The Mennell Sign Test, also called the Three Phase Hyperextension Test, is used to assess symptom response during staged extension loading of the lumbar spine, sacroiliac joint and hip region. A positive test is usually reproduction of the client’s familiar pain during one phase of the test. The location and phase of symptom reproduction may help guide further assessment, but the test does not diagnose lumbar, sacroiliac or hip pathology on its own.
The Mennell Sign Test is commonly described as a prone orthopaedic test that applies staged extension stress to help differentiate whether symptoms appear more lumbar, sacroiliac or hip-related.
It is often associated with:
low back pain
sacroiliac joint region pain
buttock pain
anterior hip or groin symptoms
pain during hip extension
unclear lumbar, SIJ or hip symptom sources
The test is sometimes presented as three phases:
lumbar spine extension loading
sacroiliac joint stress
hip joint extension stress
This can be useful educationally, but it must be interpreted cautiously. Pain location and symptom reproduction can support assessment reasoning, yet they do not confirm the exact tissue or condition.
Current clinical education sources describe the Mennell or Three Phase Hyperextension Test as a quick prone test used to assess lumbar, sacroiliac and hip response, but high-quality diagnostic accuracy evidence for the exact test is limited.
Test name: Mennell Sign Test
Also known as: Mennell’s Test, Three Phase Hyperextension Test
Body region: Lumbar spine, sacroiliac joint and hip
Client position: Prone
Main movement: Passive hip extension with staged stabilisation
Positive finding: Reproduction of familiar pain during a specific phase
Negative finding: No familiar pain or meaningful symptom reproduction
Main limitation: Limited direct diagnostic accuracy evidence for the exact test
The Mennell Sign Test is a prone orthopaedic test where the professional extends the client’s hip while using different stabilisation positions to bias different regions.
The aim is to observe whether passive extension reproduces familiar symptoms in:
lumbar spine region
sacroiliac joint region
buttock region
anterior hip or groin region
posterior thigh region
The test should be treated as a symptom provocation and localisation test, not a diagnostic confirmation test.
The test may help professionals:
explore whether hip extension reproduces familiar symptoms
compare lumbar, SIJ and hip-region responses
identify which region may need further assessment
guide test selection, such as SIJ provocation cluster or hip ROM tests
record symptom behaviour clearly
educate clients about movement-related symptom response
It is most useful when combined with history, movement testing, neurological screening where relevant, hip ROM and other sacroiliac or lumbar tests.
The Mennell Sign Test assesses:
symptom response to passive hip extension
pain location during different stabilisation phases
lumbar, SIJ or hip-region sensitivity to extension loading
side-to-side symptom difference
movement tolerance
guarding or apprehension
It does not directly assess:
sacroiliac joint structure
disc pathology
nerve root compression
hip labral integrity
femoroacetabular impingement
inflammatory sacroiliitis
tissue healing
sport or work readiness
This test may be useful for professionals assessing clients with:
low back pain
buttock pain
SIJ-region pain
groin or anterior hip symptoms
pain with walking stride, running or hip extension
unclear lumbar/hip/SIJ symptom presentation
It is suitable only when the client can safely lie prone and tolerate gentle hip extension.
Consider the Mennell Sign Test when:
symptoms are reproduced with hip extension
pain location may involve lumbar, SIJ or hip regions
a client reports pain with stride, running, bridging or prone extension
you need a structured way to compare left and right sides
you want to decide whether further lumbar, SIJ or hip testing is appropriate
Use caution or avoid the test when there is:
recent trauma
suspected fracture
recent hip, pelvis or lumbar surgery
severe or worsening neurological symptoms
high-irritability back, hip or groin pain
inability to lie prone
hip extension restriction that causes sharp pain
suspected inflammatory or systemic condition requiring medical review
pregnancy or postpartum pelvic pain where prone positioning is uncomfortable
client fear, guarding or distress
Stop if symptoms escalate, become sharp, spread distally, or do not settle when the limb is returned to neutral.
Usually no equipment is required.
Helpful options:
plinth or firm treatment table
pillow if prone positioning needs modification
pain rating scale
body chart
Measurz assessment record
Explain the test:
“We are going to gently lift your leg while you lie face down and monitor where you feel symptoms. This test does not diagnose a condition by itself. Tell me if the pain is familiar, where you feel it and how strong it is.”
Record baseline:
pain score
symptom location
side tested
familiar symptoms
prone comfort
hip extension tolerance
Client lies prone.
Head and trunk relaxed.
Legs straight unless modified.
Pelvis level.
Shoes removed if they affect positioning.
Stand beside the tested leg.
Support the distal thigh or lower leg.
Use the other hand to stabilise the pelvis or lumbar region depending on the phase.
Move slowly and monitor symptoms continuously.
Stabilise the pelvis lightly.
Lift the thigh into gentle hip extension.
Observe whether symptoms appear in the lumbar region.
Stabilise the sacrum or pelvis more firmly.
Extend the hip again.
Monitor for familiar SIJ-region or buttock pain.
Stabilise the pelvis to reduce lumbar and pelvic movement.
Extend the hip while observing anterior hip, groin or thigh symptoms.
Compare with hip extension ROM and other hip tests if needed.
Different teaching sources describe these phases slightly differently, so record the exact version used. Current clinical education descriptions commonly frame the test as a staged prone hyperextension test for lumbar, SIJ and hip-region symptom response.
Passive hip extension.
Slow and controlled.
Do not force end range.
Compare left and right sides.
Ask:
“Where do you feel that?”
“Is that your familiar pain?”
“Does it feel like back, buttock, groin, hip or leg pain?”
“Rate it from 0 to 10.”
“Does it spread, sharpen or ease?”
A positive finding is reproduction of the client’s familiar symptoms during one phase of the test.
Examples:
lumbar pain during lumbar-biased phase
SIJ-region or buttock pain during pelvic/sacral stabilisation
anterior hip or groin pain during hip-biased extension
clear side-to-side difference in familiar symptoms
A negative finding means:
no familiar pain is reproduced
symptoms are not meaningfully changed
hip extension feels similar on both sides
only non-familiar stretch or pressure is reported
Stop if:
pain becomes sharp or escalating
neurological symptoms increase
symptoms spread further down the leg
the client cannot relax or tolerate prone
hip extension feels unsafe
the client asks to stop
A positive Mennell Sign Test may increase suspicion that the tested movement or region is relevant to the client’s symptoms.
Depending on the phase and symptom location, it may suggest the need to further assess:
lumbar extension sensitivity
sacroiliac joint pain provocation
hip extension restriction
anterior hip or groin symptoms
posterior pelvic pain
lower-limb neural symptoms if symptoms travel distally
A positive test does not confirm a lumbar, SIJ or hip diagnosis. Pain can be influenced by joint sensitivity, muscle guarding, hip flexor stiffness, lumbar extension sensitivity, neural sensitivity or general irritability.
A negative test may reduce suspicion that prone hip extension loading is a major symptom driver at that time.
However, a negative test does not exclude:
sacroiliac joint pain
hip pathology
lumbar-related pain
nerve involvement
movement sensitivity in other positions
Further assessment may still be needed if the history, symptoms or function remain suggestive.
At the time of writing, high-quality peer-reviewed diagnostic accuracy evidence reporting sensitivity, specificity or likelihood ratios for the Mennell Sign Test itself appears limited.
This means the test should be interpreted as a clinical reasoning tool rather than a stand-alone diagnostic test.
For sacroiliac joint pain more broadly, the strongest evidence supports clusters of SIJ pain provocation tests, not isolated tests like Mennell’s. A 2021 systematic review with meta-analysis assessed clusters of SIJ pain provocation tests and found that clustered tests may be more useful than a single test, but accuracy still varies by population, study design and reference standard.
A commonly cited SIJ provocation-test study reported that three or more positive SIJ provocation tests had sensitivity of 94% and specificity of 78% against diagnostic injection in that study context, but this does not apply directly to the Mennell Sign Test unless the same test cluster and reference standard are used.
Plain-language interpretation:
A positive Mennell Sign may guide further assessment, but it does not confirm the pain source.
A negative Mennell Sign may be reassuring, but it does not exclude lumbar, SIJ or hip involvement.
Likelihood ratios for this exact test are not well established.
SIJ interpretation is stronger when multiple pain provocation tests reproduce the client’s familiar pain.
Direct reliability and validity evidence for the Mennell Sign Test appears limited.
For SIJ testing more broadly, research suggests that pain provocation clusters have better support than motion palpation or isolated manual tests. A study comparing motion palpation and pain provocation tests with SIJ block as a reference standard found that diagnostic performance depends strongly on test type and reference standard.
A systematic review on palpatory SIJ mobility tests found limited support for many palpatory tests and reported better intra-examiner agreement for some sitting flexion-type tests, but this evidence should not be transferred directly to Mennell’s Sign.
Reliability improves when the professional records:
exact phase used
side tested
stabilisation method
symptom location
familiar versus unfamiliar pain
pain score
movement range
client guarding
stopping reason
comparison side
Common errors include:
calling the test diagnostic
forcing hip extension
not recording which phase reproduced symptoms
not asking whether the pain is familiar
confusing hip flexor stretch with a positive test
ignoring lumbar extension compensation
not comparing both sides
interpreting SIJ pain from one test alone
failing to record symptom location clearly
Limitations:
limited direct diagnostic accuracy evidence
different protocol variations exist
pain location can be non-specific
prone position may not suit all clients
hip extension restriction may alter the test
guarding can change results
positive findings need follow-up testing
negative findings do not exclude pathology
The Mennell Sign Test can help professionals:
document symptom response to hip extension
compare lumbar, SIJ and hip-region symptom behaviour
decide whether to assess SIJ provocation cluster tests
decide whether hip ROM or hip special tests are needed
monitor symptom irritability over time
educate clients using safe language
support referral decisions when symptoms are concerning
It is most useful when combined with:
lumbar flexion and extension ROM
hip extension ROM
hip quadrant or FADIR/FAIR tests if relevant
SIJ compression, distraction, thigh thrust and sacral thrust tests
Slump Test or Straight Leg Raise if leg symptoms are present
pain history and functional task review
Record:
Test name: Mennell Sign Test
Side tested: left, right or both
Result: positive, negative, unclear or unable to test
Phase: lumbar-biased, SIJ-biased or hip-biased
Pain score: before, during and after
Symptom location: lumbar, SIJ region, buttock, groin, anterior hip, thigh or leg
Symptom quality: sharp, ache, stretch, pressure, numbness, tingling
Familiar pain: yes, no or unsure
Movement direction: passive hip extension
Position used: prone, modified prone or unable
Comparison side: same response, different response or not tested
Confidence in result: high, moderate or low
Irritability: low, moderate or high
Compensations: pelvis lift, lumbar extension, rotation, guarding
Reason for stopping: pain, guarding, symptoms, client request or no issue
Related findings: SIJ cluster tests, hip ROM, lumbar ROM, Slump, SLR, gait
Interpretation note: “Finding supports assessment reasoning but does not diagnose a condition.”
Retest date: if monitoring over time
Recording these details improves repeatability, communication, client education, assessment reasoning, monitoring over time, team consistency and reporting quality.
It assesses symptom response during passive hip extension in prone, with staged stabilisation intended to bias lumbar, sacroiliac or hip-region loading.
A positive test is reproduction of the client’s familiar pain during one phase of the test. The phase and symptom location help guide further assessment.
No. It may increase suspicion when symptoms match the history and other findings, but it does not confirm SIJ pain on its own.
The phases are used to observe whether symptoms appear more lumbar, SIJ-region or hip-region related during controlled hip extension loading.
A negative test means familiar symptoms were not reproduced. It may reduce suspicion for symptoms related to this movement, but it does not exclude lumbar, SIJ or hip involvement.
No. It is best used with history, lumbar and hip ROM, SIJ provocation tests and neurological screening where relevant.
No. It can support assessment reasoning, but readiness decisions need symptoms, strength, function, workload, confidence and professional judgement.
The Mennell Sign Test is a prone staged hip extension test.
It is used to observe lumbar, SIJ and hip-region symptom response.
A positive test reproduces familiar symptoms during one phase.
A negative test does not exclude lumbar, SIJ or hip involvement.
Direct diagnostic accuracy evidence for this exact test is limited.
SIJ interpretation is stronger when using validated provocation clusters.
Record side, phase, pain score, symptom location and familiar pain.
Use the result as part of a broader assessment, not as a diagnosis.
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Dreyfuss, P., Michaelsen, M., Pauza, K., McLarty, J., & Bogduk, N. (2009). Validity of physical exam maneuvers in the diagnosis of sacroiliac joint pain. Pain Medicine, 10(2), 255–262. https://doi.org/10.1111/j.1526-4637.2008.00531.x
Nejati, P., Safarcherati, A., & Karimi, F. (2020). Accuracy of the diagnostic tests of sacroiliac joint dysfunction. Journal of Chiropractic Medicine, 19(1), 28–37. https://doi.org/10.1016/j.jcm.2019.12.002
Saueressig, T., Owen, P. J., Diemer, F., Zebisch, J., & Belavy, D. L. (2021). Diagnostic accuracy of clusters of pain provocation tests for detecting sacroiliac joint pain: Systematic review with meta-analysis. Journal of Orthopaedic & Sports Physical Therapy, 51(9), 422–431. https://doi.org/10.2519/jospt.2021.10469
Szadek, K. M., van der Wurff, P., van Tulder, M. W., Zuurmond, W. W. A., & Perez, R. S. G. M. (2009). Diagnostic validity of criteria for sacroiliac joint pain: A systematic review. The Journal of Pain, 10(4), 354–368. https://doi.org/10.1016/j.jpain.2008.09.014
