Test: Lumbar Quadrant Test

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Background/Purpose

The Lumbar Quadrant Test, also known as Kemp's Test or the Extension-Rotation Test, is a provocative examination used to assess lumbar facet joint pathology and foraminal stenosis (Stuber et al., 2014). The test is designed to determine if the lumbar spine is the source of the patient's symptoms by placing the spine in a position of maximum compression (Student Physical Therapist). The combined motion of extension, ipsilateral lateral flexion, and rotation decreases the intervertebral foramen to its smallest size and maximally compresses the facet joints on the side being tested (Student Physical Therapist; Clinical Gate). This test is particularly useful for diagnosing facet joint syndrome, which results from repetitive stress, cumulative trauma, inflammation, or stretching of the joint capsule, and accounts for approximately 5-15% of cases of chronic axial low back pain (ResearchGate). The test can also identify foraminal stenosis, as the position narrows the intervertebral foramen and may compress nerve roots (Singh; Stuber et al., 2014). The Lumbar Quadrant Test serves as a lumbar clearing test and is extremely useful in ascertaining the source of the patient's symptoms (Student Physical Therapist). Studies report that 82.2% of chiropractors use this test often or almost always for diagnosing lumbar spine conditions (Stuber et al., 2014).

Procedure

Patient Position:
The patient can be either standing or sitting, though sitting is commonly described (Student Physical Therapist; Physiopedia)
The patient's arms are folded across the chest (Student Physical Therapist)
The patient should be unsupported and in an upright neutral position initially (Clinical Gate)

Procedure:
Examiner Position: The examiner stands behind the patient and slightly to the side being tested (Clinical Gate). The examiner places one hand on the patient's lumbar spine and the other hand on the contralateral shoulder (WikiSM)
Extension Phase: The examiner places the lumbar spine in hyperextension (Student Physical Therapist; Clinical Gate)
The examiner may choose to maintain the hyperextension by placing their knee against the lumbar spine (Student Physical Therapist)
Extension should be taken to end range
Combined Movement: While maintaining extension, the patient or examiner guides the spine into combined ipsilateral lateral flexion (side bending) and rotation to the same side (Student Physical Therapist; Clinical Gate)
These movements are combined, moving into the "quadrant" position
All movements should be taken to end range

Overpressure Application: The examiner applies an overpressure through the patient's shoulders to further compress the facet joints and narrow the intervertebral foramen (Student Physical Therapist; Clinical Gate)
The movement is continued until the limit of range is reached or until symptoms are produced (Clinical Gate)

Symptom Assessment: Ask the patient about pain reproduction:

Note the location of pain (local lumbar vs. radiating)
Document the quality and intensity of symptoms
Local pain suggests facet joint pathology, while radiating pain below the knee suggests nerve root irritation (Physiopedia; WikiSM)

Repeat Opposite Side: The uninvolved side should be tested first, then the test is repeated on the opposite side for comparison (Clinical Gate)

Alternative Method:
Some clinicians perform the test by having the patient lean away from the examiner, then twist into forward flexion, and eventually bring them back into lateral flexion and extension (WikiSM).

Important Notes:
This test position is a common position used for spinal manipulation; therefore, the examiner should take care not to overstress the rotation during assessment (Clinical Gate)
In some cases, the examiner may hear a "click" or "pop" when performing this test, similar to sounds heard with manipulation (Clinical Gate)
The test has limited diagnostic accuracy and should be used in combination with other clinical findings (Radiopaedia)
Performed: Unilaterally

Dialog

The patient stands or sits while the examiner guides the lumbar spine into combined extension, ipsilateral lateral flexion, and rotation, then applies overpressure through the shoulders to assess for facet joint pain or foraminal stenosis.

Criteria

• No pain or radiation

Measurement

LOINC Code

Scale/Grading

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