Lumbar Rocking Test
Original Editor - Matt Huey
Top Contributors - Matt Huey and Carina Therese Magtibay
Introduction
Lumbar spine instability is a possible cause of low back pain (LBP). Some research has stated up to 57% of people with LBP is due to lumbar instability[1]. Often the diagnosis of instability is made through imaging[2]. Imaging can be difficult to obtain either through access or cost. The utilization of special tests in the clinic can assist in confirming a diagnosis to lead to further treatment.
The purpose of this test is to determine if the LBP someone is experiencing is due to instability since this test should cause a translation of the spinal segment, which a person with lumbar instability would have more translation of the spinal segment in positions of flexion.
How to Perform the Test
- Have the patient in the supine position
- Have the patient bring their knees up to their chest, this is to lock in the hips and knees in a hyperflexed position
- Examiner brings the patient's knees further up to the chest, than provides a quick jerk
- If pain is produced in the lumbar region, then instability is suspected
Research
A study[3] has been performed which compared the Lumbar Rocking test to the Passive Lumbar Extension (PLE) test for determining lumbar instability. In the study, the PLE test had a positive result in 35 of the 50 participants, whereas, the Lumbar Rocking test found 46 out of the 50 to have a positive result. It was determined the PLE test had a sensitivity of 68.89%, specificity of 20%, positive predictive value of 88.57% and a negative predictive value of 6.66% and the Lumbar Rocking test has a sensitivity of 95.56%, specificity of 40%, positive predictive value of 93.47% and negative predictive value of 50%. It was stated that the along with these findings the Lumbar Rocking test was more comfortable being done in the supine position because the PLE test is in prone or in standing which can cause pain. Additionally the rocking test locks the hips and pelvis so it can pinpoint tenderness in the lumbar spine and the pain from the PLE test could be from the hip, SI joint, or lumbar spine.
There are limitations to this study is that it was only done in one center which makes it more of a pilot study. Additional studies looking at patients in multiple locations can provide more benefit. The test findings could also be compared to a dynamic MRI to determine the validity of the test as well.
References
- ↑ Fritz, J. M., Piva, S. R., & Childs, J. D. (2005). Accuracy of the clinical examination to predict radiographic instability of the lumbar spine. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 14(8), 743–750. https://doi.org/10.1007/s00586-004-0803-4
- ↑ Chatprem, T., Puntumetakul, R., Kanpittaya, J. et al. A diagnostic tool for people with lumbar instability: a criterion-related validity study. BMC Musculoskelet Disord 22, 976 (2021). https://doi.org/10.1186/s12891-021-04854-w
- ↑ Rathod, A. K., Garg, B. K., & Sahetia, V. M. (2019). Lumbar rocking test: A new clinical test for predicting lumbar instability. Journal of craniovertebral junction & spine, 10(1), 33–38. https://doi.org/10.4103/jcvjs.JCVJS_5_19