Waddell's signs

Waddell's signs are a group of physical signs, first described in a 1980 article in Spine, and named for the article's principal author, Professor Gordon Waddell (1943–2017), a Scottish Orthopedic Surgeon. Waddell's signs may indicate non-organic or psychological component to chronic low back pain. Historically they have also been used to detect malingering in patients with back pain. While testing takes less than one minute, it has been described as time-consuming and alternatives have been proposed.

Use of Waddell's signs

Waddell, et al. (1980) described five categories of signs:

Tenderness tests: superficial and diffuse tenderness and/or nonanatomic tenderness

Simulation tests: these are based on movements which produce pain, without actually causing that movement, such as axial loading and pain on simulated rotation

Distraction tests: positive tests are rechecked when the patient's attention is distracted, such as a straight leg raise test

Regional disturbances: regional weakness or sensory changes which deviate from accepted neuroanatomy

Overreaction: subjective signs regarding the patient's demeanor and reaction to testing

Any individual sign marks its category as positive. When three or more categories were positive, the finding was considered clinically significant. However, assessing the patient on the basis of overreaction has raised concerns regarding observer bias and idiosyncrasies related to the patient's culture. Consequently, a practitioner may assess the patient on the remaining four categories, with two or more positive categories being considered clinically significant.

One or two Waddell's signs can often be found even when there is not a strong non-organic component to pain.