WADDELL’S TESTING:

1) Superficial Non-Anatomic Tenderness: [negative] the patient was moderately squeezed and light-touch was applied at/over the wrist region, the elbow region, the temples, the ankles region and knee region. With the exception of the right posterior knee and thigh hypersensitivity, there were no inappropriate pain responses. The patient was also extremely sensitive to light touch over the lumbar and cervical spine. All responses to non-anatomic regions were appropriate. There was hypersensitivity; however, this is attributed to the phenomenon of “Central Sensitization” and “Fear-Avoidance” and NOT malingering.

2) Over Reaction: [negative] the patient responded appropriately to all orthopedic testing and, in this examiners opinion, did not overreact. She was very sensitive and even fearful to palpation over the cervical and lumbar spine; however, this is – again – is attributed to the phenomenon of "Central sensitization” and “Fear-Avoidance,” rather than malingering.

3) Axial Loading of the Spine: [positive] axial loading of the spine produced neck and low back pain; however, simple passive rotation of the hips and shoulder did not produce patient pain. Axial loading of the damaged disc material (this patient does have a confirmed central disc protrusion in the lumbar spine) certainly could and does cause pain, especially in patients who are "sensitized" and suffer from fear avoidance.

4) Straight Leg Raise: [negative] Prone vs. Seated: as noted in the AMA-Guide prescribed “Accessory Validity Test,” the patient’s prone testing nearly matched her seating testing, which reproduced right posterior knee pain. There was about 15° difference between the two, which is normal in this evaluator’s opinion.

5) Non-Sensory Dermatome Loss & Cogwheel Rigidity: [negative] I found no cogwheel rigidity or global dermatomal sensory loss. The only loss of sensation was found specifically in the right L5 and S1 dermatome, as the patient did not perceive light touch or vibration well in these areas.