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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