The Physio Project

Comment below:

Significant pain & swelling 4 days post traumatic inversion injury.. XR images below:

Avulsion fracture distal fibula 😢

OR

No bony injury identified 😃

LOVE THIS! 👏🏽 Brad Beer

A back that is sore, really is quite normal! Does it mean you have a "bad" back... Definitely not!

Great quote from , and one to really learn from.

If you think you have a "bad back", why not book in with a chartered physiotherapist today to get you back to normal!

Here at Rugby Physio, we tailor each treatment to your specific needs. With daytime and evening appointments available, you can easily fit us into your busy lifestyle!

A nice refresher for the Lever sign or Lelli test in diagnosing ACL tears. A good one to add in while performing the other standard tests.

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The Lever Sign For ACL Rupture
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A new clinical test for the diagnosis of ACL rupture is described:
The so-called “Lever Sign”
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Lelli, et al., (2016), performed a prospective study on 4 groups of patients based on MRI findings and Clinical Phase.
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The hypothesis was the manual test would be diagnostic for both partial and complete tears of the ACL regardless of the elapsed time from injury.
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METHODS:
400 patients were evaluated and divided into 4, equal-sized groups:
Group A (acute phase with positive MRI for complete ACL rupture)
Group B (chronic phase with positive MRI for complete ACL rupture)
Group C (acute phase with positive MRI for partial ACL rupture)
Group D (chronic phase with positive MRI for partial ACL rupture). .
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Clinical assessment was performed with:
Lachman test
Anterior Drawer test
Pivot Shift test
Lever Sign test
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[A]
The Lever Sign test involves placing a fulcrum under the patient’s calf and applying a downward force to the quadriceps.
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Depending on whether the ACL is intact or not:
the patient’s heel will either
[B]
rise off of the examination table .
[C]
or remain down. .
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Additionally, the Lever Sign test was performed on the un-injured leg of all 400 patients as a control.
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RESULTS:
All tests were nearly 100 % sensitive for patients with chronic, complete tears of the ACL. .
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However, for patients with acute, partial tears, the sensitivity was much lower for:
Lachman test (0.42)
Anterior Drawer test (0.29)
Pivot Shift test (0.11)
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But sensitivity for the Lever Sign test was (1.00) for patients with acute, partial tears
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CONCLUSIONS:
In general, chronic, complete tears were most successfully diagnosed but acute, partial tears were least successfully diagnosed. .
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The Lever Sign test is more sensitive to correctly diagnosing both acute and partial tears of the ACL compared with other common manual tests. .
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CLINICAL RELEVANCE:
Some ACL ruptures may be more accurately diagnosed with the Lever Sign
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SOURCE:
Lelli, et al. 2016. The “Lever Sign”: a new clinical test for the diagnosis of anterior cruciate ligament rupture.