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.