

• Distraction test
  • Patient sitting with head passively distracted
    • Identifies intervertebral foramen and/or facet dysfunction
  • Positive: decrease in symptoms or decrease in upper limb pain

• Lhermitte’s sign
  • Patient long sitting on mat; therapists passively flex the patient’s head and hip while keeping the knee in extension. Repeat with the other hip.
    • Identifies upper motor neuron lesions
  • Positive: electrical pain down the spine and into the upper or lower limbs

• Alar ligament test
  • Patient seated and therapist palpates C2 spinous process; the therapist passively flexes the upper cervical spine with lateral flexion and rotation
    • Tests the integrity of the alar ligament
  • Positive: Inability to palpate C2 and/or inability to feel movement at C2

Thoracic spine scoliosis screening

• Adam’s Forward Bend Test:
  • The child bends forward at the waist while keeping their knees straight.
    • Checks for any asymmetry or curvature in the spine.
• Positive: elevation of the ribs on one side of the spine

Lumbar spine

• Slump test
  • Patient sits with knees flexed and neutral neck and head; progress through the following steps- passively flex head and neck, passively extend knee, passively dorsiflex ankle of limb- repeat with opposite leg
    • The therapist will stop at a step if reproduction of symptoms occurs
      • Tests for neurological dysfunction of the lower extremity
    • Positive: pain, paresthesias, numbness/tingling, and other neurological symptoms

• Prone instability test
  • Patient prone with torso supported on the mat, legs off the edge, with both feet supported on the ground. The therapist applies posterior/anterior springing throughout the lumbar spine to identify painful segments. The therapist then instructs the patient to lift the legs off the floor and perform the me posterior/anterior springing
    • Tests the instability of the lumbar spine
    • Positive: decreased pain during posterior/anterior springing with the legs raised compared to when the feet are supported on the ground

• Quadrant test
  • Patient standing
    • Facet dysfunction: instruct patient to lateral bend to left, rotate to right, and maximally extend to compress facet joint on left. Repeat on the opposite side.
    • Intervertebral foramen: instruct patient to lateral bend left, rotate left, and maximally extend to close the intervertebral foramen on the left. Repeat on the opposite side.
      • Tests the compression of neural structures at the facet and intervertebral foramen
    • Positive: pain or paresthesias in a dermatomal pattern or localized pain if facet dysfunction

Neurological dysfunction

• Lower limb tension tests- assist with identifying peripheral nerve injury by placing the lower limb in positions that will stress the nerve

Sacroiliac

• Long sitting
  • Patient supine with therapist palpating the medial malleolus- therapist observes alignment. The therapist then asks the patient to come to a long sitting position to observe if alignment at the medial malleolus is still present.
    • Tests for leg length discrepancy due to the sacroiliac joint
  • Positive: one leg observed longer when coming to a long sitting position compared to the supine position

Temporomandibular joint (TMJ)

• Elevation (Closing):
  • Contraction of the masseter, temporalis, and medial pterygoid muscles raises the mandible.
• Depression (Opening):
  • Relaxation of the elevator muscles and contraction of the digastric, geniohyoid, and mylohyoid muscles lowers the mandible.
• Protrusion (Forward Movement):
  • Contraction of the lateral pterygoid muscles moves the mandible forward.
• Retrusion (Backward Movement):
  • Contraction of the posterior fibers of the temporalis muscles moves the mandible backward.
• Lateral Deviation (Side-to-Side Movement):
  • Contraction of the lateral pterygoid muscle on one side moves the mandible toward that side.

Special tests of TMJ

• TMJ compression
  • Patient sitting or supine; therapist stabilizes the patient’s head with one hand while the other hand pushes the mandible superiorly, causing a compressive load to the TMJ
    • Assess pain in the retrodiscal tissues
  • Positive: pain in the TMJ