NONORGANIC PHYSICAL SIGNS IN LOW BACK PAIN
(Waddell Signs)
- A Set of Five Types of Physical Signs
- Can Be Used to Screen Individuals Who Require Detailed Psychological
Assessment
- Scoring
- Any individual sign counts as positive for that type
- Three or more types positive = clinically significant
- The Signs
- Tenderness
- superficial - skin is tender to light pinch over a wide area of lumbar skin
- nonanatomic - deep tenderness over a wide area, not localized to one
structure, often extends to thoracic spine, sacrum, or pelvis
- Simulation Tests - give the impression that an examination is being done,
when in fact it is not
- axial loading - vertical loading over the standing patient’s skull by the
examiner’s hands - may cause neck pain, but shouldn’t cause low back
pain
- rotation - turn standing patient to one side by rotating lower extremities
(not spine)
- Distraction Tests - reevaluating a positive finding while the patient’s
attention is not focused on the test - distraction must be
nonpainful, nonemotional, and
nonsurprising
- indirect observation - can patient move the body part without pain when
not being directly examined?
- straight leg raise - if positive when examined supine,
do "flip test" (sitting SLR) - can be done while testing for
Babinski sign while sitting - if no pain in sitting then distraction sign
is positive
- Regional Disturbances - widespread divergence from accepted neuroanatomy
- weakness - "cogwheeling" or many muscle groups that cannot be
explained neuroanatomically
- sensory - "stocking" distribution of sensory changes
- Overreaction
- disproportionate verbalization, facial expression, muscle tension and
tremor, collapsing, sweating
- most difficult type of sign to asses because:
- cultural variation
- examiner bias
Waddell G, McCulloch JA, Kummel E, Venner RM: Nonorganic physical signs
in low-back pain. Spine, 5(2) 117-125, March/April 1980.