The Spine Exam Basics

Cervical Spine

Spurling's Maneuver

  • Active/Passive

  • Tests for cervical disk herniation, cervical nerve root compression

  • Technique

    • Patient seated rotates, extends, and laterally flexes the cervical spine.  

    • Examiner in front of or behind patient places hand on top of the patient's head and applies an axial load (Some hold the load for up to a minute, while others provide the axial load in short bursts. I personally apply and hold the compression for 10-30 seconds.)

    • The maneuver should be performed with the C-spine rotated to both sides

    • A positive result occurs when the maneuver elicits symptoms/pain down the arm

    • A negative result is when there is no pain or symptom recreation with the maneuver

Lumbar Spine

Straight leg raise/Bragard Test​

  • Passive

  • Tests for lumbar herniated disk

  • Technique

    • Patient supine

    • Examiner to affected side of patient and lifts each leg, individually, from the ankle to angle of 30-70°, then the ankle is dorsiflexed and the big toe extended

    • A positive result occurs when the maneuver elicits symptoms/pain in the leg and/or back, and worsens with ankle dorsiflexion and big toe extension

    • A negative result is when there is no pain with the maneuver

Flip Test

  • Passive

  • Tests for lumbar herniated disk, sciatica

  • Technique

    • Patient seated with legs dangling

    • Examiner in front of patient

    • Examiner straightens each leg, individually, from the heel

    • A positive result occurs when the maneuver elicits symptoms/pain in the leg to the back, causing the patient to lean backward

    • A negative result is when the patient does not experience symptoms that cause him/her to lean backward