Test: One Leg Standing Lumbar Extension Test

Video Link

Background/Purpose

The One Leg Standing Lumbar Extension Test, also known as the Stork Test, Stork Standing Test, or One-Legged Hyperextension Test, is designed to assess for lumbar joint dysfunction, particularly pars interarticularis stress fractures (spondylolysis) or spondylolisthesis (Physiopedia). Spondylolysis is a fracture of the pars interarticularis, and the progression of active spondylolysis to non-union has been associated with an increased incidence of spondylolisthesis and lumbar disc degeneration. Earlier recognition of acute spondylolysis is associated with improved fracture healing and is important in preventing the formation of non-union and its consequences (Masci et al., 2006). This injury typically occurs at the level of L4-L5, though it has started to be seen higher up in the lumbar spine as well, and is particularly common in young athletes involved in activities requiring repetitive extension or rotation of the spine (Miller et al., 2005). The test can also identify facet joint pathology when rotation is combined with extension (Physiopedia). The only reported pathognomonic finding for active spondylolysis is reproduction of pain with the performance of the one-legged hyperextension test (Masci et al., 2006). The test is commonly used in pediatric and adolescent populations as well as in athletes with low back pain that worsens with extension activities.

Procedure

Patient Position:
The patient stands upright, facing away from the examiner (Masci et al., 2006)
The patient may face a wall with the non-weight-bearing foot placed against the wall for support and balance (Dutton, 2008)
The patient should be barefoot or in flat shoes on a level surface

Procedure:
Initial Positioning: The examiner stands directly behind the patient, positioned close enough to provide stability if the patient requires assistance or loses balance (Physiopedia)
Single Leg Stance: Instruct the patient to stand on their left leg first and raise their right leg with the right hip slightly flexed and right knee flexed to approximately 80 degrees (Masci et al., 2006)

The weight-bearing leg should remain straight (Reiman & Manske, 2011)
The patient should establish balance before proceeding

Lumbar Extension: While standing on one leg, ask the patient to actively extend (hyperextend) their lumbar spine backward (Masci et al., 2006; Physiopedia)
The trunk tilt should result from lumbosacral extension, not hip movement (Reiman & Manske, 2011)
The examiner may help stabilize the patient during the extension movement (Hoppenfeld, 1976)
The patient should hold this position briefly

Symptom Assessment: Ask the patient if this active maneuver reproduces their pain (Masci et al., 2006)
Document the location of pain (lumbar, sacroiliac, or radiating)
Note the intensity and quality of pain
A positive test occurs when pain is produced either ipsilaterally or bilaterally (Miller et al., 2005)

Repeat Opposite Side: The maneuver is repeated on the right side by having the patient stand on the right leg (Masci et al., 2006; Physiopedia)
Optional Variation with Rotation: If rotation is combined with extension and pain results, this indicates possible facet joint pathology on the side to which rotation occurs (Physiopedia)

Important Notes:
Balance is critical for this test; patients without good balance may be poor candidates (Kalichman & Hunter, 2008)
This is primarily an observational test, though the examiner should be ready to provide support (Physiopedia)
The testing position increases lumbar lordosis and weight-bearing load on the facet joints, sacroiliac joints, and hip joint on the weight-bearing side (Kalichman & Hunter, 2008)
Performed: Unilaterally

Dialog

The patient stands on one leg and extends the lumbar spine backward while the examiner observes for reproduction of back pain .

Criteria

• No reproduction of pain
• No asymetrical symptoms
• No pain with rotaiton

Measurement

LOINC Code

Scale/Grading

selection range; grade - LOINC ID
Option - Value option selection range; grade - LOINC IDPass ; Pass - Fail ; Fail -