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PTA215: Therapeutic Exercises - Special Tests

Overview

PTA215: Therapeutic Exercises - Special Tests

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Category: Physical Therapy

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Overview PTA215: Therapeutic Exercises - Special Tests Subject: — Category: Other Visibility: public Tags: — Add your notebook summary. Section 1

🦴Lumbar Spine

Lateral Shift Correction

What is it for: Directional preference assessment and treatment for lumbar pain with a lateral shift
What are we looking for: Centralization of symptoms and visible correction of the trunk deviation

How to perform: Patient standing, block the rib cage and pelvis, then guide the thorax and pelvis back toward midline

1. Position the patient standing with the shifted side accessible
2. Flex the patient's elbow against the side of the deviated rib cage
3. Stand on the side to which the thorax is shifted and place your shoulder against the patient's elbow
4. Wrap your arms around the opposite side of the pelvis
5. Pull the pelvis toward you while pushing the thorax away gradually
6. Look for centralization of symptoms
7. If the shift is corrected, follow immediately with backward bending

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Passive Physiological Intervertebral Movements (PPIVMs)

What is it for: Assessment of lumbar segmental mobility

What are we looking for: Hypomobility, symptom reproduction, and segment-to-segment motion quality
How to perform: Patient side-lying, clinician uses a piano grip at the interspinous spaces while moving the lower extremities into flexion and extension

1. Place the patient in side-lying with knees bent
2. Rest the patient's legs on your anterior hip
3. Use a piano grip to place your fingers in the interspinous spaces
4. Use the other hand to move the patient's legs into flexion and extension
5. Compare the amount and quality of motion between lumbar segments
6. Note stiffness, pain, or symptom reproduction

✕✕✕✕
Central PA Mobilization

What is it for: Lumbar accessory motion assessment and treatment

What are we looking for: Pain provocation, stiffness, and response to extension-biased mobilization

How to perform: Apply a posterior-to-anterior force over the spinous process using body weight and a gradual pressure

1. Position the patient prone
2. Place the pisiform over the target spinous process
3. Interlace the other hand over the top hand
4. Keep your head and trunk over your arms
5. Apply a gradual posterior-to-anterior force only strong enough to assess motion and symptoms
6. Use the finding for assessment or to help improve extension and rotation

Unilateral PA Mobilization

What is it for: Assessment and treatment of unilateral lumbar hypomobility

What are we looking for: Restricted motion, pain, and segment-specific asymmetry

How to perform: Apply a unilateral posterior-to-anterior force over the transverse process

1. Position the patient prone
2. Place one thumb over the other on the transverse process of the involved segment
3. Keep the thumbs aligned to avoid hyperextension
4. Apply a controlled unilateral posterior-to-anterior force
5. Assess for symptom response and mobility
6. Use the technique to improve extension and ipsilateral rotation when indicateTo stretch into extension: extend hips

To stretch into flexion: flex hips (hook-lying, picture)
To stretch into side-bending, move lower extremities to one side

SUMMARY

Assessment	Primary Use	Position	Main Action	Positive/Meaningful Finding
Lateral Shift Correction	Directional preference / shift correction	Standing	Manual correction of thorax and pelvis	Centralization of symptoms or improved alignment
PPIVM	Segmental mobility	Side-lying	Move legs while palpating interspinous spaces	Stiffness, pain, or asymmetrical segmental motion
Central PA	Accessory motion assessment	Prone	Posterior-to-anterior force on spinous process	Pain reproduction or limited segmental mobility
Unilateral PA	Unilateral accessory motion assessment	Prone	Posterior-to-anterior force on transverse process	Pain, asymmetry, or unilateral hypomobility

STUDY GUIDE

Category
Non-Weightbearing Bias Pathologies: Acute Discogenic Pain Severe Herniated Nucleus Pulposus (disc herniation) Acute Radiculopathy Procedures/Education Hook-lying lumbar traction Educate the patient in positions of comfort Educate in the nature of low back pain and balancing activity with rest Exercises: DKTC Seated self-traction with armrests Leaning forward on counter Progress from NWB bias to the more appropriate directional category as symptoms calm
Extension Bias Pathologies: Disc Herniation Discogenic Low Back Pain Poor Posture/Structural Fatigue Muscular Back Pain Procedures/Education: Lateral shift correction Educate the patient on symptom-relieving positions and progression Education in healthy back-care strategies Exercises: Self-correction of lateral shift Prone lying Prone on elbows Prone press-up / prone on hands Standing lumbar extension Walking as tolerated
Flexion Bias Pathologies: Lumbar Spinal Stenosis Spondylolisthesis Facet Syndrome Chronic Degenerative Disc Procedures/Education: Educate the patient on functional flexed positions Foot on step stool for symptom relief Bicycling instead of walking when needed Positional traction in flexion Exercises Posterior pelvic tilt Lower trunk rotation Cat/camel Child's pose / prayer pose Global trunk muscle training Stretching for hip mobility

Hypermobility / Functional Instability Pathologies: Connective Tissue Disorders such as Hypermobility Spectrum Disorders (HSD) and Ehlers-Danlos Syndromes (EDS) which causes lax ligaments, reducing passive Stability Degenerative Disc Disease/Spondylosis Lumbar Segmental Instability (LSI) Spondylolisthesis Trauma/Ligamentous Laxity Procedures/Education Educate the patient in neutral spine Educate the patient in good postural alignment for functional activity Demonstrate aberrant movements and lumbar control strategies Exercises: TrA activation / drawing-in maneuver Abdominal bracing Posterior pelvic tilt Bent knee fallout Bird dog Progression with upper and lower extremity movement

🦴 HIP & SI JOINT

FADIR Test

What is it for: Femoroacetabular impingement, anterior labral involvement, and iliopsoas irritation

What are we looking for: Reproduction of anterior hip pain

How to perform: Patient supine, flex the hip to 90 degrees, then adduct and internally rotate

1. Position the patient in supine
2. Flex the test hip to 90 degrees
3. Adduct the hip
4. Internally rotate the hip
5. A positive test reproduces anterior hip pain

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FABER Test

What is it for: Intra-articular hip pathology, ligament teres irritation, and hip impingement

What are we looking for: Groin pain or posterior hip/SIJ pain

How to perform: Patient supine, place the test leg in flexion, abduction, and external rotation, then lower toward the table

1. Position the patient in supine
2. Flex the test hip and place the foot on the opposite leg
3. Abduct and externally rotate the hip
4. Slowly lower the test leg toward the table
5. Groin pain suggests intra-articular hip pathology
6. Posterior pain may suggest ligament teres injury or hip impingement

✕✕✕

SI Compression Test

What is it for: Sacroiliac joint symptom provocation

What are we looking for: Reproduction of the patient's familiar SIJ symptoms

How to perform: Patient side-lying with hips and knees flexed, apply a downward force through the upper iliac crest

1. Place the patient in side-lying with hips and knees at about 90 degrees
2. Kneel or stand so you can contact the uppermost iliac crest
3. Apply a vertical downward compressive force
4. Reproduction of familiar symptoms is a positive test

✕✕✕

SI Distraction Test

What is it for: Sacroiliac joint symptom provocation

What are we looking for: Reproduction of the patient's familiar SIJ symptoms

How to perform: Patient supine, apply a posteriorly directed force to both ASIS

1. Position the patient in supine
2. Place your hands over both ASIS
3. Apply a posteriorly directed force through the pelvis
4. Reproduction of familiar symptoms is a positive test

✕✕✕

Trendelenburg Test

What is it for: Hip abductor weakness or poor frontal-plane pelvic control

What are we looking for: Pelvic drop on the unsupported side or compensatory trunk lean

How to perform: Patient stands on one leg while the examiner observes pelvic alignment

1. Have the patient stand tall
2. Ask the patient to lift one foot off the ground and balance on the test limb
3. Observe the pelvis from behind
4. A drop of the contralateral pelvis or a marked trunk lean suggests a positive test

✕✕✕

Thomas Test

What is it for: Hip flexor tightness

What are we looking for: Inability of the test thigh to remain flat on the table

How to perform: Patient supine, hold one knee to the chest while the opposite leg stays relaxed

1. Position the patient supine near the edge of the table
2. Ask the patient to hold one knee tightly to the chest
3. Let the opposite leg relax
4. Observe whether the test thigh stays flat on the table
5. If the thigh rises, the test is positive for hip flexor tightness

✕✕✕

SUMMARY

Test	Structure / Condition	Position	Main Action	Positive Finding
FADIR	FAI / anterior labrum / iliopsoas	Supine	Flexion + adduction + internal rotation	Anterior hip pain
FABER	Hip joint / SIJ	Supine	Flexion + abduction + external rotation	Groin pain or posterior pain
SI Compression	Sacroiliac joint	Side-lying	Compress upper iliac crest	Reproduction of symptoms
SI Distraction	Sacroiliac joint	Supine	Posterior force through both ASIS	Reproduction of symptoms
Trendelenburg	Hip abductors	Standing, single-leg stance	Observe pelvic alignment	Contralateral pelvic drop or trunk compensation
Thomas	Hip flexors	Supine	Opposite hip flexion to chest	Test thigh rises off table

STUDY GUIDE

Category	Procedures/Education	Exercises
Transferring With THA Precautions	Bed mobility and sit-to-stand training for posterior/posterolateral approach Bed mobility and sit-to-stand training for anterior/anterolateral approach Bed mobility and sit-to-stand training for transtrochanteric approach	Practice safe scooting, sit-to-stand, and transfer sequencing Maintain approach-specific precautions during functional mobility
Hip OA - Conservative Management	Education, nonimpact activity, and activity modification Decrease pain at rest and with weight bearing Grade I-II oscillations and self-oscillation strategies Gait training with SPC on the contralateral side and seating modifications	Neutral spine and TrA activation Stretching for limited ROM without reproducing symptoms Glute, hip rotator, and core strengthening Bike, treadmill, and balance work as tolerated
S/P THA	Immediate WBAT with AD as ordered Transfer training and precaution review Monitor incision, DVT risk, and tolerance to activity Avoid low chairs and excessive joint loading early on	Acute: ankle pumps, A/AROM, TKE, submaximal isometrics, marching Subacute: LAQ, bridges, side-lying hip ER/ABD, standing 4-way hip, heel/toe raises Later: SLS, step-ups, mini squats, lunges, side stepping, bike, stair training
Labrum Tear / FAI - Conservative Management	Education in avoiding provoking activities and positions Control inflammation Restore lumbopelvic alignment and control	TrA activation and neutral spine drills Stretching with avoidance of symptom reproduction Balance hip muscle length with strength Pelvic and core stabilization with CKC strengthening
S/P Hip Arthroscopy	Respect tissue healing and post-op precautions Gradually progress ROM and loading	Acute: TrA activation, hip and knee isometrics, ankle pumps Subacute: SKTC, hamstring stretch, adductor stretch, SLR at appropriate timing, 3-way hip, bridges, mini squats Later: advanced core stabilization, squats, single-leg squats, multidirectional lunges, SLS on foam, step-ups
S/P Hip ORIF	Follow MD weight-bearing status Avoid post-op complications and progress gait safely	Acute: ankle pumps, A/AROM, standing 3-way hip, submaximal isometrics Subacute: standing 4-way hip, heel/toe raises, SLS, step-ups, mini squats, Romberg, bike, pool Later: lunges, forward and lateral step-ups, resisted hip extension/abduction, selective stretching, stair training

🦵 KNEE

🦵 KNEE SPECIAL TESTS

Lachman Test

What is it for: Anterior Cruciate Ligament (ACL)

What are we looking for: Increased anterior movement of the tibia compared to the uninvolved side

How to perform: Patient supine, knee in slight flexion, stabilize the femur, then translate the proximal tibia anteriorly

1. The patient is supine, and the involved limb is on the side of the examiner
2. The knee joint is placed into 20-30 o of knee flexion
3. One hand of the examiner is placed on the femur for stabilization, while the other hand is applied to the posteromedial aspect of the proximal tibia in an attempt to translate it anteriorly
4. Any subluxation anteriorly compared to the uninjured knee demonstrates a positive test.

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Anterior Drawer Test

What is it for: ACL

What are we looking for: Increased anterior tibial displacement

How to perform: Patient supine, knee flexed, foot on table, both hands behind tibia, pull anteriorly

1. The knee is flexed between 60° and 90° with the foot resting on the exam table
2. The examiner puts both hands behind the tibia and attempts to displace the tibia anteriorly while the foot remains resting on the table
3. Increased tibial displacement with the foot in neutral indicates a positive test which is graded by severity:
Grade I: 5 mm
Grade II: 5-10mm
Grade III: >10 mm
4. The test is then repeated with the tibia in 15 degrees of external rotation and then in 30 degrees of internal rotation to determine integrity of posterolateral and posteromedial corners

✕✕✕✕✕

Pivot Shift Test

What is it for: Anterolateral rotary stability, including ACL
What are we looking for: Palpable shift or clunk during reduction

How to perform: Internally rotate the tibia, apply valgus force, and flex the knee

1. The knee is placed in 20-30° of flexion. Hold foot with one hand and place other hand at the knee behind fibula. Internally rotate the tibia and extend the knee, causing anterior subluxation of tibia
2. Apply valgus force while maintaining IR torque of tibia and flex the knee. At around 30-40°, the knee should reduce
3. The reduction is due to the ITB pulling the tibia back to normal position during the knee flexion
4. Positive result is the palpable shift or clunk during subluxation and reduction.”

✕✕✕✕✕✕✕✕✕✕✕✕

Posterior Drawer Test

What is it for: Posterior Cruciate Ligament (PCL)

What are we looking for: Excessive posterior translation of tibia on femur

How to perform: Patient supine, knee flexed to 90°, stabilize lower leg, push tibia posteriorly

1. Patient in supine with knee flexed to 90° and hip flexed 45°
2. Examiner stabilizes the lower leg by sitting on top of forefoot
3. Examiner places thumbs on anterior joint space and wraps fingers around proximal tibia, then pushes posteriorly
4. Positive: excessive posterior translation of tibia on femur.

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Posterior Sag Sign

What is it for: PCL

What are we looking for: Tibia sagging posterior on the femur

How to perform: Patient supine, knee flexed to 90°, examiner supports the legs and observes tibial position

1. Patient in supine, knee flexed 90°
2. Examiner passively lifts patient’s legs and rests it on their forearm
3. Positive: tibia sagging posterior on the femur.

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Valgus Stress Test

What is it for: Medial Collateral Ligament (MCL)

What are we looking for: Excessive valgus movement

How to perform: Patient supine, apply valgus force in full extension and again at 20–30° flexion

❖ Patient supine
❖Examiner places inside hand on the medial lower leg and outside hand on lateral knee
❖Examiner applies valgus force on fully extended knee with outside hand
❖Positive: excessive valgus movement (ACL may be involved)
❖Repeat valgus force with knee flexed 20-30°
❖Positive: excessive valgus movement (MCL more isolated).

✕✕✕✕✕✕✕✕✕✕

Varus Stress Test

What is it for: Lateral Collateral Ligament (LCL)

What are we looking for: Excessive varus movement

How to perform: Patient supine, apply varus force in full extension and again at 20–30° flexion

❖Patient supine, hip abducted
❖Examiner on medial side of test leg, place inside hand on the medial knee and outside hand on lateral lower leg
❖Examiner applies varus force on fully extended knee with inside hand
❖Positive: excessive varus movement (ACL may be involved)
❖Repeat varus force with knee flexed 20-30°
❖Positive: excessive varus movement (LCL more isolated).

✕✕✕✕✕✕✕✕✕✕

McMurray Test

What is it for: Meniscus, medial and lateral

What are we looking for: Pain or click at the joint line

How to perform: Patient supine with knee fully flexed, rotate tibia and slowly extend the knee

Patient supine, knee fully flexed
Examiner grasps foot with one hand and palpates the knee joint line with the other

Medial: Examiner externally rotates the tibia and maintains it while extending the knee slowly
Positive: pain, or click at the joint line

Lateral: Examiner internally rotates the tibia and maintains it while extending the knee slowly
Positive: pain, or click at the joint line.

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Apley Compression Test

What is it for: Meniscus

What are we looking for: More pain with compression than with distraction

How to perform: Patient prone with knee flexed to 90°, stabilize thigh, rotate tibia, then repeat with compressive force

Patient prone with knee flexed 90°
Examiner stabilizes thigh using one hand and places the other hand on the patient’s heel
Examiner internally and externally rotates the tibia, noting if the patient has any pain
Examiner then applies compressive force through the tibia and repeats internal and external rotation of tibia
Positive: more pain with compressive force compared to when tibia is distracted.

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SUMMARY

Test	Structure	Position	Main Action	Positive Finding
Lachman	ACL	Supine, 20–30° flexion	Anterior translation of tibia	Anterior subluxation/translation
Anterior Drawer	ACL	Supine, 60–90° flexion	Anterior pull on tibia	Increased tibial displacement
Pivot Shift	ACL / rotary stability	Supine	IR tibia + valgus + flexion	Palpable shift or clunk
Posterior Drawer	PCL	Supine, knee 90°, hip 45°	Posterior push on tibia	Excess posterior translation
Posterior Sag Sign	PCL	Supine, knee 90°	Observe tibia under gravity	Posterior sag
Valgus Stress	MCL	Supine	Valgus force	Excess valgus movement
Varus Stress	LCL	Supine, hip abducted	Varus force	Excess varus movement
McMurray	Meniscus	Supine, knee fully flexed	Rotation + extension	Pain or click at joint line
Apley Compression	Meniscus	Prone, knee 90°	Compression + rotation	More pain with compression

STUDY GUIDE

Category	Procedures/Education	Exercises
Knee OA - Conservative Management	Use a phase-based progression from acute to subacute care Reduce mechanical stress while improving mobility and activation	Acute: heel slides, seated knee flexion, selective stretching, muscle setting, seated hip flexion, SLR Subacute: strengthening and balance/proprioception including SLS, weight shifts, tandem standing, Romberg
TKA / UKA	Progress from acute to chronic protection as tolerated Restore ROM, muscle activation, gait, and endurance	Acute: heel slides, seated knee flexion, muscle setting, LAQ, seated hip flexion, SLR Subacute: mini squats, step-ups, mini lunges, 3-way hip, SLS, weight shifts, walking, bike Chronic: leg press, hamstring curls, 4-way hip, BOSU, wobble board, foam, tandem walk
Ligament Sprains / Tears - Conservative	Protect healing tissue while restoring ROM and function	Acute: muscle setting, heel slides Subacute: PREs, mini squats, SLS, endurance progression
ACL / PCL Reconstruction	Follow graft-specific precautions Progress by phase from ROM and activation to return-to-function work	Acute: heel slides, maintenance of other joints, multi-angle isometrics, SLR, low-load hamstring PRE Subacute: CKC strengthening, PRE, SLS, BOSU, bike, jogging as appropriate Chronic: advanced CKC strengthening, plyometrics, agility drills, sport-specific training, running and cutting
Meniscus Tear - Conservative	Address muscle imbalance by stretching what is tight and strengthening what is weak	Acute: ROM and muscle activation Subacute: strengthening, muscle imbalance correction, SLS, BOSU, Airex Chronic: advanced CKC work, eccentric control, loaded squats, sport-specific training, plyometrics, RNT
Meniscal Repair / Meniscectomy	Respect surgical precautions and staged loading Emphasize ROM, quad control, balance, and return to function	Acute: heel slides, supine AROM into flexion, muscle setting, hip strengthening Subacute: LLLD/LLPS for ROM, hip PREs, OKC and CKC single-plane knee strengthening, mini trampoline, BOSU, bike, walking Chronic: functional simulation, multiplanar pivoting, plyometrics, agility drills, jogging at the appropriate time

🦶 ANKLE/FOOT

🦶 ANKLE SPECIAL TESTS

External Rotation Stress Test

What is it for: Syndesmosis
What are we looking for: Pain over anterior or posterior tib-fib ligament or interosseous region
How to perform:

Patient seated with knee at 90° EOB
Examiner faces pt & stabilizes the knee with on hand, cups heel with the other hand holds ankle in neutral & applies a passive ER stress to foot & ankle
Positive: Pain over anterior or posterior tib-fib ligament or interosseous
SN: 58%
SP: 96%.

✕✕

Ankle Anterior Drawer Test

What is it for: Anterior Talofibular Ligament (ATFL)

What are we looking for: Excessive anterior translation of the talus

How to perform: Patient supine, stabilize the distal tibia and fibula, hold the heel in slight plantarflexion, and pull anteriorly

1. Position the patient supine
2. Stabilize the distal tibia and fibula with one hand
3. Hold the heel with the other hand in about 10-20 degrees of plantarflexion
4. Apply an anterior pull of the talus in the ankle mortise
5. Excessive anterior translation is a positive test

✕✕✕✕✕✕✕

Talar Tilt Test

What is it for: Calcaneofibular Ligament (CFL)

What are we looking for: Excessive inversion or pain

How to perform: Patient supine or side-lying, hold the ankle in neutral and tilt the calcaneus into inversion

1. Position the patient supine or side-lying
2. Place the ankle in neutral dorsiflexion
3. Grasp the heel
4. Tilt the calcaneus into inversion while applying an anterior glide as needed
5. Excessive inversion or pain is a positive test

✕✕

Thompson Test

What is it for: Achilles tendon rupture

What are we looking for: Absence of plantarflexion with calf squeeze

How to perform: Patient prone with feet over the edge of the table, squeeze the calf and observe for plantarflexion

1. Position the patient prone with the feet over the edge of the table
2. Make sure the patient is relaxed
3. Gently squeeze the calf muscle
4. Observe for plantarflexion
5. Absence of plantarflexion is a positive test

✕✕

Test	Structure	Position	Main Action	Positive Finding
External Rotation Stress	Syndesmosis	Seated, knee 90° EOB	Passive ER stress	Pain over tib-fib/interosseous
Ankle Anterior Drawer	ATFL	Supine, ankle 10–20° PF	Anterior pull of talus	Excess anterior translation
Talar Tilt	CFL	Supine or side-lying, ankle neutral	Inversion tilt	Excess inversion or pain
Thompson	Achilles tendon	Prone, feet over edge	Calf squeeze	Absence of PF

STUDY GUIDE

Category	Procedures/Education	Exercises
Ankle OA - Conservative Management	Phase-based progression from acute to chronic protection Maintain joint mobility and improve accessory motion	Acute: ankle pumps, ABCs, appropriate stretching, isometrics, proximal PREs Subacute: ankle PREs, proximal strengthening, SLS, weight shifts, progress to compliant surfaces Chronic: CKC strengthening, star excursion, SLS on compliant surfaces
Total Ankle Arthroscopy	Respect post-op precautions Initiate stretching and light-impact CV work as allowed	Acute: toe ROM progressing to DF/PF ROM, muscle setting, proximal strengthening Subacute: PRE progression to squats, lunges, heel raises, Airex, BOSU, wobble
Ankle Sprain - Conservative Management	Protect the healing ligament and restore multiplanar motion	Acute: pain-free PF/DF, muscle setting, proximal strengthening Subacute: multiplanar ROM, extrinsic strengthening, SLS, wobble, weight shifts Chronic: CKC strengthening, star excursion, plyometrics, bounding
Ankle Fracture - Conservative Management	Maintain proximal motion and strength while fracture heals Progress weight bearing per guidance	Acute: maintain proximal ROM, PF/DF, intrinsic strengthening, isometrics Subacute: multiplanar ROM, PREs, SLS, wobble board, Airex Chronic: CKC functional training, plyometrics, RNT
Ankle ORIF	Respect surgeon-directed precautions and weight-bearing progression	Acute: ankle alphabets, circles, isometrics, proximal strengthening Subacute: PREs, standing heel raises, SLS, BOSU, wobble board Chronic: heel/toe raises in SLS, lunges, squats, balance progression, plyometrics
Ankle Tendon Rupture - Conservative	Protect the tendon during early healing	Toe flexion for the first 8 weeks, then progress to the standard tendon repair exercise sequence
Ankle Tendon Rupture Repair	Follow tendon-healing precautions closely Gradually restore ROM, load tolerance, and function	Acute: AROM in plantarflexion, submaximal isometrics, weight shift Subacute: soleus stretching, band resistance for proximal joints, bilateral heel raise, partial lunges, seated wobble board Chronic: eccentrics, tendon loading, pool-to-land plyometrics, sport-specific progression from low speed to full speed
Plantar Fascia Pain	Correct length-strength imbalances Load the plantar fascia through the windlass mechanism	Acute: passive stretch, AROM, isometrics Subacute: stretch what is tight and strengthen what is weak Intrinsic and extrinsic strengthening with towel crunches, marble grabs, PREs, CKC loading, SLS, marches, wobble board, BOSU

Section 5

Sections: Lumbar Spine, Hip, Knee, Ankle/Foot

🦴 LUMBAR SPINE

Lateral Shift Correction

What is it for: Directional preference assessment and treatment for lumbar pain with a lateral shift

What are we looking for: Centralization of symptoms and visible correction of the trunk deviation

How to perform: Patient standing, block the rib cage and pelvis, then guide the thorax and pelvis back toward midline

1. Position the patient standing with the shifted side accessible
2. Flex the patient's elbow against the side of the deviated rib cage
3. Stand on the side to which the thorax is shifted and place your shoulder against the patient's elbow
4. Wrap your arms around the opposite side of the pelvis
5. Pull the pelvis toward you while pushing the thorax away gradually
6. Look for centralization of symptoms
7. If the shift is corrected, follow immediately with backward bending

Passive Physiological Intervertebral Movements (PPIVMs)

What is it for: Assessment of lumbar segmental mobility

What are we looking for: Hypomobility, symptom reproduction, and segment-to-segment motion quality

How to perform: Patient side-lying, clinician uses a piano grip at the interspinous spaces while moving the lower extremities into flexion and extension

1. Place the patient in side-lying with knees bent
2. Rest the patient's legs on your anterior hip
3. Use a piano grip to place your fingers in the interspinous spaces
4. Use the other hand to move the patient's legs into flexion and extension
5. Compare the amount and quality of motion between lumbar segments
6. Note stiffness, pain, or symptom reproduction