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
- 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
- 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)
- Patient in supine with maximal flexion of neck performed with rotation to left and right
- 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
- Patient sitting with head laterally bending towards the involved side while the therapist applies pressure straight down
- 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
- Patient sitting and neck passively moved into lateral flexion and rotation to the non-painful side, followed by extension. Repeat the painful side.
- 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
- Patient sitting with head passively distracted
- 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
- 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.
- 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
- Patient seated and therapist palpates C2 spinous process; the therapist passively flexes the upper cervical spine with lateral flexion and rotation
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.
- The child bends forward at the waist while keeping their knees straight.
- 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
- The therapist will stop at a step if reproduction of symptoms occurs
- 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
- 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
- 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
- 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
- Patient standing
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
- 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.
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
- 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