What are Waddells signs?
Although most back pain is organic, some patients present with complaints of low back pain that are manifestations of a psychosomatic disorder. To distinguish anatomic (organic) back pain from nonorganic, Waddell and colleagues found eight signs that identify nonorganic back pain. Distinguishing between these two possibilities may be clinically relevant as patients with clinical findings outlined by Waddell are less likely to respond to surgical and medical interventions and are at increased risk for disability, healthcare utilization, and have higher rates of depression, pain-related anxiety, and catastrophizing. Armed with this knowledge, clinicians can more appropriately intervene on behalf of patients and may minimize unnecessary testing or surgical intervention. Patients satisfying three or more of Waddell’s signs may have a nonanatomic cause for their low back pain.
• Superficial tenderness—discomfort to light touch to skin overlying back.
• Nonanatomic tenderness—tenderness that crosses multiple somatic boundaries or moves to various sites during the exam.
• Axial loading— report of low back pain when pressing down on the top of the head of a standing patient.
• Simulated rotation—when the shoulders and pelvis are rotated in unison <30 degrees (i.e., acetabular rotation test) in either direction, the structures in the back are not stressed. If patient reports pain with this maneuver, this test is considered positive.
• Distracted straight-leg raise—report of pain in low back or posterior thigh with <10 degrees of elevation of leg when supine, or pain with standard straight-leg raise test when a patient is recumbent but no pain when the patient is sitting and the knee is extended so that the leg is at a 90-degree angle with the pelvis.
• Regional sensory change—“stocking” or global distribution of numbness, not in dermatomal distribution.
• Regional weakness—“breakaway” weakness in patient with normal strength on muscle testing.
• Overreaction—disproportionate grimacing, tremor, exaggerated verbalization, or collapse in a way not to hurt themselves during the exam.