Special Tests

Weber–Barstow 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
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Supine to Long–Sit Test

Steps: Patient is in a supine position with the heels off of the end of the table; Examiner "clears the hips" using the Weber–Barstow Maneuver; Examiner passively extends the patient's legs & compares the position of the medial malleoli; Examiner pulls the patient up to a long–sit 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)
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Supine ("True") Leg Length Discrepancy Measurement Test

Steps: Patient is placed in a supine; Examiner "clears the hips" using the Weber–Barstow 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 ¼ inch between the two legs
Positive Test Implication: Possible structural leg–length difference
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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 Implication: Femoral length difference (lateral view–increased anterior position); tibial length difference (front view–increased height difference)
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Craig's Test for Femoral Anteversion/Retroversion

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 8–15°
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
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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 mid–thigh; 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
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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
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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
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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
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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
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SI Distraction Test

Steps: Athlete is in the side–lying 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
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Piriformis Tightness Test

Steps: Athlete is side–lying 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)
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90–90 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
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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
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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)
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Patrick's Test (Faber Test or Figure–Four Test)

Steps: Athlete is supine with the foot of the involved side crossed over the opposite thigh (figure–4 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)
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Trendelenburg's Test

Steps: Athlete stands with the feet evenly distributed (i.e. approximately shoulder–width 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
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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 dick, abdominal trauma, tumor, or osteophyte in lumber canal
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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
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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
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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
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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 sciatic–type pain or any reproduction of symptoms is indicative of a positive test
Positive Test Implications: Sciatica or dural irritation
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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
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Single Straight Leg Raise Test

Steps: Subject begins supine with both knees extended; Examiner stands at subject’s 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
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Bilateral Straight Leg Raise Test

Steps: Subject begins supine with both knees extended; Examiner stands at subject’s side with distal arm supporting the heels and proximal hand on the subject’s 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
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Malinger's Rotational Test

Steps: With the subject standing the examiner asks the patient to perform trunk rotation while the examiner stabilizes the patient’s 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
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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
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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
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