Orthopedic Tip of
NON-ORGANIC NECK PAIN SIGNS
Sobel and colleagues developed and assessed
the reliability of a group of non-organic signs
applicable to neck pain patients. 26 consecutive
patients with neck pain histories of more than
4 months were evaluted by 2 health care providers
for the presence of cervical non-organic signs.
As patterned afte the low back pain signs of
Waddell, the 5 signs consist of 7 tests as follows:
a. Superficial; patient reports pain with light
touch or pinching.
b. Non-anatomical; widespread tenderness outside
of the cervical/upper thoracic region to deep
a. Rotation of the head/shoulders/trunk/pelvis
3. Range of Motion
a. Patient rotates neck right and left as far
as possible (positive if > 50% deficit in
4. Regional Disturbance
a. Sensory loss: light touch or pinprick decrease
that is non-anatomical.
b. Motor loss: manual muscle testing with non-anatomical
weakness with "giveway weakness" or
observed normal strength but weakness when formal
tests are performed.
At any time during the examination, any of the
following are observed:
a. Moderate to extremely stiff, rigid, or slow
b. Rubbing the affected area for more than 3
c. Clutching, grasping, or squeezing the area
for more than 3 seconds
d. Grimacing because of pain
f. Disproprotionate verbalization
g. Muscle tension
The percent of agreement between the 2 raters
ranged between 68% and 100% with simulation
(seated test) being the lowest (68%) and regional
sensory disturbance being the highest (100%).
The average agreement was 84%. As the number
of positive signs increased, so did the percentage
of agreement. The test is considered positive
if 3 of 5 signs are present.
Rehabilitation of the Spine, 2nd Edition, Craig
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