What is the role of nonphysiologic testing (Waddell signs) is the assessment of mechanical low back pain?

Updated: Mar 30, 2020
  • Author: Everett C Hills, MD, MS; Chief Editor: Stephen Kishner, MD, MHA  more...
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Nonphysiologic testing (Waddell signs) should be performed. The presence of 3 or more positive findings out of the 5 types may be clinically significant in terms of psychosocial issues or poor surgical outcome. Isolated positive signs are of limited value.

Nonorganic tenderness consists of the following:

  • Superficial - Skin tenderness to light pinch over a wide area of lumbar surface

  • Nonanatomic - Deep tenderness over a wide area, often extending cephalad to the thoracic spine or caudad to the sacrum

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