What is a Forward Bending Test?

Also known as the ‘Adams Test’, a forward bending test is a standard test used by health professionals to evaluate a patient’s scoliosis. It’s a simple test that involves having a patient stand and bend over at a 90-degree angle.

Advantages of a Forward Bending Test

A forward bending test is a simple, noninvasive test used to evaluate a patient’s spine. The test is a go-to for medical professionals conducting an exam on a patient who’s concerned they might have scoliosis.

As adolescent idiopathic scoliosis is the most common form of the condition, it’s often parents and caregivers who have the concern that their child might have an abnormally curved spine. 

A forward bending test requires no equipment, meaning it’s a noninvasive and accessible method for parents and caregivers to gauge if there are any potential issues with a child’s spine. This can also reduce the need for taking extra X-rays and reducing radiation exposure.

Advantages of a Forward Bending Test.

Early Diagnosis

The main advantage to any form of scoliosis testing is that it can lead to early diagnosis and treatment. While an early diagnosis is helpful in a number of medical conditions and diseases, when it comes to progressive conditions like scoliosis, early detection can have significant benefits in terms of implementing an effective treatment plan.

Scoliosis is a complex condition that can take many forms.

  • Ranging from mild to severe, the symptoms that are commonly experienced by people with scoliosis range from subtle to noticeable. 
  • The first sign of scoliosis is that the shoulders aren’t level.
  • Usually, the right shoulder is higher than the left.
  • By the time the shoulders aren’t level, that would be an indication for an Adam’s Test with a scoliometer. 
  • This would also apply if one leg appears shorter than the other or the hips aren’t balanced.

The fact that mild scoliosis carries very few, if any, noticeable symptoms in adolescents poses a big challenge in terms of diagnosing the condition early. 

  • The big advantage of diagnosing scoliosis early is initiating treatment before the condition has progressed in severity and the body has adjusted to the curvature. 
  • There’s a strong correlation between early diagnosis and successful treatment. While it is never too late to start treatment, patients who discover their scoliosis early on have an advantage over those whose conditions aren’t diagnosed until they’ve experienced significant progression.
  • While the nature of the condition itself makes it difficult to diagnose, the adolescent age group it most commonly affects, from 10 to 18 years old, poses another challenge.

Why Adolescents Might Hide Their Condition

  • The absence of pain and noticeable symptoms, in certain forms of the condition, make it difficult for an average person or caregiver to spot. When you think of the age group most commonly affected by the condition, we’re talking about 13-, 14-, 15-year-old kids. This age group isn’t exactly characterized by transparency and confidence.
  • Regardless of how close you are to your child, there is still a real possibility that they’ll try to hide the condition. If a 15-year-old boy notices one day that his spine looks or feels different, or that he’s walking differently from his friends, a common response is to conceal. 
  • At this age, it’s common for kids to want to blend in; they don’t want to stand out as different from their peers, so they might see the changes to their body as something to be embarrassed about and hide. It’s not uncommon for these kids to spend time in front of the mirror practicing how to hide any postural asymmetries.
  • Avoiding embarrassment is a strong motivation among tweens and teenagers; they get very good at hiding any postural abnormalities that might develop as a result of their scoliosis.

Why Adolescents Might Hide Their Condition.

The Hunchback Stigma and Popular Culture

In addition to the natural reaction of adolescents to hide their condition due to embarrassment, we also have to acknowledge that there’s still a strong stigma attached to deformities of the spine.

Most people have seen or heard of The Hunchback of Notre Dame. Books and movies of this nature are powerful forces in popular culture and impact how society as a whole sees and feels about ‘hunchbacks’. While the term is no longer seen as politically correct, its damage is still felt.

Adolescents are especially vulnerable to the dictates of popular culture and this is important to keep in mind. Between popular movies and books, commercials and social media, there is a real push for people to look and feel their best; this can be a real issue for adolescents in terms of feeling pressure to have that perfect look or perfect body.

Scoliosis carries a heavy psychological effect; because of this, we feel that ‘hump’ should not be used in discussing the condition. We feel that ‘arch’ is a better word without the negative connotations.

Common Concealment Methods to Watch For

If you’re the parent or caregiver of an adolescent, don’t lose hope. Not all adolescents will automatically hide their condition should they discover it on their own, but being aware of the tendency and signs to watch for can help those who might:

  • Wearing a lot of black clothing.
  • Wearing hoodies to conceal the upper back.
  • Excessive time spent in front of the mirror.
  • Wearing a T-shirt when swimming to conceal the back.

Parents experience a lot of guilt for not noticing their loved one’s scoliosis sooner; this is rarely the parent’s fault. In cases of neuromuscular scoliosis, I’ve seen curvatures progress as much as 17 degrees in a single month, making it look like the condition appeared overnight.

The best thing a parent or caregiver can do is inform themselves and make every effort to have an open dialogue with their adolescents. 

  • Don’t be afraid to ask if they’ve noticed any changes to their body they’re confused about or want to talk about. The worst they can do is say no, but at least they know you’re there, you’re interested, and the dialogue has been opened.
  • If you suspect a spinal condition, the forward bending test is something you can conduct yourself at home, followed by a visit to your general practitioner or a scoliosis specialist for X-rays and an official diagnosis. 

Have an open dialogue.

The Process of a Forward Bending Test

For a health professional or parent to perform a forward bending test, the patient or individual would be asked to first stand straight. Then they would be asked to bend forward at a 90-degree angle as if they are touching their toes. The parent or doctor performing the test would stand behind them.

In this position, the back will be visually assessed for the presence of a rib arch. When examining a scoliosis patient bending forward, you’re going to see a rib arch more pronounced on one side. Rib arches are primarily more prominent on the right side of the body, as that’s where 80 percent of kids develop scoliosis.

The forward bending test can tell us where a curvature is along the spine, but a more reliable method is to combine the forward bending test with a Scoliometer. 

  • A scoliometer is a small device with a bubble in it that is run up and down the spine to measure trunk asymmetry. 
  • The scoliometer is placed on the individual’s spine as they are bending forward.
  • The reading for scoliosis is measured in degrees and can show how much the spine is tilted in the area. 
  • Cell phone apps called ‘scoliometer’ can be searched.
  • While not a diagnostic tool, it can help give parents an idea when a child should be checked.
  • 7 degrees on a Scoliometer usually equal 20 degrees on an X-ray.

Combining a forward bending test with the use of a scoliometer has become an accepted method for indicating the presence of scoliosis. We recommend that with a scoliometer reading of 4 degrees, an assessment by a CLEAR Scoliosis Institute doctor should be performed.

Scoliometer Test

While standard medical treatment would suggest watching and waiting at 4 degrees, here at CLEAR, we disagree. The sooner scoliosis is diagnosed, the sooner it can be corrected, especially at 11 to 20 degrees.

Understanding Spinal Biomechanics

Spinal biomechanics refers to the mechanics of the spine and how its components work individually and collectively to maintain stability. It also includes how traumas and disorders exert their destabilizing effects on the spine.

It is the principle of spinal biomechanics that makes a curvature and related asymmetries more visible when bending forward. As a patient bends forward and goes into flexion, adverse mechanical tension is placed directly on the spinal cord all the way from the neck into the lower back. 

What happens is the spinouses (bumps on the back of the spine), instead of rotating normally to the right side, are going to rotate to the left side. When the spinal cord is under stress, in flexion, or bending forward, that becomes very apparent to the point that you can see the presence of a rib arch and other asymmetries.

When the spine loses the healthy curves that provide it with strength and flexibility, the body will respond by adding new curves, but those cures aren’t healthy ones, and this is how the body attempts to restabilize itself.

Conclusion

As the nature of progressive conditions, such as scoliosis, is to worsen, the goal is to diagnose the condition as early as possible so treatment can be started before significant progression has occurred and the body has adjusted to the curvature.

The sooner scoliosis can be treated, the better the potential results will be.

People’s experience of living with scoliosis varies across a wide spectrum. Postural changes, the presence of pain, and other scoliosis-related symptoms depend on a number of factors including age, the condition’s cause, and the size and location of the curvature.

While a forward bending test, combined with a scoliometer, can’t replace the assessment and precise curvature measurements of an X-ray, it can indicate that there is a likelihood of the condition and that further testing should be done.

In dealing with adolescent idiopathic scoliosis, diagnosing the condition can be difficult for a number of reasons: the absence of pain, subtle postural changes that are hard to spot, and the tendency for some adolescents to hide the changes happening to their bodies. 

The more severe the condition is, the more likely it is to produce noticeable postural changes and symptoms. In instances where an adolescent is likely to hide postural changes out of embarrassment, a forward bending test, combined with a scoliometer, is an accessible, noninvasive, and effective means of finding out if there is, indeed, cause for concern.

For parents and caregivers concerned scoliosis is a possibility, I would suggest a forward bending test combined with a scoliometer. A cell phone app can help and can be found by searching ‘scoliometer’ on a mobile device. Having a loved one stand straight and bend forward at a 90-degree angle makes the characteristic rib arch and other asymmetries more noticeable; this can be highly advantageous when it comes to confirming a diagnosis and initiating treatment.

Here at the CLEAR Scoliosis Institute, we encourage a proactive approach that benefits from early detection. A forward bending test is an effective and simple test that doesn’t require equipment and can be done safely at home. If you’ve conducted the test and noticed a rib arch or a general asymmetry to the body, a visit to the CLEAR Scoliosis Institute can provide you with an official diagnosis and a positive treatment plan.

Additional Resources:

“The author’s views are his or her own and may not reflect the views of CLEAR Scoliosis Institute.”

Author: Dr. Dennis Woggon

Dr. Woggon graduated cum laude from Palmer College of Chiropractic in 1974 and has been in practice ever since. He founded CLEAR Scoliosis Institute in 2000, and invented The Vibe Whole-Body Vibration Platform, Vibrating Traction, and the Scoliosis Traction Chair.
Reach out to Dr. Dennis Woggon

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