Back Pain, Waddell's Signs of Nonorganic Component
[select name="Q1" value="no=0|YES=1"] <-- 1. Tenderness: Positive is generalized tenderness overlying the entire lumbar area when skin is lightly pinched or rolled.
[select name="Q2" value="no=0|YES=1"] <-- 2. Simulation: The object of these tests is to give the patient the impression that a specific test is being performed when in fact it is not.
• Axial loading: Positive when low back pain is reported on vertical loading over the standing patient's skull by the examiner's hands. Neck pain is common and should be discounted.
• Rotation: Positive if low back pain is reported when shoulders and pelvis are passively rotated in
the same plane as the patient stands relaxed with feet together.
[select name="Q3" value="no=0|YES=1"] <-- 3. Distraction: The object of this test is to distract the patient in such a way that a positive result under normal testing circumstances becomes negative in the distracted patient. The most useful test involves Straight Leg Raising (SLR). When the patient complains of pain doing SLR while supine but does not complain of pain doing SLR while sitting, the test is positive. This test is commonly referred to as the "flip test."
[select name="Q4" value="no=0|YES=1"] <-- 4. Regionalization: Pain distributions are a function of known anatomic pathways and structures. Interpretation of the exam depends on patient giving non-anatomic or non-physiologic responses to testing.
• Weakness: Positive test is a voluntary muscle contraction accompanied by recurrent giving way,
producing motions similar to a cogwheel. Patient may show weakness on testing but have adequate
• Sensory: Alterations to sensibility to touch and pinprick occur in a non-anatomic pattern (stocking-glove distribution or diminished sensation over entire half or quadrant of body).
[select name="Q5" value="no=0|YES=1"] <-- 5. Overreaction: Disproportionate verbalization, facial expression, muscle tension, tremor, collapsing or sweating. Consider cultural variations.
Count --> [calc memo="result" value="score1=(Q1)+(Q2)+(Q3)+(Q4)+(Q5)"] / 5 Waddell's Signs
Interpretation --> [calc memo="result" value="score1=(Q1)+(Q2)+(Q3)+(Q4)+(Q5);score1>2?'High probability of non-organic pathology - further psychologic evaluation recommended':'Negative screen for non-organic pathology'"]
[checkbox memo="display/hide references" name="footnotes" value=""][conditional field="footnotes" condition="(footnotes).is('')"]
[link url="//www.ncbi.nlm.nih.gov/pubmed/6446157" memo="#1"] Waddell G, McCulloch JA, Kummel E, Venner RM. Nonorganic physical signs in low-back pain. Spine (Phila Pa 1976). 1980 Mar-Apr;5(2):117-25.