What Are the Most Useful Osteopathic Tests?

Each of us will regularly use a number of tests when examining patients, each test having a part to play in providing a complete diagnosis. Tests also help to evaluate a patient’s response to treatment, as well as to serve as differential diagnosis during the initial consultation.

Some tests tend to be more reliable than others, and many tests in the teaching manuals are rarely used because they are forgotten in time.

Please think of some of the tests you like to use in practice.

• When and why do you use them?

• What is your rational in using one whilst excluding others?

• Do you conduct some tests all the time and with every patient?


I’ve listed three tests below that I regularly use with more or less every patient as they help me understand flexibility patterns, gait, specific areas of weakness and stress levels. I test them regularly and mark them as +/- and on an objective scale of 0-10 (high=excellent, low=poor)

I also ask the patient to provide their subjective input using the same criteria.


• Adam’s Test
This gives a simple visual test for pelvic symmetry and is used in functional or anatomical scoliosis assessment. In addition to the static test, which allows for the diagnosis of short leg conditions, the patient can be asked to conduct an active version of this test. Lateral flexion, flexion and rotation of the trunk on the pelvis may be a useful addition to diagnosing limited active range.

Adams test is a simple tool, which relies on visual parameters. Frequently it is helpful to assess the subject’s active ranges from a distance, as well as close up.

During the active assessment of flexion of the trunk on the pelvis, the assessor’s eyes are lined up horizontally with the Posterior Superior Iliac Spines, with their thumb positioned over the PSIS landmark.

A positive Adams is seen when the spinal column loses its vertical plane relative to the pelvis. The thoraco-lumbar spine produces a torsional deviation from the vertical. One side of the lumbar spine will produce a concavity, the other a convexity. The quadratus lumborum will be palpably shorter on the concave side.

In dynamic short leg conditions where the soft tissues are asymmetric due to factors such as fascial contraction, spasm or nerve irritation, the degree of asymmetry will change quickly over a few days when treatment commences.

In anatomical or fixed cases where contraction of tissues has occurred over time and with associated calcification and stenosis of adjacent joints, reversal is not anticipated.

• Fabre Patrick Test
The Fabre assessment is used in determining hip flexibility, and is also affected by the tension levels of the soft tissues, which support hip and knee function. The subject is in supine with each hip being assessed independently to allow comparative values.

Ask the subject to stretch the hip slowly towards hip flexion, abduction and external rotation, as this can add a dynamic component to the test. By then placing the soles of each heel together (contracting adductor longus and the posterior hip extensors) this action will lift the pelvis upward.

This additional procedure may be helpful to assess muscular co-ordination and tone, though it introduces a complexity to the basic test. By adding abdominal input to the primary active muscle groups being assessed, the assessor can gain an insight into the patient’s ‘core’ stability.


• Adrenal Stress Test
Osteopathic medicine acknowledges the viscero-somatic reflex pattern in common illnesses. When internal organs are subject to abnormal physiological stressors, they produce local as well as distal signs and symptoms via the ANS.

Frank Chapman in the 1930’s and latterly Irvine Korr and JM. Hoag researched and identified many of these reflex networks. These are now used in daily clinical practice to differentially diagnose and treat levels of tissue dysfunction, which had been initially identified as of simple musculoskeletal origin.

The Chapman’s reflex point for the adrenals is immediately overlying bi-laterally the 12th rib, on the costo-vertebral joint. It is situated immediately below the subcutaneous fatty and connective tissues, and attached to the lumbo-dorsal fascia, sacrospinalis and the medial side of quadratus lumborum.

Moderate pressure is applied to the point (in a slightly inferior to superior direction), initially to locate the point. Having located the point positively, then the practitioner needs to identify the degree of reflex spasm produced by the patient. A simple verbal response is obtained to confirm/deny tenderness.

A further level of pressure-induced tenderness may be elicited to provide the degree of adrenal fatigue. This can also be recorded as necessary.


Perhaps you had some unexpected responses and still don’t know what the underlying problem was, then please offer it up for discussion.

If this topic finds popularity we should be able to build up a compendium of practical tests, and share some useful clinical tips within the osteopathic community.