What do physical findings dissociated from physiological or anatomical principles suggest in the evaluation of chronic low back pain (cLBP)?

Updated: Aug 22, 2018
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Answer

Answer

Dissociation of physical findings from physiological or anatomical principles is the key with patients in whom psychological factors are suspected to be influential. Examples of this phenomenon include nondermatomal patterns of sensory loss, nonphysiological demonstrations of weakness (give-way weakness when not caused by pain, or ratchety weakness related to simultaneous agonist and antagonist muscular contraction), and dissociation between the lumbar spinal movements found during history-taking or counseling sessions from movements observed during examination.

The assessment of Waddell signs has been popularized as a physical examination technique to identify patients who have nonorganic or psychogenic embellishment of their pain syndrome. One of the examination techniques that Waddell proposed is simulated rotation of the hips en masse with the lumbar spine without allowing for spinal rotation; this maneuver normally does not cause pain. Another is the application of light pressure on the head, which should also be painless. Likewise, gentle effleurage of superficial tissues is unlikely to cause pain. Other techniques include a striking dissociation between testing straight leg raising with the patient sitting versus supine and the examiner's discovery of nonphysiologic weakness and/or sensory deficits by the patient.


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