Mennell's Sign / Mennell's Test (Latest 2022)

What is Mennell’s Sign?

The Mennell’s sign or Mennell’s test is one of the pain-provocation tests that is used to assess degenerative processes in the sacroiliac joint.

This test was created by James Mennell, an orthopedic doctor, to detect spondyloarthropathy conditions such as Ankylosing Spondylitis.

Procedure for Performing the Mennell’s Sign

There are generally two procedures for performing the mennell’s sign. One is the Classic Extension Method, and the other is the Three-phase hyperextension method.

Let me first explain to you the classic extension test method

Let us assume that the examiner is examining the left sacroiliac joint of the patient.

Position of the Patient – The patient lies in a prone position.

Examiner’s Role

The examiner immobilizes the patient’s sacrum with his left hand. In other words, the examiner manually puts pressure on the SI joint with his left hand. While simultaneously grasping the patient’s extended left leg with his right hand and suddenly hyperextending that left leg (patient’s left hip).

Test Results

Mennell’s sign is positive if the patient feels familiar pain in the hip region. If the patient does not feel any pain in the hip region, then it doesn’t mean that it excludes damage to the SI joint. This test was further developed into the three-phase hyperextension test to get the more exact results.

What is the Three-Phase Hyperextension Test?

The three-phase hyperextension test (or mennell’s test) is used to differentiate between the involvement of the sacroiliac joint, lumbar spine, or hip joint. In other words, the three-phase hyperextension test is used to differentiate whether the problem is due to the sacroiliac joint, lumbar spine, or hip joint.

How To Perform the Three-Phase Hyperextension Test?

Well, while researching on the procedure of the three-phase hyperextension method. We found out that the procedure mentioned in books is quite different from the procedure mentioned on youtube. So we will explain both of the procedures.

When there is a controversy between the two methods and you are in clinical practice. Do one thing perform the test by using both the methods. You’ll find by yourself only which method works best for you.

Let’s understand both methods. We have mentioned both the methods below (book & youtube). Therefore for better understanding, we have also embedded the video of the youtube method below.

The procedure of performing the three-phase hyperextension test is divided into 3 phases.

Starting position of the patient – The patient lies in a prone position. The starting position of the patient remains the same (prone) in all three phases of the test.

Phase 1 – To check if the pain is coming from the Hip joint

Book Method

In this phase, the examiner grasps the patient’s extended leg with his right hand and raises it into hyperextension while immobilizing the pelvis with the left hand.

Youtube Method

The examiner will fixate the pelvis on the tuber ischiadicum into the ventral caudal direction with his left hand. And with the right hand, the examiner will grab the patient’s ipsilateral leg (same side leg) from the inside to create an internal rotation. This is a hip closed-packed position, and now after grabbing the patient’s ipsilateral leg (same side leg) from the inside, the examiner will bring the leg into hyperextension. For a better understanding, you can watch the below-embed video.

Phase 2 – To check if the pain is coming from the SI joint

Book Method

In this phase, the examiner grasps the patient’s extended leg with his right hand and passively raises it into hyperextension while passively immobilizing the patient’s sacrum parallel to the SI joint with the left hand.

Youtube method

The examiner will fixate the sacrum below its pivoting point at S2 in the ventral caudal direction with his left hand. And with the right hand, the examiner grasps the patient’s ipsilateral leg (same side leg) and raises the leg into hyperextension.

Phase 3 – To check if the pain is coming from the Lumbar spine

Book Method

In this phase, the examiner grasps the patient’s extended leg with his right hand and passively raises it into hyperextension while passively immobilizing the 5the lumbar vertebrae with the heel of the left hand. By moving the immobilizing hand up the spine, the examiner can also assess higher sections of the lumbar spine.

Youtube method

The examiner will fixate the Th12 (thoracic 12) vertebrae in the ventral caudal direction with a pinch grip. And now, with the right hand, the examiner grasps the patient ipsilateral leg (same side leg) and raises the leg into hyperextension.

What does a positive Three-phase hyperextension Test Mean?

If the condition is normal, there will be no pain in any phase of the test.
The hip joint should allow about 10-20 degrees of hyperextension.
The sacroiliac joint should show slight movement (joint play), and the lumbar spine should allow elastic hyperextension (lordosis) at the lumbosacral junction.

Results

Result of Phase 1 (Hip Joint)

Pain, when the ilium is immobilized, indicates a muscle contracture (rectus femoris/ or psoas) or a hip disorder.

Result of Phase 2 (SI Joint)

Pain, when the sacrum is immobilized, indicates a motion restriction of the sacroiliac joint or other disorder of the SI joint, like ankylosing spondylitis.

Result of Phase 3 (Lumbar Spine)

Pain, when the lumbar spine is immobilized, indicates protrusion or extrusion of an intervertebral disk or vertebral motion restriction.