The therapist should avoid traction of the neck and lower limbs and not attempt to treat the herniated disc directly (Hendrickson, 2020). Slump test This tests for nerve root compression due to a disc herniation in the lumbar region. The client should be seated on the edge of the therapy table, spine erect, with their feet hanging freely. They will be asked to interlace their fingers behind their back before slumping their entire spine—including their neck—into flexion. Next, the client will extend the knee on the affected side and dorsiflex their ankle. A positive result is indicated by numbness, tingling, burning, and/or pain in the lower back at any time during the test. The therapist should avoid traction of the neck and lower limbs and not attempt to treat the herniated disc directly (Hendrickson, 2020). Quadratus Lumborum (QL) length test This tests for hypertonicity of the QL muscle. The client may be seated or standing. The therapist stands behind the client and notes the position of the bilateral hips at the posterior superior iliac spine (PSIS). The client then laterally flexes their trunk to one side and then the other while the therapist notes which side has a reduced ROM at the PSIS. A reduced ROM in combination with an elevated hip free of pain indicates a shortened QL. All manual strokes, including cross-fiber friction at the posterior iliac crest, are indicated (Hendrickson, 2020).
of the spine with directional massage, myofascial release, or trigger point therapy, but the client’s long-term relief can only be expected if the client’s scoliosis is functional in nature. It is outside most manual therapists’ scope of practice to attempt structural corrections (Hendrickson, 2020). Scoliosis short leg test This tests for uneven leg length that may be causing functional scoliosis. The client should be standing. The therapist is in front of the client noting the position of the bilateral hips and shoulders to see if there is any tilting due to scoliosis. The therapist places a thin book under the foot of the suspected shorter leg, which itself may be indicated by either an inferiorly situated hip or shoulder. A positive result is indicated if the curvature disappears after the book is placed under the shorter leg’s foot. Hypertonic muscles of the lower back and hips should be addressed with directional massage, PNF stretches, myofascial release, and/ or trigger point therapy (Hendrickson, 2020). Kemp’s test (Lumbar quadrant test) This tests for nerve root compression due to a disc herniation in the lumbar region. The client is standing and hyperextends their back, then laterally flexes their trunk to the affected side before returning to the neutral position. The client may also go into lateral flexion toward the affected side, then rotate their trunk toward the affected side. A positive result is indicated by tingling, numbness, burning, and/or pain down the leg of the affected side. Iliopsoas strength test This tests for weakness of the iliopsoas muscles. The client should be lying on the therapy table in the supine position with their knees in full extension; no bolster is placed underneath them. The client is asked to actively raise one of their thighs off the table with a slight lateral rotation while flexing their knee to 30 degrees. The client is asked to maintain this position. If they cannot, the iliopsoas group is considered weak. Active-resisted exercises may be employed to strengthen the iliopsoas. Trigger points in the deep psoas muscle may also inhibit the strength of this hip flexor group, in which case trigger point therapy and PNF stretches are indicated (Manske & Magee, 2018). Iliopsoas length test I This tests for hypertonicity of the iliopsoas muscles. The client should be on the therapy table in the supine position, again, with no bolster. The therapist places the foot of the side being tested on the opposite knee (in a “figure 4” position). Hypertonic iliopsoas muscles are indicated if the hip of the side being tested rises above the opposite knee. Non-invasive PNF stretches may help release this hypertonic group (Manske & Magee, 2018). Iliopsoas length test II This tests for hypertonicity of the iliopsoas muscles. The client should be on the therapy table in the supine position near the edge of the table on the side being tested, again with no bolster. The therapist drapes the thigh of the hip being tested off the edge of the table. Hypertonic iliopsoas muscles are indicated if the client’s thigh does not drop below tabletop level. Noninvasive PNF stretches may help release this hypertonic group (Manske & Magee, 2018). Thigh adductor length test This tests for hypertonicity of the adductor group of muscles. The client should be lying in the supine position. On the thigh that is being tested, the client will place the plantar (bottom) surface of their foot on the medial portion of the opposite knee. (The client should be in a “figure 4” position.) From this position, the therapist will push down
SECTION V: ORTHOPEDIC TESTS FOR THE HIPS
on the knee on the side of the adductors that are being tested. (The therapist may want to place a hand on the opposite thigh’s quadricep muscles just above the knee for stabilization purposes.) Hypertonic adductor muscles are indicated if the knee is unable to touch the table top. Note that hypertonic adductor muscles may be involved in dysfunctions of the pelvic floor. Directional massage, PNF stretches, and trigger point therapy may relieve the hypertonicity of this group (Manske & Magee, 2018). Hip range of motion test This tests for hypertonic muscles or a dysfunction of the hip joint. The client should be in the supine position, and their knees may be bolstered for comfort. The client’s thigh is brought into approximately 45 degrees of flexion at the hip while keeping the knee flexed. The therapist will perform circumduction of the hip joint. Limited ROM or pain around the femur’s greater trochanter may indicate hypotonic muscles depending upon where ROM is limited. Pain deep in the joint or crepitus (crackling) at any point through the ROM may indicate a dysfunction between the acetabulum and the head of the femur. The head of the femur can be pressed into the acetabulum to elicit pain to confirm the result. PNF stretches may lengthen hypertensive muscles that may be limiting ROM, though the therapist should avoid performing ROM movements and stretches if crepitus is present (Manske & Magee, 2018). Ober’s test Tests for hypertonicity of the iliotibial band, (IT band), and the tensor fasciae latae, aka the TFL muscle. The client should be placed in the side-lying position. Their bottom leg, the leg not being tested, is flexed to 90 degrees at the hip and knee. The leg being tested is kept straight. The client is then asked to abduct their entire leg while attempting extension to 45 degrees. Then the client is asked to slowly lower their leg toward the therapy table. If the client is unable to lower their leg smoothly, this indicates hypertonicity of the IT band or TFL. Myofascial release along the IT band from knee toward the hip may by beneficial.
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Book Code: MFL1227
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