Foot and Ankle International
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presents
Wheeless' Textbook of Orthopaedics

Instability and Wt Relief Flexion Test





(for Discogenic Pain)
- Discussion:
    - performed with the patient prone with arms at the sides;
    - examiners thumbs finds an interspace and exerts sharp downward
          pressure seeking a reproduction of pain;
    - several interspaces are tested to find levels that are not painful
          for comparison;
    - if no interspace is found or if all are painful, test cannot be done;
    - if one or two levels are painful, the patient is asked to lift his
          head, shoulders, and arms and the downward pressure is repeated;
          - if pain is greater when the patient is prone & relaxed than when
              extended with paravertebral muscles tight, test is positive;
    - test stresses the painful annulus in relaxed position, but contracted
        muscles stabilize the segment, reducing stress & pain from pressure;
    - if pain is greater with the muscles contracted or the pain is
        equal with both maneuvers, the test is negative;
    - wt relief flexion is performed w/ pt supine, hips and knees flexed;
    - examiner places one arm under the patients knees and lifts patient's
        buttocks up from the examination table;
    - if the pain is decreased with this maneuver, the test is positive;



Original Text by Clifford R. Wheeless, III, MD.