Head, Neck, Back & Spine Special Tests

Head Region Special Tests Schwabach

Strike tuning fork against the palm, then

Hearing Loss place on mastoid process; from
alternating therapist / examiner’s mastoid
Conductive hearing loss–outer & middle process to patient’s mastoid process
ear problem; ear canal, eardrum, pinna
★ Vibration heard should get quieter and
● Difficulty transmitting sound waves
quieter after each time examiner
caused by blockage or infection alternates
● LOUDNESS
*assesses bone conduction
Sensorineural hearing loss–inner ear
problem; cochlea, semicircular canals
● Difficulty interpreting sounds Cervical Spine Special Tests
● Nerves transmitting sounds to higher
centers of the brain may be affected
● CLARITY Cervical Spine (Provocative Tests)

Spurling’s
Tuning fork–causes vibration when struck
on the palm Indicated for radiculitis or pain on
dermatomal distribution
Hearing Loss Head is placed passively into lateral
flexion (affected side first), then examiner
Weber applies compression force
Strike tuning fork against the palm, then
(+) Ipsilateral pain in the dermatomal
place on the vertex of the skull
distribution
N = Both ears should hear equal vibration
Reverse spurling sign: pain is felt
contralaterally through the dermatomal
(+) One ear hears louder compared to
distribution; indicated for tension myalgia
other ear
Jackson Compression Test
Rine
Indicated for radiculitis or pain on
Strike tuning fork against the palm, then
dermatomal distribution
place on (1) mastoid process and note
the time it takes until the vibration heard
Head is placed passively into cervical
stops (2) 1-2 cm beside the ear and note
rotation (affected side first), then
the time it takes until the vibration heard
examiner applies compression force
stops
(+) Ipsilateral pain in the dermatomal
N = air conduction is twice as much as
distribution
the bone conduction

* assesses air & bone conduction *Modified Spurling’s Test

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Head, Neck, Back & Spine Special Tests

Maximum Cervical Compression Test Wrist & hand: extended

Indicated for radiculitis or pain on Nerve bias: Median & Anterior

dermatomal distribution Interosseous Nerve

Head is placed passively into lateral ULTT 2 Shoulder: ABD 10°

flexion followed by cervical rotation on Elbow: extended
the same side (affected side first), then Forearm: supinated
examiner applies compression force Wrist & hand: extended

(+) Ipsilateral pain in the dermatomal Nerve bias: Median, Axillary,

distribution Musculocutaneous Nerve

*Modified Spurling’s Test ULTT 3 Shoulder: ABD 10-90° & IR

Elbow: extended
Forearm: pronated
Cervical Spine (Relieving Tests) Wrist & hand: flexed & ulnar
deviated
Distraction Test
Nerve bias: Radial Nerve
Indicated for radiculopathy or nerve
impingement ULTT 4 Shoulder: ABD 10-90°
Elbow: flexed
Examiner’s one hand is under the chin, Forearm: supinated
other hand is under the occiput, then Wrist & hand: extend &
apply distraction radially deviated

(+) Pain relief Nerve bias: Ulnar Nerve

Shoulder Abduction Test ● Shoulder depression first before

Indicated for radiculopathy or nerve
impingement on the C4-C5 (C5-C6)
segments
This can be passively or actively done;
elevate the arm until the arm rests on top
of the head
abducting in the upper limb tension
tests
● Cervical area should be in lateral
flexion contralaterally
● Elbow must be positioned last
because it has a large range of motion

(+) Pain relief = Bakody’s Sign Neurological & Musculoskeletal Test

Scalene Cramp Test

Nerve
Position the head into lateral flexion and
Upper Limb Tension / Elvey’s / Upper rotation ipsilaterally; place the chin into
Limb Neurodynamic Test the hollow portion of the clavicle

ULTT 1 Shoulder: ABD 110° (+) localized pain on shoulder region =

Elbow: extended triggered points
Forearm: supinated (+) radiating pain = plexopathy

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Head, Neck, Back & Spine Special Tests

Musculoskeletal & Ligamentous Tests Halstead Shoulder extension

with contralateral
Pettmans Distraction Test cervical rotation

Method 1: Patient is in supine; examiner Allen Elbow flexion with

pulls the head or applies distraction force cervical rotation (test
by putting one hand is under the chin, both contralateral &
other hand is under the occiput ipsilateral)

Method 2: Patient is in supine; cervical
area is flexed, chin tucked, then apply
distraction force
(+) pain = lax tectorial membrane
Sharp-Purser Test
* Always assess the radial pulse before
doing the special test (except for roos),
then check again after; absent or
diminished pulse indicates thoracic
outlet syndrome

One hand is directed at the forehead, Slump Test / Sitting Dural Stretch Test
thumb of other is directed at the spinous
process of C2; patient will actively flex the Thoracic and lumbar flexion while in
head sitting position; (+) pain

N = hand on forehead and thumb moves ST 1 Hip: flexion

with the patient’s head following the Knee: extension
motion Ankle: DF

(+) hand at the forehead goes up and Nerve bias: cervical & lumbar
thumb goes down = laxity of the nerves, spinal cord, sciatic nerve
transverse ligament / atlanto-axial
(A-A) instability ST 2 Hip: flexion & ABD
Knee: extension
Ankle: DF
Thoracic Outlet Syndrome Tests
Nerve bias: obturator nerve
Wright Test Shoulder placed in
hyperabduction ST 3 * Side-lying Slump

Costoclavicular Shoulder placed in Hip: flexed at 20°

/ Military Brace hyperextension Knee: flexion
Test Ankle: PF

Roos / EAST / Reverse T position Nerve bias: femoral nerve

Hand’s up Test followed by close
open of the hands Cervical position is in flexion

(+) cannot sustain ST 4 * Long-sitting Slump

position
Hip: flexion
Adson Shoulder extension Knee: extension
with ipsilateral Ankle: DF
cervical rotation

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Head, Neck, Back & Spine Special Tests

Nerve bias: cervical & lumbar Nerve bias: Disc Prolapse

nerves, spinal cord, sciatic nerve
* Contralateral leg is being raised
Cervical position is in flexion & rotation
SLR + DR = Braggard

Straight Leg Raising Test (SLR) / SLR + Big toe extension = Siccard
Lasegue’s Test
Big toe extension = Turyn
General positioning: supine
Examiner passively moves extremity
Lumbar & SI Joint Pathology
SLR 1 Hip: flexed & ADD
Knee: extended Gaenslen’s Test
Ankle: DF
Foot: neutral Indicated for L4 nerve root pathology
Toes: neutral
Patient can be in sidelying (supine
Nerve bias: sciatic & tibial nerve modification); upper leg brought into
hyperextension & knee of lower leg is
SLR 2 Hip: flexed brought to the chest; stabilize pelvis
Knee: extended
Ankle: DF (+) pain
Foot: everted
Toes: extended Stork Standing / Lumbar Extension /
One Leg Stance Test
Nerve bias: tibial nerve
Indicated for pars interarticularis fracture /
SLR 3 Hip: flexed spondylolisthesis
Knee: extended
Ankle: DF Ask patient to stand on one LE; add
Foot: inverted lumbar extension if no pain
Toes: neutral
(+) pain
Nerve bias: sural nerve
Flamingo Test
SLR 4 Hip: flexed
Knee: extended Indicated for SI Joint pathology
Ankle: PF
Foot: inverted Ask the patient to stand on one LE then
Toes: neutral hop

Nerve bias: common peroneal (+) pain

nerve
Yeoman’s Test
SLR 5 * Well-Leg Raising Test
Indicated for SI joint pathology–Sacroiliac
Hip: flexed ligaments
Knee: extended
Ankle: DF Patient is in prone with knee flexed to 90°
then ipsilateral hip will be hyperextended

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Head, Neck, Back & Spine Special Tests
(+) pain
Gillet’s / Sacral Fixation / Posterior
Ipsilateral Rotation (PIR) Test
Indicated for SI joint hypomobility
Patient is standing; examiner is behind
patient palpating PSIS using both thumbs;
ask patient to bring one knee to chest;
PSIS should move inferiorly
(+) if the thumb in the ipsilateral side did
not move inferiorly
Piedallu’s Test
Indicated for SI joint pathology
Patient is in sitting in a flat, solid, hard
surface; examiner will palpate PSIS with
both thumbs; ask patient to flex trunk or
bend forward
(+) if one PSIS is higher than the other
during trunk flexion
Muscular Dysfunction Special Tests
Beevor’s Sign
Indicated for weak rectus abdominis
muscle or nerve innervating it
Patient is in supine; ask patient to perform
partial sit up, raising the upper back off
the surface; note for the umbilicus; then
ask the patient to cough
(+) umbilicus deviates on one side
Gluteal Skyline Test
Indicated for
Patient is prone; the examiner is behind
the patient observing the bulk of the
gluteal muscles (g. max) if it is
symmetrical; ask the patient contract /
squeeze the buttocks
(+) asymmetry of the buttocks
Special Test for Malingering
Burns Test
Ask the patient to kneel on top of the chair
then reach for the floor
(+) patient overbalances & unable to
reach the floor
Hoover’s Test
Patient is in supine; examiner cups both
heels; ask patient to lift the painful
extremity
(+) there is no pressure placed by the
contralateral LE
UMNL Special Tests
Romberg Test
Indicated for dorsal column
Ask patient to stand with eyes closed for
20-30 seconds; note for postural sway
(+) postural sway
Eyes closed = dorsal column
Eyes open = cerebellum
Lhermitte's Sign
Indicated for radiculopathy, meningeal
irritation, lesion to spinal cord, and UMNL
Patient is in long-sitting; examiner
simultaneously flex the cervical region
and hip
(+) sharp, electric like pain / sensation
Brundzinski & Kernig Test
Patient is in supine; examiner flex the
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Head, Neck, Back & Spine Special Tests

cervical region followed by hip flexion; if

pain is felt, flex the knee

Cervical flexion = brudzinski / sotto-hall /

hyndman / lidner

(+) pain disappears when knee is flexed

Special Tests for

Increased Intrathecal Pressure

Naffziger Test

Examiner squeezes jugular veins of

patient for 30 seconds; then ask the
patient to cough

(+) severe pain

Valsalva Maneuver

Patient is sitting as if bearing down as if

holding the breath

(+) pain in the back area

(+) pain radiates to LE = sciatica

Milgram’s Test

Patient is in supine, actively lifts both legs

off the ground (5-10 cm) and holds the
position for 30 seconds

(+) patient is unable to hold the position

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