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.