🚩 Red Flags — Immediate Referral
- Saddle anaesthesia
- Bladder or bowel dysfunction
- Bilateral neurological symptoms
- Progressive weakness
- History of cancer with new unexplained spinal pain
- Fever or systemic illness with back pain
Reference: OSTEOPATHY Rheumatology & Orthopaedics Overview; OSTEOPATHY Osteopathic Evaluation Notes.
Lumbar Tests
| Test | Assesses | Standard Position | Positive Finding | Modification |
|---|---|---|---|---|
| SLR | Sciatic nerve / L4-S1 root irritation | Supine | Radicular pain 30-70° | Pregnant: side-lying SLR, affected side up. |
| Well Leg Raise | Large central disc | Supine | Contralateral radicular pain | Use side-lying only if supine intolerable. |
| Slump | Neural tension | Seated | Symptoms relieved by neck extension | Already good for pregnancy; reduce overpressure. |
| Kernig | Meningeal / nerve root irritation | Supine | Pain on knee extension with hip flexed | Use seated neural tension screen if supine not tolerated. |
| Valsalva | Intrathecal pressure / disc | Seated | Radicular symptoms reproduced | Avoid in late pregnancy or uncontrolled hypertension. |
| Milgram | Intrathecal pressure | Supine | Unable to hold legs elevated | Avoid in pregnancy and frail geriatric patients. |
| Hoover | Effort / non-organic signs | Supine | No opposite heel pressure | Use carefully; not a stand-alone diagnosis. |
| Babinski | UMN lesion | Supine | Big toe extension/fanning | Normal in infants; abnormal in adults. |
Pelvis / SI Joint Tests
| Test | Assesses | Position | Positive Finding | Modification |
|---|---|---|---|---|
| Standing Flexion / SIFT | Iliosacral dysfunction | Standing | PSIS rises first/furthest | Geriatric: support near plinth/wall. |
| Seated Flexion | Sacroiliac dysfunction | Seated | PSIS rises first/furthest | Useful if standing balance is poor. |
| Stork / Gillet | SI mobility | Standing | PSIS fails to drop | Geriatric: support patient. |
| FABER | Hip vs SI | Supine | Groin pain = hip; posterior pain = SI | Pregnant: side-lying/seated; avoid strong abduction. |
| FADIR | FAI / labral pathology | Supine | Anterior groin pain | Side-lying if supine not tolerated. |
| Gapping | Anterior SI ligaments | Supine | Posterior SI pain | Pregnant: avoid direct anterior pelvic pressure. |
| Squish | Posterior SI ligaments | Side-lying | SI pain reproduced | Good pregnancy alternative. |
| Sacral Spring | Sacral mobility | Prone | Pain/restricted spring | Pregnant: avoid prone; use side-lying respiratory motion. |
| Sphinx | Sacral torsion / extension response | Prone on elbows | Symptom or landmark change | Geriatric: use caution with spinal extension. |
References: OSTEOPATHY Rheumatology & Orthopaedics Overview; OSTEOPATHY Manipulation Notes; Lumbar Spine Dysfunction notes.