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Special Tests

WeberBarstow Maneuver Test


Steps
Patient begins in a supine position with his/her heels off the end of
the table
Examiner holds the feet of the patient & places the thumbs over the
medial malleoli while providing slight traction on the legs
Examiner instructs the patient to flex both knees & hips to place the
feet on the table aligned next to each other (line up the medial
malleoli)
Examiner instructs the patient to bridge his/her hips upward and then
return to his/her starting position
See Maneuver

Supine to LongSit Test


Steps
Patient is in a supine position with the heels off of the end of the
table
Examiner "clears the hips" using the WeberBarstow Maneuver
Examiner passively extends the patient's legs & compares the position
of the medial malleoli
Examiner pulls the patient up to a longsit position from a supine
position
Examiner observes the position of the medial malleoli for any change
from the starting position
Positive Test
Observable change in the position of the medial malleoli
Positive Test Implications
Posterior pelvic rotation (equal/short to long); anterior pelvic
rotation (equal/long to short)
See Test

Supine ("True") Leg Length Discrepancy


Measurement Test
Steps
Patient is placed in a supine
Examiner "clears the hips" using the WeberBarstow Maneuver and then
extends both legs
Examiner measures the distance from the ASIS to the crest (i.e.,
highest point) of the medial malleolus on each leg OR Examiner measures
the distance from the ASIS to the crest (i.e., highest point) of the
lateral malleolus on each leg
Positive Test
Difference of greater than inch between the two legs
Positive Test Implication
Possible structural leglength difference
See Test

Supine "Apparent" Leg Length Discrepancy Test


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 Implications
Femoral length difference (lateral viewincreased anterior position);
tibial length difference (front viewincreased height difference)
See Test

Craig's Test for Femoral


Anteversion/Retroversion Test
Steps
Athlete lies prone with the knee flexed to 90
Examiner palpates the posterior aspect of the greater trochanter
Measure angle formed between the vertical axis extending from the
tabletop and the longitudinal axis of the lower leg
Positive Test
The angle measured is outside the normal range of 815
Positive Test Implications
Excessively greater than 15 is femoral anteversion (internal
torsion); excessively less than 8 is femoral retroversion (external
torsion)

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
See Test

Fulcrum's Test
Steps
Athlete is seated with his/her knees bent at the end of the table
Examiner places his/her forearm or a similar bolster underneath of the
athlete's midthigh
Examiner uses other hand to forcefully push down on the athlete's
distal anterior thigh
Positive Test
Athlete experiences pain in his/her thigh
Positive Test Implications
Possible femoral stress fracture

Nelaton's Line Test


Steps
Athlete is lying supine with the knees extended
Examiner draws an imaginary line from the ASIS to the ischial
tuberosity (same side of the hip/pelvis)
Positive Test
Greater trochanter can be palpated well above the imaginary line
Positive Test Implications
Coxa vara; a posteriorly dislocated hip joint
See Test

Hip Scouring Test


Steps
Athlete is supine
Examiner fully flexes the athlete's hip & knee
Examiner applies downward pressure along the femoral shaft while
repeatedly externally & internally rotating the hip with multiple
angles of flexion
Positive Test
Pain or reproduction of symptoms at the hip
Positive Test Implications
Defect in the articular cartilage of the femur or acetabulum
See Test

Torque Test
Steps
Patient lies supine & close to the edge of the table so that the involved
leg can abduct over the edge of the table
Examiner passively extends the involved hip (with his/her hand
supporting at the ankle) until the pelvis begins to rotate anteriorly
Examiner then medially rotates the hip to EROM and then places a
posterolateral force at the hip joint in an attempt to distract it
Positive Test
Groin or lateral hip pain
Positive Test Implications
Sprain of the coxofemoral joint capsule or supporting ligaments
See Test

Gillet's Test
Steps
Athlete is standing with his/her PSISs visible
Examiner palpates the athlete's PSISs
Examiner has the athlete pull one knee towards his/her chest & hold
while examiner observes PSISs
Positive Test
Restricted side moves very little; unilateral stance is painful on the
involved side
Positive Test Implications
SI joint pathology
See Test
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
See Test

SI Distraction Test
Steps
Athlete is in the sidelying 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
See Test

Piriformis Tightness Test


Steps
Athlete is sidelying 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)
See Test

9090 Straight Leg Raising Test


Steps
Athlete lies supine with the hips and knees flexed to 90
Athlete grasps behind both of his/her thighs to stabilize the hip
joints
Athlete actively extends each knee in turn
Positive Test
Unable to extend the knee to within 20 of full knee extension
Positive Test Implications
Hamstring muscle tightness
See Test

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
See Test

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)
See Test

Patrick's Test (Faber Test or FigureFour Test)


Steps
Athlete is supine with the foot of the involved side crossed over the
opposite thigh (figure4 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)
See Test

Trendelenburg's Test
Steps
Athlete stands with the feet evenly distributed (i.e. approximately
shoulderwidth 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
See Test

Valsalva Test
Steps
With subject sitting examiner asks subject to take a deep breath and
blow against closed glottis (as if trying to have a bowel movement)
This increases intrathecal pressure
Positive Test
Pain or neurologic symptoms in buttox and thigh
Positive Test Implications
Herniated disc, abdominal trauma, tumor, or osteophyte in lumber canal
See Test
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
See Test

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
See Test

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
See Test

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
See Test

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 sciatictype pain or any reproduction of symptoms is
indicative of a positive test
Positive Test Implications
Sciatica or dural irritation
See Test

Single Straight Leg Raise Test


Steps
Subject begins supine with both knees extended
Examiner stands at subjects 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
See Test

Bilateral Straight Leg Raise Test


Steps
Subject begins supine with both knees extended
Examiner stands at subjects side with distal arm supporting the heels
and proximal hand on the subjects thighs (anteriorly) to maintain
knee extension
With subject relaxed the examiner slowly raises both legs until
tightness or pain is noted
Positive Test
Low back pain
Positive Test Implications
If low back pain occurs at less than 70 degrees of hip flexion
sacroiliac joint involvement is indicated
If low back pain occurs at greater than 70 degrees of hip flexion lumbar
spine involvement is indicated
See Test

Malinger's Rotational Test


Steps
With the subject standing the examiner asks the patient to perform
trunk rotation while the examiner stabilizes the patients 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
See Test

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
See Test

Stork Test
Steps
Subject begins standing and is asked to extend back, while the examiner
spots subject
The subject is then asked to stand on one foot and extend their back
once again
Finally the subject is asked to stand on the opposite foot and extend
the back
Positive Test
Complaints of pain in the lumbar region
Positive Test Implications
Possible pars intrarticularis pathology

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

Lumbar Examination
Introduction

The first aim of the physiotherapy examination for a patient


presenting with back pain is to classify the patient according to the
diagnostic triage recommended in international back pain
guidelines[1]. Serious (such as fracture, cancer, infection and
ankylosing spondylitis) and specific causes of back pain with
neurological deficits (such as radiculopathy, caudal equina
syndrome)are rare [2] but it is important to screen for these
conditions[1][3] . Serious conditions account for 1-2% of people
presenting with low back pain and 5-10% present with specific
causes LBP with neurological deficits [4]. When serious and specific
causes of low back pain have been ruled out individuals are said to
have non-specific (or simple or mechanical) back pain.

Non-specific low back pain accounts for over 90% of patients


presenting to primary care [5] and these are the majority of the
individuals with low back pain that present to physiotherapy.
Physiotherapy assessment aims to identify impairments that may
have contributed to the onset of the pain, or increase the likelihood
of developing persistent pain. These include biological factors (eg.
weakness, stiffness), psychological factors (eg. depression, fear of
movement and catastrophization) and social factors (eg. work
environment) [6]. The assessment does not focus on identifying
anatomical structures (eg. the intervertebral disc) as the source of
pain, as might be the case in peripheral joints such as the knee [6].
Previous research and international guidelines suggest it is not
possible or necessary to identify the specific tissue source of pain for
the effective management of mechanical back pain [1][3][7].

The subjective assessment (history taking) is by far the most


important part of the assessment with the objective assessment
(clinical testing) confirming or refuting hypothesis formed from the
subjective.

Assessment of the lumbar spine should allow clinical reasoning to


include appropriate data collection tests from those listed below.

Subjective

The subjective examination is one of most powerful tools a clinician


can utilize in the examination and treatment of patients with LBP.
The questions utilized during this process can improve the clinicians
confidence in identification of sinister pathology warranting outside
referral, screening for yellow flags which may interfere with PT
interventions, and assist in matching PT interventions with a
patients symptoms.
History not only is the record of past and present suffering but also
constitutes the basis of future treatment, prevention, and prognosis.

Patient Intake

Self report (present complaint (PC), history of present


complaint (HPC), past medical history (PMH), drug history (DH),
social history (SH))

Region specific questions

What is the patients age?

What is the patients occupation?

What was the mechanism of injury?

How long has the problem bothered the patient?

Where are the sites and boundaries of pain?

Is there any radiation of pain? Is the pain centralizing or


peripheralizing

Is the pain deep? Superficial? Shooting? Burning?


Aching?

Is the pain improving? Worsening? Staying the same?


Is there any increase in pain with coughing? Sneezing?
Deep breathing? Laughing?

Are there any postures or actions that specifically


increase or decrease the pain or cause difficulty?Is the pain worse in
the morning or evening? Does the pain get better or worse as the
day progresses? Does the pain wake you up at night?Which
movements hurt? Which movements are stiff?

Is paresthesia (a pins and needles feeling) or


anesthesia present?

Has the patient noticed any weakness or decrease in


strength? Has the patient noticed that his/her legs have become
weak while walking or climbing stairs?

What is the patients usual activity or pastime? Before


the injury, did the patient modify or perform any unusual repetitive
or high-stress activity?

Which activities aggravate the pain? Is there anything in


the patients lifestyle that increases the pain?

Which activities ease the pain?

What is the patients sleeping position? Does the patient


have any problems sleeping?

Does the patient have any difficulty with micturition?


Are there any red flags that the examiner should be
aware of, such as a history of cancer, sudden weight loss for no
apparent reason, immunosuppressive disorder, infection, fever, or
bilateral leg weakness?

Is the patient receiving any medication?

Is the patient able to cope during daily activities?

Special Questions

Red Flags

Although uncommon serious spinal conditions (such as those listed


below) may present as LBP in approximately 5% of patients
presenting to primary care office: [8][8].

Cauda equina syndrome

Cancer

Ankylosing spondylitis

Lumbar stenosis

Lumbar disc herniations


Vertebral fracture

Spinal infection

Abdominal aortic aneurysm

[9]

During the investigation, you must pay attention to any red flags
that might be present indicating serious pathology. Koes et al
(2006)[10] mentioned the following red flags:

Onset age < 20 or > 55 years

Non-mechanical pain (unrelated to time or activity)

Thoracic pain

Previous history of carcinoma, steroids, HIV

Feeling unwell

Weight loss

Widespread neurological symptoms

Structural spinal deformity

Read more about red flags in spinal conditions


Other Flags

It is also important to screen for other (yellow, orange, blue and


black) flags as these may interfere with physiotherapy interventions.

Read more about the Flag System

Outcome Measures

Fear Avoidance Belief Questionnaire

STarT Back Screening Tool

Acute Low Back Pain Screening Questionnaire

The Quebec Back Pain Disability Scale

Oswestry Disability Index

Hendler 10-Minute Screening Test for Chronic Back Pain


Patients

The Roland-Morris Disability Questionnaire

Investigations
Has the patient had any other investigations such as radiology (Xray,
MRI, CT, ultrasound) or blood tests?

Objective

The purpose of the objective examination (clinical testing) is to


confirm or refute hypothesis formed from the subjective
examination.

When assessing the lumbar spine, the examiner must remember that
referral of symptoms or the presence of neurological symptoms often
makes it necessary to clear or rule out lower limb pathology. Many
of the symptoms that occur in the lower limb may originate in the
lumbar spine. Unless there is a history of definitive trauma to a
peripheral joint, a screening or scanning examination must
accompany assessment of that joint to rule out problems within the
lumbar spine referring symptoms to that joint.

Examination procedures should be performed from


standing-sitting-lying and pain provocation movements saved until
last.

Observation
Movement Patterns

How does the patient enter the room?

A posture deformity in flexion or a deformity with a lateral


pelvic tilt, possibly a slight limp, may be seen.

How does the patient sit down and how comfortably/


uncomfortably does he or she sit?

How does the patient get up from the chair? A patient with
low back pain may splint the spine in order to avoid painful
movements.

Posture

Scoliosis (static, sciatic, idiopathic)

Lordosis (excessive, flattened)

Kyphosis (thoracic)

Increased Lordosis Kyphosis


[11]

Other observations

body type

attitude

facial expression

skin

hair

leg length discrepancy (functional, structural)

Functional Tests

1. Functional Demonstration of pain provoking movements

2. Squat test - to highlight lower limb pathologies. Not be done


with patients suspected of having arthritis or pathology in the lower
limb joints, pregnant patients, or older patients who exhibit
weakness and hypomobility. If this test is negative, there is no need
to test the peripheral joints (peripheral joint scan) with the patient
in the lying position [12].
Movement Testing

AROM (flexion 40-60, extension 20-35, side flexion 15-20


- looking for willingness to move, quality of movement, where
movement occurs, range, pain, painful arc, deviation)

Overpressure (at the end of all AROM if they are pain-free,


normal end-feel should be tissue stretch)

Sustained positions (if indicated in subjective)

Combined movements (if indicated in subjective)

Repeated movements (if indicated in subjective)

Muscle Strength (resisted isometrics in flex, ext, side flex,


rotation; core stabilty, functional strength tests)

Neurologic Assessment

Neurologic assessment is indicated where there is suspicion of


neurologic deficit.
3]

Myotomes

[14]

L2: Hip flexion

L3: Knee extension

L4: Ankle dorsiflexion

L5: Great toe extension

S1: Ankle plantar flexion, ankle eversion, hip extension

S2: Knee flexion

Dermatomes

[15]

Reflexes

[16]

Patellar (L3L4) (commonly used in clinical practice)


Medial hamstring (L5S1) (rarely used in clinical
practice)

Lateral hamstring (S1S2) (rarely used in clinical


practice)

Posterior tibial (L4L5)(rarely used in clinical practice)

Achilles (S1S2) (commonly used in clinical practice)

Neurodynamic testing - slump, SLR, PKB and modified


versions where appropriate

Circulatory Assessment

If indicated it may be necessary to perform a haemodynamic


assessment.

7]

Palpation
It is crucial for a reliable diagnosis and intervention of treatment to
adequately palpate the lumbar spinous processes.

Within the scientific world, there has been a debate about the
palpation of the spinous processes because scientists assumed that
often different persons indicated the processes in a different place
(Mckenzie et al) [18]. However, Snider et al (2011) [19] have shown
that the indicated points of the different therapists lie that the
distance between the indicated points of the different therapists is
much smaller than it had always been claimed. Obviously, there were
differences because some therapists have more experience and others
have more anatomical knowledge. Also, the difference in personality
between the therapists led to differences in locating the processes.

Furthermore, this investigation has proven that it is more useful to


indicate different points instead of just 1 point. Also it has been
proven that a manual examination to detect the lumbar segmental
level is highly accurate when accompanied by a verbal subject
response (Philips 1996). [20]
There are of course elements that hinder the palpation. For example,
a BMI (body mass index) of 30kg/m2 considerably diminishes the
accuracy (Ferre et al) [21]. Anatomical abnormalities might also cause
problems. The abnormality of the 12th rib leads, for example, to a
negative palpatory accuracy in the region L1-L4 for all
therapists. [22]

Passive Intervertebral Motion (PPIVMs, PAIVMs)


Muscle Tone

3]

Clear Adjacent Joints

Thoracic spine - seated rotation with combined movements


and overpressure

Sacroiliac joints - various tests have been described to clear


the SIJ such as Gillet test, sacral clearing test, cluster tests

Hips - PROM with overpressure

Knees and ankles - should also be cleared for restrictions that


may affect movement patterns

Special Tests

For neurological dysfunction:

Centralization/peripheralization
Cross straight leg raise test

Femoral nerve traction test

Prone knee bending test or variant

Slump test or variant

Straight leg raise or variant

4]

For lumbar instability:

H and I test

Passive lumbar extension test

Prone segmental instability test

Specific lumbar torsion test

Test for anterior lumbar spine instability

Test for posterior lumbar spine instability

For joint dysfunction:


Bilateral straight leg raise test

One-leg standing (stork standing) lumbar extension test

Quadrant test

For muscle tightness:

9090 straight leg raise test

Ober test

Rectus femoris test

Thomas test

Other tests:

Sign of the buttock

Brief Examination

If you have little time a brief examination of patients with back pain
has two basic purposes.
1. Firstly it will help screen patients for possible serious spinal
pathology even though taking a good history is much more
important.

2. Secondly it will improve patient satisfaction and effectiveness


of the consultation.

It is suggested that the following be performed as a bare minimum:

1. Inspect general appearance, gross structural deformities

2. Active movements flexion (significant limitation often


pathological), extension, side flexion

3. Myotomes rise from a knee squat (L3/4), walk on heels


(L4/5) and walk on toes (S1/2).

4. SLR (if leg pain or if you feel is needed for reassurance) +/-
slump test

Obviously, if the history raises concerns that there may be


non-spinal pain, structural deformity, widespread neurological
disorder or serious spinal pathology it is appropriate to examine the
patient more fully as per normal clinical practice.

What Next?
Lumbopelvic disorders are not a homogeneous group of conditions,
and subgrouping or classification of patients with back pain has been
shown to enhance treatment outcomes [25][26]. Classification of
lumbopelvic disorders should adequately define the primary signs
and symptoms and guide therapeutic interventions. The examination
allows us to arrive at a diagnosis and impairment classification for
the condition. These classification systems help us to avoid the pitfalls
of attempts to identify the pathoanatomic cause of the patients
symptoms.

References

1. Jump up to:1.0 1.1 1.2 Koes BW, van Tulder M, Lin C-WC,
Macedo LG, McAuley J, Maher C. An updated overview of clinical
guidelines for the management of non-specific low back pain in
primary care. Eur Spine J 2010;19:207594

2. Jump up Henschke N, Maher CG, Refshauge KM, et al.


Prevalence of and screening for serious spinal pathology in patients
presenting to primary care settings with acute low back pain.
Arthritis Rheum 2009;60:307280.

3. Jump up to:3.0 3.1 van Tulder M, Becker A, Bekkering T, et al.


Chapter 3. European guidelines for the management of acute
nonspecific low back pain in primary care. Eur Spine J
2006;15(Suppl 2):S16991
4. Jump up O'Sullivan, P. and Lin, I. Acute low back pain
Beyond drug therapies. Pain Management Today, 2014, 1(1):8-14

5. Jump up Koes BW, van Tulder MW, Thomas S. Diagnosis and


treatment of low back pain. BMJ 2006;332:143034.

6. Jump up to:6.0 6.1 M.Hancock. Approach to low back pain.


RACGP, 2014, 43(3):117-118

7. Jump up Hancock MJ, Maher CG, Latimer J, et al.


Systematic review of tests to identify the disc, SIJ or facet joint as
the source of low back pain. Eur Spine J 2007;16:153950.

8. Jump up to:8.0 8.1 Deyo, R. et al. What Can the History and
Physical Examination Tell Us About Low Back Pain? JAMA. 1992.
268(6):760-766.

9. Jump up Physiotutors. Low Back Pain Guideline: Screening


& History-Taking (Part 2). Available
from: https://www.youtube.com/watch?v=QVBxB59Y4Y4

10. Jump up Koes B.W. van Tulder M. W., Thomas S.; diagnosis
and treatment of low back pain; BMJ volume 332, 17 June 2006;
1430-1434

11. Jump up Physiotutors. Observation and Posture Analysis.


Available from: https://www.youtube.com/watch?v=Zp5iC3Ioq7U

12. Jump up Magee, D. Lumbar Spine. Chapter 9 In: Orthopedic


Physical Assessment. Elsevier, 2014
13. Jump up Scott Bainbridge. Lumbar Spine Examination.
Available from: http://www.youtube.com/watch?v=IijlOJPHk1s[last
accessed 19/08/15]

14. Jump up Physiotutors. Myotomes Lower Limb | Peripheral


Neurological Examination. Available
from: https://www.youtube.com/watch?v=ptO9ZvsUPDg

15. Jump up Physiotutors. Dermatomes Lower Limb | Peripheral


Neurological Examination. Available
from: https://www.youtube.com/watch?v=SzAyUsA25MQ

16. Jump up Physiotutors. Lower Limb Deep Tendon Reflexes |


Peripheral Neurological Examination. Available
from: https://www.youtube.com/watch?v=kFkRa17hlVc

17. Jump up tsudpt11's channel. Maitland Lumbar PAIVM


(skeletal model). Available
from: http://www.youtube.com/watch?v=t0OCzavA6SY[last
accessed 19/08/15]

18. Jump up McKenzie AM, Taylor NF. Can physiotherapists


locate lumbar spinal levels by palpation? Physiotherapy 1997;83:
235-9.

19. Jump up Karen T. Snider, Eric J. Snider, Brian F.


Degenhardt, Jane C. Johnson and James W. Kribs; palpatory
accuracy of lumbar spinous processes using multiple bony landmarks.
Journal of Manipulative and Physiological Therapeutics; 2011
20. Jump up Phillips D. R.; Twomey L. T.; A comparison of
manual diagnosis with a diagnosis established by a uni-level lumbar
spinal block procedure; manual therapy, March 1996, pages 82-87

21. Jump up 3. Ferre RM, Sweeney TW. Emergency physicians


can easily obtain ultrasound images of anatomical landmarks
relevant to lumbar puncture. Am J Emerg Med 2007;25:291-6.

22. Jump up Karen T. Snider, Eric J. Snider, Brian F.


Degenhardt, Jane C. Johnson and James W. Kribs; palpatory
accuracy of lumbar spinous processes using multiple bony landmarks.
Journal of Manipulative and Physiological Therapeutics; 2011

23. Jump up Physical Therapy Nation. Lumbar and SIJ


Examination. Available
from: http://www.youtube.com/watch?v=EL5tXj81Q8M[last
accessed 19/08/15]

24. Jump up Ed Schrank. Lumbar Stability Tests. Available


from: http://www.youtube.com/watch?v=jDoZ4d09M9Q[last
accessed 19/08/15]

25. Jump up Brennan GP, Fritz JM, Hunter SJ, et al. Identifying
subgroups of patients with acute/subacute nonspecific low back
pain: results of a randomized clinical trial, Spine 31(6):623631,
2006.

26. Jump up Childs J, Fritz J, Flynn T, et al. A clinical prediction


rule to identify patients with low back pain most likely to respond to
spinal manipulation: a validation study, Ann Intern Med
141(12):922928, 2004.