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Waddell's signs

Devised by Scottish orthopedic surgeon Gordon Waddell, MD, presence of more than 3 or 4 of these signs on physical examination suggests that back pain may be exaggerated or the result of emotional distress rather than or in addition to physical injury.

  • Superficial tenderness to light touch on the skin.
  • Nonanatomical tenderness: The pattern does not conform to related anatomic structure.
  • Gentle pressure on the top of the head produces a complaint of back pain.
  • Simulated (truncal) rotation produces complaint of pain.
  • Straight-leg raised while patient is distracted results in a) low back or posterior thigh pain, b) diminishing pain with continued raising, or c) severe pain at only 10º.
  • Nonanatomical sensory change.
  • Sudden or uneven weakness on strength testing (give way weakness).
  • Exaggerated responses or responses which cannot be reproduced.

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