Welcome back to another episode of Malanga Talks. Today, we will discuss the three most common causes of axial low back pain and how to differential between the various etiologies. Also, we will discuss the true meaning of the Waddell sign and how to interrupt these clinical findings. Waddell sign was first described by an orthopedic surgeon named Dr. Gordon Waddell, who identified patients likely to have a poor prognosis following back pain surgery. However, this sign has been misinterpreted by clinicians and insurance companies to detect malingering. These Waddell signs include overreaction, distraction, regional sensory disturbance and weakness, axial loading, superficial or non-anatomic tenderness. A score of 3 or more out of the five categories is considered a positive test. This significant finding should prompt clinicians to utilize psychological and behavioral management for low back pain. We hope you enjoy this learning experience, and this episode makes you a better future physician.

Introduction (0:00)

· Overview on axial low back pain and clinical patient presentation (0:30)

· Discogenic back pain symptoms and presentation (3:00)

· Understanding the pathophysiology of a straight leg test (6:55)

· An overview of Waddell sign (8:30)

· What are the 5 Waddell signs? (9:20)

· Non-organic pain (11:20)

· Facet vs. sacroiliac joint mediated pain symptoms (19:18)

· Discussing a positive diagnostic branch block (20:00)

· How to treat and approach a patient that exhibits Waddell’s sign (23:50)

· How to approach a patient that does not meet Waddell’s sign criteria (28:50)

· Clinical patient presentation following a motor vehicle accident (31:30)

· What is a maximal medical improvement? (38:00)