Adams Forward Bend Test

Adams Forward Bend Test is used to assess the structural or functional scoliosis of the spine. It’s usually used in school as a screening test for scoliosis.

See Also: Physical Fitness Tests

How do you do the Adams test for scoliosis?

The patient may be seated or standing. The examiner stands behind the patient and asks the patient to bend forward, sliding the hands down the front of each leg.

What is a positive Adams Forward Bend Test?

This test is performed in patients with detectable scoliosis of uncertain etiology or as a screening examination in patients with a family history of scoliotic posture.

If the scoliotic posture improves during forward bending, then the condition is a functional scoliosis; whereas if the scoliotic deformity remains with the same projection of the ribs and the lumbar distortion observed in upright posture, the condition is true scoliosis with structural changes.

A leg-length discrepancy may create a false positive.

Positive findings in those who are skeletally immature warrant referral to a physician for further evaluation.

Accuracy

One study revealed that the Interexaminer agreement for Adams forward bend test is substantial in the thoracic spine and poor in the lumbar spine. Adam’s forward bend test is more sensitive than the Scoliometer in detecting thoracic curves measuring 20 degrees or more by the Cobb method.

A scoliometer is an instrument that is used to estimate the amount of curve in a person’s spine, it’s is run along the patient’s spine from caudal to cephalad while the patient is in the position assumed for the Adam’s forward bend test.

Rib hump becomes more prominent in a flexed position. Rib hump is seen on the side of convexity of a spinal curve, but anterior rib hump is prominent on the side of concavity of the spinal curve.

Notes

Technically, spine is an asymmetrical cylinder with long anterior and short posterior distance. With forward flexion the anterior distance is ‘cramped’ and posterior distance ‘open’ up if the spine is straight.

It is imperative to the fact that unless there is advanced anterior wedging of vertebrae which is uncommon, the scoliosis is actually a lordotic deformity most prominent at the apex.

Forward flexion compresses the lordosis and buckles out the lordosis to side, making rotation more prominent. In a rotational deformity where the anterior part of spine (vertebral body) has rotated away from their anatomical location, the ‘fixed’ deformities would get accentuated by virtue of the technically ‘posterior line’ now getting compressed, and throwing rotated vertebral bodies further into disarray.

While the compensatory curves ,by virtue of being flexible, realign to reproduce the normal biomechanics and hence ‘reduce’.

Adams test tells the following:

1. Site of primary curve.
2. Flexibility of spine.
3. By virtue of accentuation of curve, the test also tells us the ‘future’ of ongoing process in terms of expected outcome.

Flexibility of Curve can be measured as the following:

Three-point bending test: With the shoulders and pelvis stabilized, an attempt is made to correct the deformity at the apex by pushing it.

Unweighting of the curve: The child is lifted of the ground with the examiner’s hands in the axilla.

Postural, Compensatory and Structural Scoliosis

Postural scoliosis: A curve that corrects totally on bending forward/lying down/traction or other maneuvers. Clinically there is NO rotation of vertebrae (this defies the definition of “scoliosis”- however there is supposedly no other better term!), there is no structural change.

Compensatory scoliosis (secondary curve/ minor curve): Curve developed as a compensatory measure to ‘structural’ or pathological defect elsewhere. There may be rotation but it is NOT FIXED (except otherwise in ‘intermediate idiopathic scoliosis’ where the compensatory curve also show clinical rotation, this type is fortunately uncommon). The curve and rotation disappears if the primary ‘defect’ elsewhere is corrected.

Structural scoliosis: the structural defect lies in the curve which shows FIXED ROTATION of vertebra and spinous process (and ribs). This rotation is persistent on clinical examination and needs intervention to correct.

‘Postural and compensatory’ are etiological terms and are not technically subset of each other so always choose the correct word!

References

1. Côté P, Kreitz BG, Cassidy JD, Dzus AK, Martel J. A study of the diagnostic accuracy and reliability of the Scoliometer and Adam’s forward bend test. Spine (Phila Pa 1976). 1998 Apr 1;23(7):796-802; discussion 803. doi: 10.1097/00007632-199804010-00011. PMID: 9563110.
2. Clinical Tests for the Musculoskeletal System 3rd Edition.