Special Orthopedic Tests — Quick Reference

Foraminal Compression Test (Spurling's Test)

• Purpose: Reproduce nerve root compression symptoms from cervical foraminal stenosis or disc herniation
• Technique: Client seated. Examiner laterally flexes and rotates the cervical spine toward the symptomatic side, then applies gentle downward axial compression
• Positive indicator: Reproduction of ipsilateral radicular arm pain, paresthesia, or numbness — does NOT count if only local neck pain
• References: Magee & Manske (2021), Ch. 3 Cervical Spine, Special Tests (pp. 198–219); Zulak (2018), Ch. 14 Cervical Spine Assessment; Hoppenfeld (1976), Ch. 5

Cervical Distraction Test

• Purpose: Confirm foraminal origin of radicular arm symptoms; assess whether traction relieves compression
• Technique: Client supine or seated. Examiner cups the occiput and chin, applies gentle upward axial traction
• Positive indicator: Reduction or elimination of radicular arm symptoms with traction
• References: Magee & Manske (2021), Ch. 3 Cervical Spine (pp. 198–219); Zulak (2018), Ch. 14

Upper Limb Tension Test 1 (ULTT1 — Median Nerve Bias)

• Purpose: Assess neural tension in the median nerve pathway; identify cervical nerve root or brachial plexus involvement
• Technique: Client supine. Examiner: (1) depresses shoulder girdle, (2) abducts shoulder to 90°, (3) supinates forearm, (4) extends elbow, (5) extends wrist and fingers, (6) laterally flexes cervical spine away from test side
• Positive indicator: Reproduction of arm symptoms (paresthesia, pain) that are reduced by releasing wrist extension or adding cervical lateral flexion toward the side
• References: Magee & Manske (2021), Ch. 3 Cervical Spine (pp. 198–219); Zulak (2018), Ch. 14; Elvey (1986) neurodynamic testing methodology

Vertebral Artery Test (Cervical Quadrant Test)

• Purpose: Safety screen before cervical manipulation or sustained extension/rotation techniques; detect vertebrobasilar insufficiency
• Technique: Client supine or seated. Examiner extends and ipsilaterally rotates the cervical spine, holds position 30 seconds. Watch for VBI signs
• Positive indicator: Dizziness, nystagmus, diplopia, dysarthria, drop attacks, or nausea — immediate cessation required
• References: Magee & Manske (2021), Ch. 3 Cervical Spine (p. 218); Zulak (2018), Ch. 14; Rattray & Ludwig (2000)

Cervical Flexion Rotation Test

• Purpose: Assess C1–C2 (atlantoaxial) mobility; identify upper cervical contribution to cervicogenic headache
• Technique: Client supine. Examiner fully flexes the cervical spine (chin toward chest), then passively rotates to each side
• Positive indicator: Less than 45° rotation or symptom reproduction (ipsilateral headache/suboccipital pain) on the affected side
• References: Magee & Manske (2021), Ch. 3 Cervical Spine; Zulak (2018), Ch. 14

Lhermitte's Sign

• Purpose: Detect demyelination of the posterior columns of the spinal cord (MS, myelopathy, cervical stenosis)
• Technique: Client seated or supine. Examiner passively or actively flexes the cervical spine (chin toward chest)
• Positive indicator: Electric shock–like sensation radiating down the spine and into the arms, trunk, or legs — distinguishes posterior column pathology from radiculopathy
• References: Magee & Manske (2021), Ch. 3 Cervical Spine (p. 208); Zulak (2018), Ch. 14; Werner (2012)

Valsalva Test (Cervical)

• Purpose: Identify increased intrathecal or intervertebral disc pressure causing radicular symptoms
• Technique: Client seated. Examiner asks client to take a deep breath, hold, and bear down as if having a bowel movement (increases intrathecal pressure for 2–3 seconds)
• Positive indicator: Reproduction of radicular pain into the arm — indicates disc herniation or space-occupying lesion
• References: Magee & Manske (2021), Ch. 3 Cervical Spine; Zulak (2018), Ch. 14

Sharp-Purser Test (Atlantoaxial Instability)

• Purpose: Detect transverse ligament laxity at C1–C2; screen for atlantoaxial instability before cervical mobilization in rheumatoid arthritis, Down syndrome, post-trauma, and chronic whiplash
• Technique: Client seated with cervical spine in slight flexion. Examiner places one hand on the forehead and the spinous process of C2 with the other. Apply a posterior translation (push) to the forehead while stabilizing C2
• Positive indicator: A palpable "clunk" or sliding sensation as C1 reduces posteriorly on C2, or relief of myelopathic symptoms (paresthesia, dizziness) — indicates transverse ligament rupture; absolute contraindication to cervical manipulation; urgent referral
• References: Magee & Manske (2021), Ch. 3 Cervical Spine; Zulak (2018), Ch. 14

Alar Ligament Stress Test

• Purpose: Assess integrity of the alar ligaments restraining lateral flexion and rotation of C1 on C2; screen for upper cervical instability in whiplash, RA, Down syndrome, and post-trauma
• Technique: Client supine. Examiner palpates the C2 spinous process while passively side-bending the head. Normally C2 spinous process should rotate immediately into the side-bend (toward the contralateral side). Then repeat with passive rotation
• Positive indicator: Excessive lateral flexion or rotation without immediate C2 spinous process movement, or reproduction of symptoms — indicates alar ligament insufficiency; absolute contraindication to upper cervical manipulation
• References: Magee & Manske (2021), Ch. 3 Cervical Spine; Zulak (2018), Ch. 14

Hoffmann's Sign

• Purpose: Screen for upper motor neuron lesion of the cervical cord (cervical myelopathy, MS, ALS); upper extremity equivalent of the Babinski sign
• Technique: Examiner stabilizes the client's middle finger at the proximal interphalangeal joint, then briskly flicks the nail of the middle finger downward (into flexion)
• Positive indicator: Reflex flexion and adduction of the thumb and/or index finger — suggests upper motor neuron pathology; warrants neurological referral
• References: Magee & Manske (2021), Ch. 3 Cervical Spine; Zulak (2018), Ch. 14

Neer Impingement Test

• Purpose: Detect subacromial impingement of the supraspinatus or supraspinatus tendon
• Technique: Client seated. Examiner stabilizes the scapula and passively forward flexes the arm (thumb down/internally rotated) with the elbow extended, forcing the greater tubercle against the anteroinferior acromion
• Positive indicator: Pain in the anterolateral shoulder, especially between 70° and 120° of forward flexion
• References: Magee & Manske (2021), Ch. 5 Shoulder, Special Tests (pp. 323–382); Zulak (2018), Ch. 10

Hawkins-Kennedy Impingement Test

• Purpose: Detect subacromial impingement; more sensitive than Neer's for internal impingement
• Technique: Client seated or standing. Examiner forward flexes the arm to 90°, then internally rotates (thumb points down), forcing the supraspinatus under the coracoacromial ligament
• Positive indicator: Anterolateral shoulder pain reproduced by internal rotation
• References: Magee & Manske (2021), Ch. 5 Shoulder (pp. 323–382); Zulak (2018), Ch. 10

Painful Arc Test

• Purpose: Identify subacromial impingement or rotator cuff pathology in the mid-range of shoulder abduction
• Technique: Client standing. Examiner observes active shoulder abduction through full range — watch for pain between 60° and 120°
• Positive indicator: Pain within the 60°–120° arc; pain that disappears above 120° suggests subacromial etiology
• References: Magee & Manske (2021), Ch. 5 Shoulder (pp. 323–382)

Drop Arm Test (Codman's Test)

• Purpose: Detect complete supraspinatus (rotator cuff) tear
• Technique: Client seated or standing. Examiner passively abducts the arm to 90°, then asks the client to slowly lower the arm to the side
• Positive indicator: Unable to control the lowering — arm drops; or pain and weakness prevent smooth lowering
• References: Magee & Manske (2021), Ch. 5 Shoulder (pp. 323–382); Zulak (2018), Ch. 10

Empty Can (Jobe's) Test

• Purpose: Test supraspinatus integrity; detect supraspinatus tear or impingement
• Technique: Client standing. Arms elevated to 90° in the scapular plane (30° anterior to frontal plane), thumbs pointing down (empty can position). Examiner applies downward resistance
• Positive indicator: Weakness or pain with downward resistance — weakness suggests tear, pain suggests impingement
• References: Magee & Manske (2021), Ch. 5 Shoulder (pp. 323–382); Zulak (2018), Ch. 10

Full Can Test

• Purpose: Alternative to empty can for supraspinatus assessment; less impingement provocation
• Technique: Same as empty can but thumbs point upward (full can position), arm in scapular plane at 90°; examiner applies downward resistance
• Positive indicator: Weakness suggesting supraspinatus tear
• References: Magee & Manske (2021), Ch. 5 Shoulder (pp. 323–382)

Cross-Body Adduction Test (Scarf Test)

• Purpose: Detect acromioclavicular joint pathology or posterior shoulder tightness
• Technique: Client seated. Examiner forward flexes the arm to 90°, then adducts horizontally across the body toward the opposite shoulder
• Positive indicator: Pain over the AC joint or anterior shoulder — AC joint pathology; pain in the posterior shoulder suggests posterior capsule tightness
• References: Magee & Manske (2021), Ch. 5 Shoulder (pp. 323–382); Zulak (2018), Ch. 10

Apprehension Test (Shoulder)

• Purpose: Detect anterior glenohumeral instability following anterior dislocation or repetitive subluxation
• Technique: Client supine or seated. Examiner abducts arm to 90°, applies passive external rotation in increasing increments
• Positive indicator: Guarding, apprehension, or resistance to further ER — client fear that shoulder will dislocate
• References: Magee & Manske (2021), Ch. 5 Shoulder (pp. 323–382); Zulak (2018), Ch. 10

Lift-Off Test (Gerber)

• Purpose: Test subscapularis integrity
• Technique: Client standing with hand behind back (dorsal side against lumbar spine). Client attempts to actively lift hand away from back
• Positive indicator: Inability to lift hand off back — suggests subscapularis rupture
• References: Magee & Manske (2021), Ch. 5 Shoulder (pp. 323–382)

External Rotation Lag Sign (ERLS)

• Purpose: Detect infraspinatus and teres minor tears
• Technique: Client seated, elbow at 90°, shoulder at 20° of elevation. Examiner passively externally rotates arm to near maximal ER, then releases. Client must hold position
• Positive indicator: Arm falls into internal rotation (lag) — indicates external rotator tear
• References: Magee & Manske (2021), Ch. 5 Shoulder (pp. 323–382)

Bear Hug Test

• Purpose: Detect subscapularis tears (particularly upper portion)
• Technique: Client places palm of test hand on opposite shoulder, fingers extended, elbow at shoulder height. Examiner applies force to lift hand from shoulder. Client resists
• Positive indicator: Weakness or inability to maintain position — subscapularis involvement
• References: Magee & Manske (2021), Ch. 5 Shoulder (pp. 323–382)

Yocum's Test

• Purpose: Detect subacromial impingement (alternative to Neer/Hawkins)
• Technique: Client places hand on opposite shoulder. Examiner lifts elbow upward while client resists
• Positive indicator: Anterolateral shoulder pain reproduced — impingement positive
• References: Magee & Manske (2021), Ch. 5 Shoulder (pp. 323–382)

Speed's Test (Biceps / Straight Arm Test)

• Purpose: Detect bicipital tendinitis (long head of biceps at bicipital groove)
• Technique: Client standing, arm in 90° forward flexion, elbow extended, forearm supinated. Examiner applies downward resistance
• Positive indicator: Pain at the bicipital groove
• References: Magee & Manske (2021), Ch. 5 Shoulder (pp. 323–382); Zulak (2018), Ch. 10

Shoulder ROM Screen (Arm Elevation)

• Purpose: Detect post-surgical restriction, adhesive capsulitis, or axillary web syndrome (cording)
• Technique: Bilateral active shoulder forward flexion and external rotation; compare sides. Note degrees of restriction and presence of cording in axilla
• Positive indicator: Loss of glenohumeral forward flexion or external rotation compared to contralateral side; ER <30° = typical freezing phase threshold
• References: Rattray & Ludwig (2000); Zulak (2018), Ch. 10; Walton (2010), oncology massage considerations

Apley's Scratch Test

• Purpose: Functional assessment of combined shoulder movements; detect adhesive capsulitis or post-surgical restriction
• Technique: Three maneuvers: (1) reach up and touch opposite scapular spine, (2) reach across front to touch opposite acromion, (3) reach behind back to touch inferior angle of opposite scapula. Compare sides bilaterally
• Positive indicator: Inability to complete any maneuver; hallmark limitation in adhesive capsulitis is ER restriction (<30° in freezing phase)
• References: Magee & Manske (2021), Ch. 5 Shoulder; Zulak (2018), Ch. 10

Coracoid Pain Test

• Purpose: Identify rotator interval inflammation or coracoid impingement
• Technique: Client seated. Examiner palpates directly over the coracoid process with the fingertip
• Positive indicator: Pain at the coracoid with palpation (83% sensitivity for rotator interval pathology)
• References: Magee & Manske (2021), Ch. 5 Shoulder (pp. 323–382)

Sulcus Sign (Inferior Glenohumeral Instability)

• Purpose: Detect inferior glenohumeral instability — a component of multidirectional instability common in hypermobile or post-traumatic shoulders
• Technique: Client seated with arm relaxed at side. Examiner grasps the wrist or elbow and applies a downward (inferior) traction force on the humerus
• Positive indicator: A visible or palpable depression (sulcus) greater than 1 cm between the acromion and humeral head — graded 1+ (<1 cm), 2+ (1–2 cm), 3+ (>2 cm)
• References: Magee & Manske (2021), Ch. 5 Shoulder, Special Tests; Zulak (2018), Ch. 12

Relocation Test (Jobe's Relocation)

• Purpose: Confirm anterior glenohumeral instability or anterior labral tear identified by a positive apprehension test
• Technique: Client supine with shoulder at 90° abduction and elbow at 90°. Examiner externally rotates the shoulder until apprehension is elicited (positive apprehension test), then applies a posterior force on the proximal humerus while maintaining external rotation
• Positive indicator: Reduction of apprehension or pain with the posterior force, AND return of apprehension when the posterior force is released (surprise test) — confirms anterior labral or capsular pathology
• References: Magee & Manske (2021), Ch. 5 Shoulder; Zulak (2018), Ch. 12

Pectoralis Minor Length Test

• Purpose: Assess pectoralis minor shortening — a contributor to scapular protraction, anterior shoulder pain, thoracic outlet syndrome, and upper crossed syndrome
• Technique: Client supine with arms at sides. Examiner observes the position of the posterior acromion relative to the table and may use a tape measure
• Positive indicator: The posterior acromion sits more than 2.5 cm (one inch) above the table — indicates a shortened pectoralis minor pulling the scapula into anterior tilt and protraction
• References: Magee & Manske (2021), Ch. 5 Shoulder; Zulak (2018), Ch. 12; Sahrmann (2002)

Cozen's Test (Lateral Epicondylitis)

• Purpose: Detect lateral epicondylitis (tennis elbow) — ECRB tendon origin at lateral epicondyle
• Technique: Client seated, elbow flexed at 90°, forearm pronated. Examiner stabilizes elbow; client makes a fist and extends wrist against resistance
• Positive indicator: Sharp pain at the lateral epicondyle
• References: Magee & Manske (2021), Ch. 6 Elbow, Special Tests (pp. 443–462); Zulak (2018), Ch. 11

Mill's Test (Lateral Epicondylitis)

• Purpose: Detect lateral epicondylitis via passive stretch
• Technique: Client standing. Examiner pronates the forearm, extends the wrist fully, and passively extends the elbow while palpating the lateral epicondyle
• Positive indicator: Pain at the lateral epicondyle on passive stretch of ECRB
• References: Magee & Manske (2021), Ch. 6 Elbow (pp. 443–462); Zulak (2018), Ch. 11

Maudsley's Test (Resisted Middle Finger Extension)

• Purpose: Specifically isolate ECRB — most specific test for lateral epicondylitis
• Technique: Client seated, elbow extended. Client extends middle finger against examiner resistance at the PIP joint while examiner palpates lateral epicondyle
• Positive indicator: Pain at the lateral epicondyle — ECRB origin provoked
• References: Magee & Manske (2021), Ch. 6 Elbow (pp. 443–462)

Tinel's Sign (Elbow — Ulnar Nerve)

• Purpose: Detect ulnar nerve irritation or entrapment at the cubital tunnel (medial epicondyle)
• Technique: Examiner taps over the ulnar nerve at the cubital tunnel (posterior to the medial epicondyle)
• Positive indicator: Tingling, burning, or electric sensation radiating into the ring and little finger
• References: Magee & Manske (2021), Ch. 6 Elbow (pp. 443–462); Zulak (2018), Ch. 11

Wartenberg's Sign (Ulnar Nerve)

• Purpose: Detect ulnar nerve compression at the elbow (cubital tunnel) or wrist (Guyon's canal) by demonstrating intrinsic hand muscle weakness
• Technique: Client extends fingers fully with the hand on a flat surface. Examiner asks client to actively adduct (close together) all fingers
• Positive indicator: The little finger drifts into and remains in abduction — indicates weakness of the third palmar interosseous (ulnar nerve, C8–T1)
• References: Magee & Manske (2021), Ch. 6 Elbow / Ch. 7 Wrist and Hand; Zulak (2018), Ch. 11

Upper Limb Tension Test 3 (ULTT3 — Radial Nerve Bias)

• Purpose: Assess neural tension in the radial nerve pathway; differentiate radial tunnel syndrome, cervical radiculopathy, or thoracic outlet from local musculoskeletal pain
• Technique: Client supine. Examiner: (1) depresses shoulder girdle, (2) extends elbow, (3) internally rotates shoulder and pronates forearm, (4) flexes wrist and fingers, (5) ulnar deviates wrist, (6) abducts shoulder slowly
• Positive indicator: Reproduction of symptoms in the lateral forearm or hand that change with cervical contralateral lateral flexion (away from the test side increases symptoms) — implicates radial nerve neural tension
• References: Magee & Manske (2021), Ch. 6 Elbow; Zulak (2018), Ch. 11; Butler (1991) neurodynamic testing

Phalen's Test (Wrist Flexion Test)

• Purpose: Detect carpal tunnel syndrome (median nerve compression at the carpal tunnel)
• Technique: Client holds both wrists in full passive flexion for 60 seconds (backs of hands touching)
• Positive indicator: Paresthesia (numbness, tingling) in the thumb, index, middle, and radial half of ring finger within 60 seconds
• References: Magee & Manske (2021), Ch. 7 Forearm/Wrist/Hand, Special Tests (pp. 519–543); Zulak (2018), Ch. 12

Tinel's Sign (Wrist — Median Nerve)

• Purpose: Detect carpal tunnel syndrome by provocating the median nerve
• Technique: Examiner taps over the carpal tunnel (transverse carpal ligament, between pisiform and scaphoid tubercle)
• Positive indicator: Tingling or paresthesia in the thumb, index, middle, and/or radial half of ring finger
• References: Magee & Manske (2021), Ch. 7 Forearm/Wrist/Hand (pp. 519–543); Zulak (2018), Ch. 12

Finkelstein's Test

• Purpose: Detect De Quervain's tenosynovitis (APL and EPB tendons at the radial styloid)
• Technique: Client tucks thumb inside a fist. Examiner applies ulnar deviation of the wrist
• Positive indicator: Sharp pain over the radial styloid and first dorsal compartment
• References: Magee & Manske (2021), Ch. 7 Forearm/Wrist/Hand (pp. 519–543); Zulak (2018), Ch. 12

Allen Test

• Purpose: Assess patency of the radial and ulnar arteries; detect arterial occlusion
• Technique: Examiner compresses both radial and ulnar arteries at the wrist simultaneously. Client makes a fist and releases (palm goes pale). Examiner releases one artery and observes refilling
• Positive indicator: Delayed refill (>5 seconds) after releasing one artery indicates ipsilateral artery compromise or thrombosis
• References: Magee & Manske (2021), Ch. 7 Forearm/Wrist/Hand (pp. 519–543); Zulak (2018), Ch. 12

Froment's Sign

• Purpose: Detect ulnar nerve palsy (adductor pollicis paralysis)
• Technique: Client attempts to hold a piece of paper between thumb and index finger (pinch grip). Examiner tries to pull the paper away
• Positive indicator: Client flexes thumb IP joint to compensate — indicates adductor pollicis weakness (ulnar nerve palsy)
• References: Magee & Manske (2021), Ch. 7 Forearm/Wrist/Hand (pp. 519–543); Zulak (2018), Ch. 12

Grip Strength Testing (MMT/Dynamometer)

• Purpose: Quantify grip strength; detect weakness from disuse, nerve involvement, or tendon pathology
• Technique: Client squeezes a dynamometer with maximum effort, 3 trials each hand; compare bilaterally
• Positive indicator: Side-to-side difference >10–15% suggests pathological weakness; Grade 0–5 MMT scale used for qualitative assessment
• References: Magee & Manske (2021), Ch. 7 Forearm/Wrist/Hand; Zulak (2018), assessment chapters

Adam's Forward Bend Test (Structural Scoliosis/Kyphosis)

• Purpose: Identify structural vertebral rotation in scoliosis (rib hump) or fixed structural kyphosis in Scheuermann's disease
• Technique: Client stands, bends forward at the waist with arms hanging free. Examiner views the spine from behind (scoliosis) or from the side (kyphosis)
• Positive indicator: Rib hump on the convex side (scoliosis — vertebral rotation) OR fixed kyphosis ≥45° that does not correct on hyperextension (Scheuermann's vs. postural kyphosis)
• References: Magee & Manske (2021), Ch. 8 Thoracic Spine, Special Tests (pp. 606–612); Zulak (2018), Ch. 13 Thoracic Spine

Prone Press-Up (Passive Extension)

• Purpose: Distinguish structural from postural kyphosis; assess thoracic mobility
• Technique: Client prone. Examiner stabilizes pelvis. Client performs push-up keeping pelvis on table, passively extending the thoracic spine
• Positive indicator: In Scheuermann's disease, kyphosis does NOT reduce with extension — confirms structural rigidity of wedged vertebral bodies
• References: Magee & Manske (2021), Ch. 8 Thoracic Spine; Zulak (2018), Ch. 13

Chest Expansion Measurement

• Purpose: Assess costovertebral and costotransverse mobility; screen for ankylosing spondylitis or COPD
• Technique: Measure thoracic circumference at the 4th intercostal space during maximal inspiration and expiration with a tape measure
• Positive indicator: Expansion <3 cm = significant restriction; <2.5 cm = ankylosing spondylitis threshold
• References: Magee & Manske (2021), Ch. 8 Thoracic Spine

Rib Spring Test

• Purpose: Assess rib mobility, joint dysfunction at the costotransverse and costovertebral joints, and identify hypomobile or hypermobile rib segments contributing to thoracic, chest wall, or referred pain
• Technique: Client prone with arms relaxed. Examiner places palms over each rib (or pair of ribs) bilaterally and applies a brisk, gentle downward "spring" force, comparing left to right
• Positive indicator: Asymmetric rib excursion, tissue resistance, pain reproduction, or palpable hypomobility — localizes rib joint dysfunction; commonly positive in costochondritis, post-thoracotomy pain, and chronic respiratory conditions
• References: Magee & Manske (2021), Ch. 8 Thoracic Spine; Zulak (2018), Ch. 13; Greenman (2003)

Straight Leg Raise (SLR / Lasegue's Test)

• Purpose: Detect lumbar nerve root tension or disc herniation causing sciatica
• Technique: Client supine. Examiner passively raises the straight leg (knee extended) until symptoms are provoked. Record the angle
• Positive indicator: Radicular symptoms (pain/paresthesia below the knee) reproduced at 30°–70° of hip flexion — local hamstring tightness pain does NOT count
• References: Magee & Manske (2021), Ch. 9 Lumbar Spine, Special Tests (pp. 666–686); Zulak (2018), Ch. 14 Lumbar; Hoppenfeld (1976), Ch. 7

Crossed SLR (Well Leg Raise)

• Purpose: Detect large or medially positioned disc herniation with significant neural compression
• Technique: Client supine. Examiner raises the UNAFFECTED leg with knee extended
• Positive indicator: Reproduction of ipsilateral (symptomatic side) radicular symptoms below the knee — high specificity (88%) for disc herniation; indicates medially positioned or large herniation
• References: Magee & Manske (2021), Ch. 9 Lumbar Spine (pp. 666–686); Zulak (2018), Ch. 14

Slump Test

• Purpose: Assess neuromeningeal tension; detect lumbar disc herniation, dural irritation, or nerve root entrapment
• Technique: Client seated at edge of table. Sequence: (1) slump thoracolumbar spine, (2) flex head forward, (3) extend knee, (4) dorsiflex ankle. Examiner applies gentle overpressure at each step. Release cervical flexion if positive to confirm neural involvement
• Positive indicator: Radicular symptoms reproduced in the lower limb that are reduced by releasing cervical flexion
• References: Magee & Manske (2021), Ch. 9 Lumbar Spine (pp. 666–686); Zulak (2018), Ch. 14

Extension Quadrant Test (Kemp's Test)

• Purpose: Detect posterior element pain (facet joint, pars interarticularis, or neural foramen compression)
• Technique: Client standing. Examiner stands behind, guiding the client into ipsilateral extension, lateral flexion, and rotation toward the affected side simultaneously (closes the facet and narrows the foramen)
• Positive indicator: Reproduction of posterior element or radicular pain on the ipsilateral side — guides identification of facet vs. disc involvement
• References: Magee & Manske (2021), Ch. 9 Lumbar Spine (pp. 666–686); Zulak (2018), Ch. 14

Valsalva Maneuver (Lumbar)

• Purpose: Increase intrathecal pressure to provoke disc herniation symptoms
• Technique: Client seated. Client takes a deep breath, holds it, and bears down as if straining (increases CSF and intradiscal pressure for 2–3 seconds)
• Positive indicator: Reproduction of radicular arm or leg symptoms — indicates space-occupying lesion (disc herniation or tumor)
• References: Magee & Manske (2021), Ch. 9 Lumbar Spine (pp. 666–686); Zulak (2018), Ch. 14

One-Leg Hyperextension Test (Stork Test)

• Purpose: Detect pars interarticularis stress fracture (spondylolysis) or spondylolisthesis
• Technique: Client standing on one leg. Client extends the lumbar spine and ipsilaterally rotates while balancing on the test leg
• Positive indicator: Posterior element pain in the ipsilateral lumbar spine — high suspicion for spondylolysis or spondylolisthesis at the pars interarticularis
• References: Magee & Manske (2021), Ch. 9 Lumbar Spine (pp. 666–686); Zulak (2018), Ch. 14

Bicycle Test (van Gelderen)

• Purpose: Detect lumbar spinal stenosis by differentiating neurogenic claudication from vascular claudication
• Technique: Client pedals a stationary bicycle for a set time; then walks until symptoms reproduce. Compare bicycle vs. walking symptom threshold
• Positive indicator: Symptoms appear with walking but NOT with cycling (lumbar spine flexed on bicycle reduces neurogenic compression) — indicates neurogenic claudication from stenosis
• References: Magee & Manske (2021), Ch. 9 Lumbar Spine (pp. 666–686)

Stoop Test

• Purpose: Detect neurogenic claudication from lumbar spinal stenosis
• Technique: Client walks until claudication symptoms appear. Client then bends forward (forward flexion opens the spinal canal)
• Positive indicator: Symptoms relieved by forward flexion — confirms neurogenic (not vascular) claudication
• References: Magee & Manske (2021), Ch. 9 Lumbar Spine (pp. 666–686)

Schober's Test

• Purpose: Quantify lumbar flexion mobility; screen for ankylosing spondylitis
• Technique: Mark the lumbosacral junction (S1) and 10 cm above. Measure distance with the client in maximum forward flexion
• Positive indicator: Increase of <5 cm with full flexion (normal is ≥5 cm increase) — indicates restricted lumbar mobility characteristic of ankylosing spondylitis
• References: Magee & Manske (2021), Ch. 9 Lumbar Spine

Bowstring Test (Cram Test)

• Purpose: Confirm sciatic nerve tension as the source of radicular leg symptoms when the straight leg raise (SLR) is positive
• Technique: With the client supine, perform an SLR until symptoms are reproduced or limited by tension. Slightly flex the knee to relieve symptoms. Then apply firm pressure to the popliteal fossa over the tibial nerve
• Positive indicator: Reproduction of radicular symptoms (sciatic distribution) with popliteal fossa pressure — confirms neural source rather than hamstring tightness
• References: Magee & Manske (2021), Ch. 9 Lumbar Spine; Zulak (2018), Ch. 16

Prone Instability Test

• Purpose: Identify lumbar segmental instability — a McGill-cited test for clients with chronic low back pain, hypermobility, or suspected segmental instability
• Technique: Client prone over the table with feet on the floor and torso on the table. Examiner applies a posterior-to-anterior pressure on each lumbar spinous process; pain noted. Client then lifts feet off the floor (engaging the lumbar extensors) and the examiner re-applies the same pressure
• Positive indicator: Pain present with feet on the floor (passive condition) but ELIMINATED with feet off the floor (active muscle stabilization) — indicates segmental instability requiring stabilization training over passive treatment
• References: Magee & Manske (2021), Ch. 9 Lumbar Spine; McGill (2016) Low Back Disorders 3e; Hicks et al. (2003)

Active Straight Leg Raise (ASLR)

• Purpose: Assess load transfer through the pelvis; detect pelvic girdle pain vs. lumbar radiculopathy
• Technique: Client supine. Client actively raises one straight leg 20 cm off the table without bending the knee. Examiner observes and asks about effort level
• Positive indicator: Inability, severe effort, or pelvic/groin pain — indicates sacroiliac load transfer dysfunction. Compression of iliac crests by examiner should reduce the effort if SI joint is the source
• References: Magee & Manske (2021), Ch. 10 Pelvis, Special Tests (pp. 744–752); Zulak (2018), Ch. 13

FABER Test (Patrick's Test)

• Purpose: Screen for hip joint pathology, SI joint dysfunction, or iliopsoas pathology
• Technique: Client supine. Test leg placed in Flexion, ABduction, and External Rotation (figure-4 position), foot resting on opposite knee. Examiner allows leg to drop under gravity or applies gentle downward pressure
• Positive indicator: Hip joint pain = hip pathology; SI joint or groin pain = SI dysfunction; inability to lower leg below the horizontal = iliopsoas tightness or hip joint restriction
• References: Magee & Manske (2021), Ch. 10 Pelvis/Ch. 11 Hip, Special Tests (pp. 744–792); Zulak (2018), Ch. 9 Hip

Trendelenburg Test

• Purpose: Detect hip abductor (gluteus medius) weakness or hip joint pathology
• Technique: Client stands on one leg. Examiner observes the pelvis — specifically the opposite side's PSIS or iliac crest
• Positive indicator: The non-stance side pelvis drops (Trendelenburg positive) — indicates weakness of the stance-side hip abductors (gluteus medius)
• References: Magee & Manske (2021), Ch. 11 Hip, Special Tests (pp. 792–822); Zulak (2018), Ch. 9 Hip; Hoppenfeld (1976)

FADIR Test

• Purpose: Screen for hip impingement (femoroacetabular impingement — FAI) or labral pathology
• Technique: Client supine. Examiner passively moves the hip into Flexion, ADduction, and Internal Rotation simultaneously
• Positive indicator: Groin or deep hip pain — high sensitivity (88–99%) for FAI; pain location guides differential
• References: Magee & Manske (2021), Ch. 11 Hip (pp. 792–822); Zulak (2018), Ch. 9

Thomas Test

• Purpose: Detect hip flexor tightness (iliopsoas/rectus femoris); assess anterior pelvic tilt contribution
• Technique: Client supine, pulls both knees to chest to flatten lumbar spine. One leg is lowered to the table. Examiner observes whether the lowered thigh can achieve full extension
• Positive indicator: Lowered leg remains elevated (thigh cannot touch table) — indicates hip flexor tightness on that side
• References: Magee & Manske (2021), Ch. 11 Hip (pp. 792–822); Zulak (2018), Ch. 9

FAIR Test (Flexion, Adduction, Internal Rotation)

• Purpose: Detect piriformis syndrome by compressing the sciatic nerve against the piriformis
• Technique: Client sidelying, hip and knee at 90°. Examiner applies downward pressure on the knee (adds adduction and internal rotation to the flexed hip)
• Positive indicator: Reproduction of buttock/posterior leg pain or paresthesia — distinguishes piriformis entrapment from lumbar disc herniation
• References: Magee & Manske (2021), Ch. 11 Hip; Zulak (2018), Ch. 9

Log Roll Test

• Purpose: Detect hip joint intra-articular pathology (labral tear, osteoarthritis, avascular necrosis)
• Technique: Client supine with hip in neutral. Examiner rolls the entire lower limb into full internal and external rotation passively
• Positive indicator: Groin pain or restricted rotation — indicates intra-articular hip pathology; purely extra-articular structures (IT band, piriformis) are NOT loaded
• References: Magee & Manske (2021), Ch. 11 Hip (pp. 792–822); Zulak (2018), Ch. 9

Hip Scour Test

• Purpose: Detect intra-articular hip joint pathology
• Technique: Client supine, hip at 90° flexion. Examiner applies axial compression through the femur and circumducts the hip through a large arc
• Positive indicator: Groin pain or a painful catch at a specific point in the arc — indicates intra-articular pathology
• References: Magee & Manske (2021), Ch. 11 Hip; Zulak (2018), Ch. 9

Diastasis Recti Test

• Purpose: Detect separation of the rectus abdominis along the linea alba (common in pregnancy/postpartum)
• Technique: Client supine. Examiner palpates midline of abdomen. Client slowly lifts head and shoulders (partial sit-up). Examiner measures gap width at umbilicus
• Positive indicator: Gap ≥2 cm between the two rectus abdominis muscles — clinically significant diastasis; ≥3 cm may require referral and modified exercise
• References: Zulak (2018); Rattray & Ludwig (2000); Holey & Cook (evidence-based MT)

Pubic Symphysis Stress Test (Lateral Iliac Compression)

• Purpose: Detect symphysis pubis dysfunction (SPD) or pelvic girdle pain
• Technique: Client sidelying. Examiner applies gentle compression toward the midline on the uppermost iliac crest
• Positive indicator: Pain at the pubic symphysis — confirms SPD contributing to pelvic girdle pain pattern
• References: Magee & Manske (2021), Ch. 10 Pelvis; Zulak (2018)

Gaenslen's Test (SI Joint Provocation)

• Purpose: Provoke pain at the sacroiliac joint by stressing it through hyperextension of one hip while flexing the contralateral hip
• Technique: Client supine near the edge of the table. The leg on the test side is dropped off the table edge into hip extension. The contralateral leg is flexed maximally onto the chest by the client. Examiner applies overpressure to both
• Positive indicator: Reproduction of unilateral SI joint or buttock pain on the test (extended) side — one of three or more positive provocation tests is needed to implicate the SI joint
• References: Magee & Manske (2021), Ch. 10 Pelvis; Zulak (2018), Ch. 15; Laslett et al. (2005)

Roos Test (Elevated Arm Stress Test / EAST)

• Purpose: Screen for thoracic outlet syndrome (neurogenic and vascular); the most-cited TOS provocation test
• Technique: Client seated with shoulders abducted to 90°, externally rotated, and elbows flexed to 90° (the "stick-up" position). Client opens and closes the fists slowly for 3 minutes
• Positive indicator: Reproduction of TOS symptoms (arm fatigue, heaviness, paresthesia, color changes, inability to complete the 3 minutes) — highly suggestive of TOS though not definitive
• References: Magee & Manske (2021), Ch. 5 Shoulder, TOS Tests; Zulak (2018), Ch. 12; Roos (1976)

Adson's Test (Vascular Thoracic Outlet)

• Purpose: Screen for vascular component of thoracic outlet syndrome (subclavian artery compression by anterior scalene)
• Technique: Client seated with arm relaxed at side. Examiner palpates the radial pulse, then has the client extend, externally rotate, and slightly abduct the arm while taking a deep breath, holding it, and rotating the head toward the test side
• Positive indicator: Diminished or absent radial pulse and/or reproduction of arm symptoms — suggests subclavian artery compression at the scalene triangle. Many false positives; should be combined with Roos and Wright tests
• References: Magee & Manske (2021), Ch. 5 Shoulder, TOS Tests; Zulak (2018), Ch. 12

Lachman's Test

• Purpose: Detect anterior cruciate ligament (ACL) tear — most sensitive test for ACL integrity (85–98%)
• Technique: Client supine, knee at 20°–30° flexion. Examiner stabilizes the distal femur with one hand, and with the other hand draws the proximal tibia anteriorly
• Positive indicator: Excessive anterior translation of tibia on femur relative to the other side, or a soft/absent endpoint — complete vs. partial ACL tear determined by endpoint quality
• References: Magee & Manske (2021), Ch. 12 Knee, Special Tests (pp. 927–947); Zulak (2018), Ch. 8 Knee; Hoppenfeld (1976)

Anterior Drawer Test (Knee)

• Purpose: Detect ACL tear (less sensitive than Lachman due to hamstring guarding)
• Technique: Client supine, hip at 45°, knee at 90°. Examiner sits on the foot to stabilize, then draws the tibia anteriorly with both hands
• Positive indicator: Excessive anterior tibial translation compared to unaffected side — hamstring guarding can produce false negatives
• References: Magee & Manske (2021), Ch. 12 Knee (pp. 927–947); Zulak (2018), Ch. 8

McMurray's Test

• Purpose: Detect meniscal tears (medial or lateral)
• Technique: Client supine. Examiner holds the knee with one hand (palpating joint line) and the foot with the other. Knee is fully flexed, then extended while simultaneously applying valgus stress + external rotation (medial meniscus) or varus + internal rotation (lateral meniscus)
• Positive indicator: A palpable or audible click or clunk at the joint line, or reproduction of medial/lateral joint line pain — distinguishes meniscal from ligamentous pathology
• References: Magee & Manske (2021), Ch. 12 Knee (pp. 927–947); Zulak (2018), Ch. 8

Valgus Stress Test (MCL)

• Purpose: Test medial collateral ligament (MCL) integrity
• Technique: Client supine, knee at 30° flexion (isolates MCL) and 0° (includes posteromedial structures). Examiner applies valgus (medial) force to the knee while stabilizing the ankle
• Positive indicator: Joint line pain or excessive opening (relative to unaffected side) — Grade I-III based on opening and endpoint
• References: Magee & Manske (2021), Ch. 12 Knee (pp. 927–947); Zulak (2018), Ch. 8

Varus Stress Test (LCL)

• Purpose: Test lateral collateral ligament (LCL) integrity
• Technique: Same position as valgus test but applying varus (lateral) force
• Positive indicator: Lateral joint line pain or excessive lateral opening
• References: Magee & Manske (2021), Ch. 12 Knee (pp. 927–947); Zulak (2018), Ch. 8

Clarke's Sign (Patellar Grind Test)

• Purpose: Detect patellofemoral pain syndrome or chondromalacia patellae
• Technique: Client supine, knee extended. Examiner places web space of hand at the superior border of the patella and applies gentle pressure distally (depresses patella into femoral groove). Client attempts gentle quad contraction while examiner maintains compression
• Positive indicator: Anterior knee pain or apprehension — indicates patellar chondral irritation
• References: Magee & Manske (2021), Ch. 12 Knee (pp. 927–947); Zulak (2018), Ch. 8

Patellar Tilt Test

• Purpose: Detect tight lateral retinaculum causing lateral patellar compression
• Technique: Client supine, knee extended. Examiner grasps the medial and lateral borders of the patella and attempts to tilt the lateral border upward (medially tilt the patella)
• Positive indicator: <0° tilt (the lateral border cannot be lifted to neutral or above) — tight lateral retinaculum; normal is ≥0° (neutral or slight medial tilt achievable)
• References: Magee & Manske (2021), Ch. 12 Knee (pp. 927–947); Zulak (2018), Ch. 8

Bulge Sign (Knee)

• Purpose: Detect minimal intra-articular knee joint effusion
• Technique: Client supine. Examiner strokes or milks the medial gutter upward (proximal), then taps the lateral aspect of the patella
• Positive indicator: Visible fluid bulge appears on the medial side — confirms intra-articular effusion as small as 4–8 mL
• References: Magee & Manske (2021), Ch. 12 Knee

Ely Test (Prone Quad Stretch)

• Purpose: Detect rectus femoris tightness contributing to patellofemoral overload
• Technique: Client prone. Examiner passively flexes the knee until the heel contacts or approaches the buttock
• Positive indicator: Spontaneous ipsilateral hip flexion (pelvis rises from table) — indicates rectus femoris tightness restricting full knee flexion
• References: Magee & Manske (2021), Ch. 12 Knee; Zulak (2018), Ch. 8

Pivot Shift Test (ACL Rotational Instability)

• Purpose: Detect anterolateral rotational instability of the knee from ACL rupture; reproduces the functional "giving way" experienced by ACL-deficient patients
• Technique: Client supine, knee in full extension. Examiner internally rotates the tibia and applies a valgus force at the knee while passively flexing from extension. The IT band, posterior to the knee axis in extension, must shift anterior as the knee flexes
• Positive indicator: A palpable or visible "clunk" at approximately 20–40° of flexion as the subluxed lateral tibial plateau reduces — highly specific for ACL rupture; difficult to perform on awake/guarded patients (often requires anesthesia for full sensitivity)
• References: Magee & Manske (2021), Ch. 12 Knee, Special Tests (pp. 800–870); Zulak (2018), Ch. 17; Galway & MacIntosh (1980)

Apley's Distraction Test

• Purpose: Differentiate ligament injury from meniscal injury in the knee — companion to Apley's Compression Test
• Technique: Client prone with knee flexed to 90°. Examiner stabilizes the thigh, grasps the ankle, and applies an upward (distraction) force while rotating the tibia internally and externally
• Positive indicator: Pain with distraction and rotation suggests ligament injury (collateral or capsular); pain ONLY with compression-rotation (Apley's Compression) and not distraction-rotation suggests meniscal pathology
• References: Magee & Manske (2021), Ch. 12 Knee; Zulak (2018), Ch. 17

O'Donoghue's Test

• Purpose: Differentiate contractile (muscle) tissue injury from inert (capsular/ligamentous) tissue injury when both pain and limited motion are present
• Technique: Take the affected joint through passive ROM (assesses inert tissues), then perform isometric resisted contraction at the same position (assesses contractile tissues)
• Positive indicator: Pain on BOTH passive ROM and resisted contraction — implicates injury to both contractile and inert structures (an "O'Donoghue triad" pattern indicating multi-tissue injury)
• References: Magee & Manske (2021), Ch. 1 Principles of Assessment; Cyriax (1982); Zulak (2018), Ch. 17

Thompson's Test (Simmonds–Thompson)

• Purpose: Detect complete Achilles tendon rupture
• Technique: Client prone with feet hanging off the end of the table. Examiner squeezes the belly of the gastrocnemius-soleus
• Positive indicator: Absence of plantar flexion response — complete Achilles tendon rupture; normal (negative) is passive plantar flexion of the foot
• References: Magee & Manske (2021), Ch. 13 Lower Leg/Ankle/Foot, Special Tests (pp. 1035–1050); Zulak (2018), Ch. 7

Windlass Test

• Purpose: Reproduce plantar fascia tension; confirm plantar fasciitis
• Technique: Client standing or non-weight-bearing. Examiner passively dorsiflexes the 1st metatarsophalangeal joint with the ankle in neutral
• Positive indicator: Reproduction of plantar heel pain (at the medial calcaneal tubercle) — indicates plantar fasciitis via the windlass mechanism (tightening of the plantar fascia through the MTP joint)
• References: Magee & Manske (2021), Ch. 13 Lower Leg/Ankle/Foot (pp. 1035–1050); Zulak (2018), Ch. 7

Anterior Drawer Test (Ankle)

• Purpose: Detect anterior talofibular ligament (ATFL) tear following ankle inversion sprain
• Technique: Client seated or supine, ankle at 20° plantar flexion. Examiner stabilizes the distal fibula and draws the calcaneus anteriorly on the tibia
• Positive indicator: Excessive anterior translation relative to the unaffected side, or a soft endpoint — indicates ATFL tear
• References: Magee & Manske (2021), Ch. 13 Lower Leg/Ankle/Foot (pp. 1035–1050); Zulak (2018), Ch. 7

Talar Tilt Test

• Purpose: Detect calcaneofibular ligament (CFL) tear
• Technique: Client seated, ankle at 0° (neutral). Examiner stabilizes tibia and forcibly inverts the calcaneus
• Positive indicator: Excessive inversion (>10° relative to unaffected side) — indicates CFL tear
• References: Magee & Manske (2021), Ch. 13 Lower Leg/Ankle/Foot (pp. 1035–1050); Zulak (2018), Ch. 7

Ottawa Ankle Rules

• Purpose: Evidence-based clinical decision rule to determine need for X-ray after ankle injury
• Technique: Palpate: (1) posterior 6 cm of fibula or lateral malleolus tip, (2) posterior 6 cm of tibia or medial malleolus tip, (3) base of 5th metatarsal (foot rules), (4) navicular (foot rules). Assess weight-bearing ability
• Positive indicator: Tenderness at any of the four palpation points, OR inability to take 4 steps immediately after injury — X-ray required to rule out fracture; 96–99% sensitivity
• References: Magee & Manske (2021), Ch. 13 Lower Leg/Ankle/Foot (pp. 1035–1050); Stiell et al. (1992) original study

Mulder's Click Test (Morton's Neuroma)

• Purpose: Pathognomonic test for Morton's neuroma (interdigital nerve entrapment)
• Technique: Examiner squeezes the metatarsal heads together (mediolateral compression) while simultaneously pressing plantarly with the thumb on the 3rd web space
• Positive indicator: Palpable or audible click with reproduction of the client's typical neuritic foot pain — distinguishes Morton's neuroma from metatarsalgia or stress fracture
• References: Magee & Manske (2021), Ch. 13 Lower Leg/Ankle/Foot; Zulak (2018), Ch. 7

Fulcrum Test (Tibial Stress Fracture)

• Purpose: High-specificity screen for tibial stress fracture
• Technique: Client seated. Examiner places forearm under the tibia as a fulcrum. With the other hand, applies gentle downward compression at the distal tibia
• Positive indicator: Focal, sharp pain at the fulcrum site — differentiates tibial stress fracture from diffuse medial tibial stress syndrome (MTSS/shin splints)
• References: Magee & Manske (2021), Ch. 13 Lower Leg/Ankle/Foot (pp. 1035–1050); Vizniak (2018)

Hop Test (Stress Fracture Screen)

• Purpose: Load bone under impact to detect stress fracture
• Technique: Client performs single-leg hopping on the affected limb, evaluating for pain reproduction
• Positive indicator: Score ≥5/10 on NRS pain with hopping — indicates bony involvement; positive result increases stress fracture likelihood and warrants imaging before massage
• References: Magee & Manske (2021), Ch. 13 Lower Leg/Ankle/Foot; Vizniak (2018)

Percussion / Vibration Test (128 Hz Tuning Fork)

• Purpose: Differentiate stress fracture from periostitis or MTSS; detect periosteal irritation
• Technique: Strike a 128 Hz tuning fork and apply the vibrating end to a bony prominence (tibia, fibula, ribs, metatarsals). Apply direct percussion with fingertip as an alternative
• Positive indicator: Focal reproduction of pain at the percussion/vibration site — stress fracture or periostitis. Diffuse pain = MTSS (negative for focal fracture)
• References: Magee & Manske (2021), Ch. 13 Lower Leg/Ankle/Foot; Vizniak (2018); Zulak (2018)

Navicular Drop Test

• Purpose: Quantify dynamic pronation; detect pes planus contribution to lower limb overuse injuries
• Technique: Measure the navicular height in subtalar neutral (seated, non-weight-bearing) then standing. The difference is the navicular drop
• Positive indicator: Drop >10 mm = excessive pronation — contributes to shin splints, plantar fasciitis, and knee overuse pathology
• References: Magee & Manske (2021), Ch. 13 Lower Leg/Ankle/Foot; Zulak (2018), Ch. 7

Squeeze Test (Syndesmotic / High Ankle Sprain)

• Purpose: Identify syndesmotic injury (high ankle sprain) — distinguished from typical lateral ankle sprain by mechanism (external rotation), location (anterior to lateral malleolus), and prolonged recovery
• Technique: Client seated or supine. Examiner squeezes the tibia and fibula together at the mid-calf
• Positive indicator: Pain reproduced at the distal tibiofibular syndesmosis (anterior to the lateral malleolus) — implicates syndesmotic ligament injury; warrants imaging and conservative management with significantly longer recovery (8–12 weeks vs 2–4 weeks for lateral sprain)
• References: Magee & Manske (2021), Ch. 13 Lower Leg, Ankle, Foot (p. 916); Zulak (2018), Ch. 18

Calcaneal Squeeze Test

• Purpose: Screen for calcaneal stress fracture, especially in runners, military recruits, and athletes with insidious heel pain
• Technique: Client seated or supine. Examiner squeezes the medial and lateral aspects of the calcaneus together with both hands
• Positive indicator: Sharp, localized pain in the calcaneus — suggests stress fracture; warrants imaging (often MRI as plain films may be negative early)
• References: Magee & Manske (2021), Ch. 13 Lower Leg, Ankle, Foot; Zulak (2018), Ch. 18

Single Leg Heel Raise Test

• Purpose: Assess gastrocnemius–soleus strength, posterior tibial tendon function, and unilateral calf endurance
• Technique: Client stands on one leg, holding a wall or chair for balance only. Asked to perform repeated heel raises (rising onto toes and lowering with control) until fatigue
• Positive indicator: Inability to perform 25 single-leg heel raises (normative value for adults under 60) suggests calf weakness; loss of medial longitudinal arch height during heel raise suggests posterior tibial tendon dysfunction
• References: Magee & Manske (2021), Ch. 13 Lower Leg, Ankle, Foot; Zulak (2018), Ch. 18

Gastrocnemius Length Test (Silfverskiöld Test)

• Purpose: Differentiate isolated gastrocnemius tightness from combined gastrocnemius–soleus tightness — clinically relevant for plantar fasciitis, Achilles tendinopathy, and forefoot overload
• Technique: Client supine. Examiner passively dorsiflexes the ankle with the knee fully extended, then with the knee flexed to 90°. Compare the available dorsiflexion in each position
• Positive indicator: Less than 10° of dorsiflexion with knee extended that improves to 10° or more with knee flexed — indicates isolated gastrocnemius tightness; if dorsiflexion remains limited in both positions, the soleus is also involved
• References: Magee & Manske (2021), Ch. 13 Lower Leg, Ankle, Foot; Zulak (2018), Ch. 18; Silfverskiöld (1924)

Babinski Sign (Plantar Reflex)

• Purpose: Detect upper motor neuron (UMN) lesion in the corticospinal tract
• Technique: Client supine. Examiner strokes the lateral aspect of the plantar surface of the foot from heel to little toe, then across the metatarsal heads (no tickling)
• Positive indicator: Extension (dorsiflexion) of the great toe AND fanning of the other toes — UMN lesion (stroke, MS, ALS, spinal cord compression). Normal (negative) = toes curl (plantar flexion)
• References: Magee & Manske (2021), Ch. 1 Introduction to Assessment, neurological tests; Zulak (2018), Ch. 15 Neurological Screening; Hoppenfeld (1976)

Romberg Test

• Purpose: Detect proprioceptive and cerebellar impairment contributing to postural instability
• Technique: Client stands feet together, arms at sides. Observe stability with eyes open for 30 seconds, then eyes closed for 30 seconds
• Positive indicator: Significant sway or loss of balance with eyes closed (positive Romberg) — indicates posterior column (proprioceptive) impairment; cerebellar ataxia produces sway with BOTH eyes open and closed
• References: Magee & Manske (2021), neurological assessment; Zulak (2018), Ch. 15

Deep Tendon Reflex (DTR) Testing

• Purpose: Assess upper vs. lower motor neuron integrity; localize spinal cord segment involvement
• Technique: Client relaxed. Examiner strikes the tendon with a reflex hammer. Standard sites: biceps (C5–C6), brachioradialis (C5–C6), triceps (C7), patellar (L3–L4), Achilles (S1)
• Positive indicator: Hyperreflexia = UMN lesion; Hyporeflexia/areflexia = LMN lesion; Compare side to side — asymmetry is significant
• References: Magee & Manske (2021), Ch. 1 Introduction, neurological assessment; Zulak (2018), Ch. 15; Hoppenfeld (1976)

House-Brackmann Scale (Facial Nerve)

• Purpose: Grade the severity of facial nerve (CN VII) palsy in Bell's palsy or other facial nerve pathology
• Technique: Examiner observes facial function at rest and with voluntary movement (raise eyebrow, close eye tightly, smile, puff cheeks)
• Positive indicator: Grade I = normal; Grade II = slight weakness; Grade III = moderate dysfunction, asymmetric with effort; Grade IV = moderately severe; Grade V = severe; Grade VI = total paralysis
• References: House & Brackmann (1985) original scale; Werner (2012); Zulak (2018)

Corneal Reflex Test

• Purpose: Test CN VII efferent limb and CN V afferent limb integrity; detect lagophthalmos risk in Bell's palsy
• Technique: Client looks slightly upward. Examiner gently touches the cornea with a wisp of cotton while approaching from the side (avoiding visual triggering)
• Positive indicator: Absent blink reflex on the affected side — incomplete eye closure (lagophthalmos) creates corneal exposure injury risk during treatment
• References: Zulak (2018), Ch. 15; neurological assessment textbooks; Werner (2012)

Schirmer's Test (Lacrimation Test)

• Purpose: Quantify tear production; detect reduced lacrimation from CN VII involvement in Bell's palsy
• Technique: Client seated with eyes open. Examiner places a standardized filter paper strip in the lower conjunctival sac of each eye for 5 minutes. Measure the length of wetting
• Positive indicator: <5 mm of wetting on the affected side — indicates significantly reduced lacrimation; increases corneal exposure risk
• References: Zulak (2018), Ch. 15; ophthalmological assessment references; Werner (2012)

SCAT6 (Standardized Concussion Assessment Tool 6th edition)

• Purpose: Multi-domain sideline and clinical concussion assessment; gold-standard per Amsterdam 2022 Consensus
• Technique: Administered by trained clinician. Domains: (1) red flag screen, (2) observable signs, (3) symptom checklist, (4) cognitive screen (SAC — Standardized Assessment of Concussion), (5) neurological screen, (6) BESS balance assessment, (7) delayed recall
• Positive indicator: Total symptom score >0; SAC score <26/30; ≥1 BESS error above baseline; or any red flag = concussion suspected — contraindication for cervical and vigorous massage until medical clearance
• References: Patricios et al. (2023), British Journal of Sports Medicine; Amsterdam Consensus (2022); Zulak (2018)

Balance Error Scoring System (BESS)

• Purpose: Quantify postural stability and vestibular/proprioceptive impairment post-concussion
• Technique: 6 stances × 20 seconds each: double leg, single leg, tandem — each on firm surface and foam. Count errors per stance (eyes closed; errors = stepping out, opening eyes, hip abduction >30°, lifting hands from hips, stumbling)
• Positive indicator: >6 errors on any stance, or total score significantly different from pre-season baseline — indicates postural precautions required
• References: Patricios et al. (2023); Guskiewicz (2001) BESS validation; Zulak (2018)

Manual Muscle Testing (MMT)

• Purpose: Grade voluntary muscle strength to document LMN or myopathic weakness; guide treatment modifications
• Technique: Client performs resisted movement against examiner resistance. Graded 0–5: 0 = no contraction; 1 = contraction only; 2 = movement with gravity eliminated; 3 = movement against gravity only; 4 = movement against some resistance; 5 = normal
• Positive indicator: Grade ≤3 = significant functional weakness; bilateral or myotomal pattern guides differential (LMN vs. myopathy vs. UMN)
• References: Magee & Manske (2021), throughout chapters; Zulak (2018), throughout chapters; Hoppenfeld (1976)

Fasciculation Mapping

• Purpose: Detect active denervation (LMN disease); observe for ALS or other motor neuron disease features
• Technique: Client at rest in good lighting. Examiner observes multiple muscle groups — trunk, proximal limb, and distal limb — for spontaneous, involuntary fine muscle twitching
• Positive indicator: Visible fasciculations at rest in multiple muscle groups — combined with UMN signs (hyperreflexia, Babinski) differentiates ALS from other conditions; LMN alone = lower MND
• References: Zulak (2018), Ch. 15; Werner (2012); neurological assessment references

Pronator Drift Test

• Purpose: Subtle screen for upper motor neuron lesion (early stroke, MS, TBI) by detecting weakness in the supinators of the affected arm
• Technique: Client stands or sits with arms outstretched in front, palms up, eyes closed, for 20–30 seconds
• Positive indicator: One arm slowly pronates and/or drifts downward — suggests UMN involvement of the contralateral cerebral hemisphere; subtle finding often present before overt weakness; warrants neurological referral
• References: Magee & Manske (2021), Ch. 1 Principles of Assessment; Zulak (2018), Ch. 14; Bickley (2017) Bates' Guide

Clonus Test

• Purpose: Detect upper motor neuron lesion via sustained involuntary rhythmic muscle contraction; commonly tested at the ankle
• Technique: Client supine with relaxed leg. Examiner supports the leg under the knee (slight flexion) and applies a brisk, sustained dorsiflexion stretch to the ankle
• Positive indicator: Sustained rhythmic plantarflexion–dorsiflexion oscillations of the ankle (3+ beats) — indicates UMN lesion; transient (1–2 beat) clonus may be normal in anxious clients but sustained clonus warrants referral
• References: Magee & Manske (2021), Ch. 1 Principles of Assessment; Zulak (2018), Ch. 14; Bickley (2017)

Orthostatic Blood Pressure Test

• Purpose: Detect orthostatic hypotension from cardiac medications, autonomic dysfunction, or post-MI reduced cardiac output; determine safe positioning during massage
• Technique: Measure BP supine (after 5 min rest), then seated (after 1–2 min), then standing (after 1–2 min)
• Positive indicator: Systolic drop ≥20 mmHg or diastolic drop ≥10 mmHg between supine and standing — indicates orthostatic hypotension; guides slow position changes during treatment
• References: Zulak (2018), Ch. 4 Vital Signs; Best, Buttris, & Hines (2020); Werner (2012)

Wells DVT Criteria (Pre-Test Probability Score)

• Purpose: Evidence-based clinical decision tool to stratify pretest probability of deep vein thrombosis before any massage decision
• Technique: Score based on: active cancer (+1), paralysis/paresis/recent cast (+1), bedrest >3 days or major surgery <12 weeks (+1.5), localized deep vein tenderness (+1), entire leg swollen (+1), calf swelling >3 cm vs. asymptomatic (+1), pitting edema (+1), collateral superficial veins (+1), alternative diagnosis equally likely (−2)
• Positive indicator: Score ≥2 = high probability — imaging required before massage; Score 1 = moderate; Score ≤0 = low probability. Active cancer is automatic +1
• References: Wells et al. (2003), New England Journal of Medicine; Zulak (2018); Werner (2012)

Homans' Sign

• Purpose: Detect deep vein thrombosis (DVT) — historical test of moderate sensitivity only
• Technique: Client supine with knee extended. Examiner passively dorsiflexes the ankle sharply
• Positive indicator: Calf pain on dorsiflexion — sensitivity 50%, specificity 50%; positive should be followed by Wells Criteria and Doppler imaging (not sufficient alone to rule in or out DVT)
• References: Magee & Manske (2021), Ch. 13 Lower Leg/Ankle/Foot (p. 1046); Zulak (2018), Ch. 7; Werner (2012)

Pitting Edema Grading (1+ to 4+)

• Purpose: Grade severity of fluid retention; distinguish pitting (soft, compressible) from non-pitting (fibrous, brawny) edema
• Technique: Press thumb firmly into the medial malleolus or tibial shaft for 5 seconds, then release and measure indentation depth/duration
• Positive indicator: 1+ = <2 mm indent, rebounds quickly; 2+ = 2–4 mm, rebounds in <15 sec; 3+ = 4–6 mm, rebounds in 1 min; 4+ = ≥8 mm, rebounds in >2 min — higher grades = more severe systemic fluid retention
• References: Zulak (2018), Ch. 4; Best, Buttris, & Hines (2020); Werner (2012)

Calf Circumference Comparison

• Purpose: Detect unilateral lower limb edema suggesting DVT or deep system involvement in thrombophlebitis
• Technique: Measure calf circumference bilaterally at exactly 10 cm below the tibial tuberosity using a tape measure
• Positive indicator: Difference ≥3 cm = clinically significant unilateral edema — raises DVT suspicion, requires Wells Criteria scoring and potential imaging
• References: Wells et al. (2003); Zulak (2018); Werner (2012)

Capillary Refill Time

• Purpose: Assess peripheral perfusion; detect vascular insufficiency or vasospasm severity
• Technique: Examiner blanches the nail bed for 2 seconds by pressing, then releases and counts seconds until color returns
• Positive indicator: >2 seconds = reduced peripheral perfusion — indicates arterial insufficiency, severe vasospasm (Raynaud's), or hypothermia
• References: Zulak (2018), Ch. 4 Vital Signs; Best, Buttris, & Hines (2020)

Jugular Venous Distension (JVD) Assessment

• Purpose: Estimate central venous pressure; detect right heart decompensation in CHF
• Technique: Client supine at 45° head elevation. Examiner identifies the pulsatile level of the internal jugular vein (or uses external jugular as reference). Measures distance above the sternal angle
• Positive indicator: JVD >3 cm above the sternal angle (or visible above the clavicle at 45°) = elevated CVP indicating right heart failure — contraindicates vigorous circulatory massage
• References: Zulak (2018), Ch. 4; Best, Buttris, & Hines (2020); Physical Examination and Health Assessment — Canadian edition

Two-Point Calf Palpation (DVT)

• Purpose: Directly palpate a thrombus within the deep calf veins
• Technique: Examiner places both hands on the calf and compresses the calf between the hands at 1 cm intervals from distal to proximal, palpating for cord-like resistance or focal tenderness
• Positive indicator: Firm, cord-like tenderness within the calf at a specific point — greatly increases clinical suspicion for DVT
• References: Wells et al. (2003); Zulak (2018); Werner (2012)

Popliteal Fossa Palpation (DVT vs. Baker's Cyst)

• Purpose: Differentiate popliteal DVT from Baker's cyst
• Technique: Client prone, knee slightly flexed. Examiner palpates the popliteal fossa with fingertips, assessing for fullness, tenderness, or a fluctuant mass
• Positive indicator: Fullness or tender mass + accompanying leg swelling = DVT until proven otherwise; a soft, fluctuant mass without warmth = more consistent with Baker's cyst
• References: Magee & Manske (2021), Ch. 12 Knee; Zulak (2018), Ch. 8; Werner (2012)

Trendelenburg Test (Varicose Veins)

• Purpose: Identify incompetence at the saphenofemoral junction causing varicose veins
• Technique: Client supine. Examiner elevates the leg to empty superficial veins, then compresses the saphenofemoral junction (1 cm medial to femoral pulse in the groin). Client stands while compression is maintained, then examiner releases compression
• Positive indicator: Rapid filling of varicosities within 30 seconds after releasing compression = incompetent perforating valves at the saphenofemoral junction
• References: Magee & Manske (2021), Ch. 13 Lower Leg/Ankle/Foot; Zulak (2018), Ch. 7

Perthes Test (Varicose Veins)

• Purpose: Assess deep vein patency before treating varicose veins
• Technique: Apply a tourniquet below the knee. Client walks for 5 minutes
• Positive indicator: Varicosities distend (increase) with walking = deep vein obstruction (blood cannot drain upward through the deep system, backs into superficial veins); varicosities that empty = patent deep system
• References: Zulak (2018), Ch. 7; Werner (2012)

Cold Provocation Test (Raynaud's)

• Purpose: Reproduce vasospastic color changes characteristic of Raynaud's disease
• Technique: Client exposes digits to cold (15°–18°C water or cold ambient environment) for 1–5 minutes. Examiner observes digital color changes
• Positive indicator: Classic triphasic response: blanching (white) → cyanosis (blue/purple) → reactive hyperemia (red) — confirms vasospastic Raynaud's episode
• References: Zulak (2018); Werner (2012); Porth (2014)

Stemmer's Sign (Lymphedema)

• Purpose: Detect established lymphedema in the digits
• Technique: Examiner attempts to pinch and lift the skin at the dorsal base of the 2nd toe (foot) or 2nd finger (hand)
• Positive indicator: Unable to pinch and lift the skin (skin is thickened and fibrous) = positive Stemmer's sign — indicates established lymphedema; specificity is high
• References: Zulak (2018); Wittlinger & Wittlinger (Dr. Vodder's Manual Lymph Drainage); Werner (2012)

FAST Assessment (Stroke Recognition)

• Purpose: Emergency stroke recognition tool for acute or worsening neurological signs during or before treatment
• Technique: Check: (F) Face — ask client to smile, observe for drooping; (A) Arms — raise both arms, observe for unilateral drift/drop; (S) Speech — ask client to speak, listen for slurring or confusion; (T) Time — document time of symptom onset
• Positive indicator: Any new positive finding (facial droop, arm weakness, speech difficulty) in a client during treatment = stop immediately and call 911; FAST was positive in 88% of strokes
• References: Zulak (2018), emergencies chapter; Werner (2012); Canadian Heart and Stroke Foundation

Talk Test / 10-Count Test

• Purpose: Bed-side screen for ventilatory limitation; assess safety of session length and positioning
• Technique: Ask client to count aloud from 1 to 10 in a single breath. Observe effort, dyspnea, and whether 10 is reached
• Positive indicator: Unable to complete a count to 10 on one breath = significant ventilatory limitation — guides reduced session duration, semi-recumbent positioning, and avoidance of respiratory-compromising techniques
• References: Zulak (2018), Ch. 4 Vital Signs; Best, Buttris, & Hines (2020)

SpO2 Measurement (Pulse Oximetry)

• Purpose: Objective measure of peripheral oxygen saturation to determine safe treatment parameters
• Technique: Clip pulse oximeter to fingertip (ensure no nail polish, adequate perfusion). Record resting value and during position changes
• Positive indicator: Normal ≥95%; 88–94% at rest = significant respiratory impairment (COPD, CF); <88% = do not proceed, provide supplemental oxygen if available; >3% drop with position change = positional oxygen sensitivity
• References: Zulak (2018), Ch. 4; Best, Buttris, & Hines (2020); Werner (2012)

Breath-Hold Test

• Purpose: Simple functional indicator of respiratory reserve for emphysema/COPD
• Technique: Client breathes normally, then at end of normal expiration holds breath comfortably as long as possible (no forced exhalation)
• Positive indicator: <20 seconds of comfortable breath-hold at rest = significant ventilatory impairment — guides session duration and positioning tolerance
• References: Zulak (2018), Ch. 4; Best, Buttris, & Hines (2020)

Pursed-Lip Breathing Response

• Purpose: Confirm air-trapping pattern (emphysema, COPD, asthma); guide respiratory support techniques
• Technique: Client exhales through slightly puckered lips (pursed-lip breathing). Examiner observes for reduction in accessory muscle use and improved SpO2 or dyspnea score
• Positive indicator: Client spontaneously uses PLB OR demonstrates improvement in SpO2 or reduced accessory muscle activity — confirms obstructive air-trapping pattern; guides therapist positioning and manual techniques
• References: Zulak (2018), Ch. 4; Best, Buttris, & Hines (2020); Werner (2012)

Chest Expansion Measurement (see Thoracic Spine section)

• See Adam's Forward Bend / Chest Expansion under Thoracic Spine.

10-g Semmes-Weinstein Monofilament Test

• Purpose: Gold-standard screen for loss of protective sensation in diabetic peripheral neuropathy
• Technique: Client supine, eyes closed. Examiner applies a 10-gram monofilament perpendicular to the plantar surface at 10 standard sites (including hallux, 1st, 3rd, 5th metatarsal heads, plantar heel) until the filament buckles. Client indicates when felt
• Positive indicator: Unable to detect monofilament at ≥1 of 10 sites = loss of protective sensation — high amputation risk; requires modified foot massage pressure
• References: Zulak (2018), Ch. 4; Best, Buttris, & Hines (2020); Porth (2014); American Diabetes Association guidelines

Vibration Sense Testing (128 Hz Tuning Fork at Hallux)

• Purpose: Early detection of peripheral neuropathy; precedes loss of protective sensation on monofilament
• Technique: Strike the 128 Hz tuning fork and apply the vibrating base to the dorsal surface of the hallux IP joint. Ask client when vibration is felt and when it stops. Compare to the examiner's own perception and to the contralateral hallux
• Positive indicator: Unable to detect vibration at the hallux when examiner or contralateral side responds normally — indicates early peripheral neuropathy (diabetic, alcoholic, B12 deficiency)
• References: Zulak (2018), Ch. 4; Best, Buttris, & Hines (2020); Magee & Manske (2021), neurological assessment

Bristol Stool Scale Assessment

• Purpose: Classify stool consistency to document GI function and guide abdominal massage decisions
• Technique: Client describes stool appearance using the 7-point Bristol Stool Scale chart (Types 1–7, from hard pellets to watery)
• Positive indicator: Types 1–2 (IBS-C, constipation) = vigorous clockwise effleurage indicated; Types 6–7 (IBS-D, diarrhea) = contraindicate vigorous abdominal petrissage; Types 3–4 = normal
• References: Zulak (2018); Werner (2012); Rattray & Ludwig (2000)

Abdominal Percussion

• Purpose: Identify gas vs. solid/fluid distribution in the abdomen; detect ascites or retained stool
• Technique: Examiner percusses systematically over all four quadrants of the abdomen with the middle finger on the surface and the opposite hand striking
• Positive indicator: Tympany (hollow drum sound) = gas predominant; Dullness = fluid or solid (stool, organ mass, ascites); Shifting dullness = ascites
• References: Zulak (2018), Ch. 4; Best, Buttris, & Hines (2020); Physical Examination and Health Assessment — Canadian edition

Abdominal Auscultation (Bowel Sound Assessment)

• Purpose: Evaluate intestinal motility; detect hypo- or hyperactive bowel sounds
• Technique: Warm stethoscope placed at the ileocecal junction (RLQ) and left lower quadrant. Listen for at least 1–2 minutes per quadrant
• Positive indicator: Hyperactive (borborygmi) = diarrhea or early obstruction; Hypoactive = constipation, post-op, ileus; Absent (no sounds in 2 min per quadrant) = medical emergency (ileus or peritonitis)
• References: Zulak (2018), Ch. 4; Best, Buttris, & Hines (2020)

Manning Criteria Screen (IBS)

• Purpose: Evidence-based clinical rule to differentiate IBS from organic bowel pathology
• Technique: Positive if ≥3 of 6 criteria: (1) pain relieved by defecation, (2) looser stools at pain onset, (3) more frequent stools at pain onset, (4) visible abdominal distension, (5) mucus per rectum, (6) feeling of incomplete evacuation
• Positive indicator: ≥3/6 criteria = probable IBS diagnosis — helps rule out IBD, colorectal cancer, and infection requiring referral
• References: Manning et al. (1978) original study; Werner (2012); Best, Buttris, & Hines (2020)

CVA Tenderness Test (Renal)

• Purpose: Detect renal or pyelonephritis tenderness at the costovertebral angle
• Technique: Client seated. Examiner places one hand flat over the CVA (junction of the 12th rib and the lumbar spine, posteriorly). Strikes firmly with the ulnar side of the other fist (indirect percussion)
• Positive indicator: Reproduction of pain or tenderness at the CVA = renal involvement (pyelonephritis, renal calculi, renal inflammation) — systemic precautions required
• References: Zulak (2018), Ch. 4; Best, Buttris, & Hines (2020); Physical Examination and Health Assessment — Canadian edition

Sinus Percussion / Tapping

• Purpose: Confirm sinusitis and localize affected sinus
• Technique: Examiner taps directly over the frontal sinuses (forehead, above supraorbital rim) and maxillary sinuses (below eyes, over the zygomatic arch)
• Positive indicator: Reproduction of pain or tenderness at the sinus site — distinguishes frontal sinusitis (forehead tap) from maxillary sinusitis (cheekbone tap)
• References: Zulak (2018), Ch. 4; Best, Buttris, & Hines (2020); Physical Examination and Health Assessment — Canadian edition

Sputum Inspection (Cystic Fibrosis)

• Purpose: Assess airway infection status and hemoptysis risk to guide appropriateness of airway clearance techniques
• Technique: Client describes or produces sputum for inspection. Examiner notes color, consistency, and presence of blood
• Positive indicator: Thick, purulent, yellow-green = active infection (increased systemic precautions); Blood-streaked (hemoptysis) = contraindication to vigorous chest physiotherapy or percussion
• References: Zulak (2018); Werner (2012); Best, Buttris, & Hines (2020)

PHQ-9 (Patient Health Questionnaire — Depression Screen)

• Purpose: Standardized, validated 9-item depression screening tool
• Technique: Client completes 9-item questionnaire rating how often they experience depression symptoms (0 = not at all, 3 = nearly every day). Maximum score 27
• Positive indicator: Score 5–9 = mild; 10–14 = moderate; 15–19 = moderately severe; ≥20 = severe depression — guides safety (question 9 = suicidal ideation screen) and treatment approach
• References: Kroenke et al. (2001), Journal of General Internal Medicine; Werner (2012); Zulak (2018)

GAD-7 (Generalized Anxiety Disorder 7-Item Scale)

• Purpose: Standardized validated anxiety screening and severity rating
• Technique: Client completes 7-item questionnaire rating anxiety symptom frequency (0–3 each). Maximum score 21
• Positive indicator: Score 5–9 = mild; 10–14 = moderate; ≥15 = severe anxiety — guides communication approach, session pacing, and psychosomatic considerations
• References: Spitzer et al. (2006), Archives of Internal Medicine; Werner (2012)

MIDAS (Migraine Disability Assessment)

• Purpose: Quantify functional disability from migraines to prioritize treatment goals and document outcomes
• Technique: 5-item questionnaire asking about days of missed work, household tasks, and social activities due to migraine in the past 3 months. Sum of days = MIDAS score
• Positive indicator: Score 0–5 = Grade I (minimal); 6–10 = Grade II (mild); 11–20 = Grade III (moderate); ≥21 = Grade IV (severe) — moderate or higher indicates priority condition justifying comprehensive treatment planning
• References: Stewart et al. (2000), Headache; Werner (2012); Zulak (2018)

SCAT6 / BESS (see Neurological Tests section)

Timed Up and Go Test (TUG)

• Purpose: Standardized fall-risk screen for older adults and clients with balance/mobility concerns; widely used in geriatric, neurological, and post-surgical populations
• Technique: Client sits in a standard chair with armrests. On the command "go," the client rises (using arms if needed), walks 3 meters at a comfortable pace to a marker, turns, walks back, and sits down. Time the entire sequence
• Positive indicator: Greater than 12 seconds = increased fall risk; greater than 20 seconds = significant mobility impairment with high fall risk; greater than 30 seconds = severely impaired
• References: Magee & Manske (2021), Ch. 1 Principles; Podsiadlo & Richardson (1991); American Geriatrics Society Falls Guidelines (2024)