L4: Dorsiflexion+Supination/Tibialis Anterior

Execution:

  1. Patient is in supine lying position
  2. The patient is asked to move into dorsiflexion and supination, while the examiner crosses the hands and gives resistance

 

Positive Outcome: Decreased strength rated with the MRC scale compared to the other side

Study Reliability Sn Sp LR+ LR-
Hancock et al. (2011): L3/L4 Disc Herniation NA 50 64 1.38 0.78
Hancock et al. (2011): L4/L5 Disc Herniation NA 46 70 1.55 0.77
Iversen et al. (2013) NA 33 68 1.05 0.98
Comment: Dorsiflexion+Supination weakness does not seem to be able to identify a specific level of lumbar disc herniation