Scenario: A 49-year-old man employed as a high school gym teacher and coach reports a long 15+ year history of generalized lumbosacral ache, which has been getting steadily worse over the past year. Lately, this has interfered with his job since the jarring motions associated with sports increase his symptoms. He recalls falling from a 12-foot wall and landing on his buttocks when he was a teenager and also recalls several sporting injuries. He recalls returning to normal activity within 6 weeks of the fall.

Up until his early 30s, he did not experience any significant back pain; however, after age 35 years, there was a steady increase in periodic low back pain. Presently, he has pain every day, which starts as a stiff ache every morning. Getting out of bed is difficult, and he must log roll to his side to get up from supine. After a hot shower and some simple exercises, he is able to move better. Coughing and jarring movements are painful. Walking is relatively pain free on level surfaces, but painful on hills and stairs. Sitting and lying relieve pain. Getting in and out of the car is difficult and many work postures, especially bending forward aggravate the pain and you must often support yourself by leaning on an arm. The pain has not radiated into the lower extremity and is confined to the low back and buttocks. There is tenderness at L4 and L5 spinous processes, with palpable step.

Question: What special tests and measures are best used to confirm and classify lumbar spondylolisthesis?

A. SLR, Quebec Back Pain Disability Scale, Prone knee bending test

B. Quadrant test, Oswestry Disability Index, Ober Test

C. FABER test, PPIVM testing, Repeated movement testing

D. Postural examination, PAIVM, Femoral nerve traction test

Answer with rationale: C. FABER test, PPIVM testing, Repeated movement testing. The FABER test stands for flexion, abduction, and external rotation. This is a pain provocation test that will help diagnose the patient’s pathology based on where and what kind of pain is reproduced. PPIVM testing stands for Passive Physiological Intervertebral Motion testing. This test utilizes joint mobilizations to identify pain location and involved spinal segments. Repeated movement testing involves either repeated flexion or extension motions to identify if a bias is present. Extension bias is more likely present with spondylolisthesis.

For more information see Chapter 130: Lumbar Spondylolisthesis in the Color Atlas of Physical Therapy