What Are Positive Waddell Signs?

Lower back pain can be caused by psychological factors.
Lower back pain can be caused by psychological factors. (Image: Hemera Technologies/PhotoObjects.net/Getty Images)

People who have been injured, particularly on the job, sometimes exaggerate or fake pain behaviors for financial incentive or to avoid work. It can be difficult to determine whether a patient's pain has a legitimate physical cause. A physician named Dr. Waddell determined that there are eight different signs that indicate that a patient's pain behaviors are either made up or caused by psychological factors. These tests are referred to as the Waddell's sign or Waddell's test.

Exaggerated Response

Exaggerated pain behaviors can be an indicator of a positive Waddell's sign. This assessment is subjective -- determined by the opinion of the evaluator. It is more reliable if the patient responds to a particular touch or test position with less complaints of pain at a different time during the evaluation. These exaggerated behaviors can include yelling, facial expressions, flinching, wincing or crying.

Generic Pain Complaints

Pain complaints that are generalized to an entire body part or extend over large areas of the body can be considered to be a positive Waddell's sign. The patient may complain of severe pain with very light touch in multiple locations. These pain complaints do not follow anatomical patterns. For example, each spinal nerve causes tingling or pain in a specific area of the arm or leg when it is irritated. Patients might complain of pain in areas supplied by multiple spinal nerves.

Simulated Maneuvers

There are several different maneuvers that appear to be legitimate tests to the patient, however should not be painful because body structures are not actually being manipulated in a way that would cause pain. One maneuver is called axial loading, where the evaluator pushes straight down on the patient's head while it is in a neutral position. Another is passive rotation of the hips and shoulders together, rotating the spine as a unit, or rotating the legs without rotating the spine. These tests are positive if the patient complains of pain.

Straight Leg Raise

Nerve compression at the lower spine will cause pain during a straight leg raise -- the patient is laying on his back and his leg is lifted into the air by the evaluator. To determine whether this pain is legitimate the test is first performed in a sitting position. The evaluator will distract the patient while passively moving the "injured" leg into a position where the knee is straight. If the patient does not respond to this, but later complains of pain with the straight leg raise, the test is considered to be positive. A legitimate spinal nerve compression will cause pain in both positions.

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