Schober Test

Last updated on: October 31, 2025

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How to perform the Schober test?
What is the positive Schober Test?
Accuracy
Notes
Modified Schober Test
Ankylosing Spondylitis
MCQ Questions
References

Schober Test is used to diagnose the restriction of lumbar spine flexion in patients with inflammatory arthropathy, particularly ankylosing spondylitis. The test serves as a measure of lumbar flexion range of motion and is also a useful tool for assessing the effectiveness of interventions designed to improve this range, such as exercise, physical therapy, and spinal manipulation.

How to perform the Schober test?

The examiner asks the patient to stand erect. From the posterior aspect, a line is drawn connecting the two posterior superior iliac spines, which is the level of S2. From the midpoint of this line, a point is marked 10 cm straight up in the midline. Now the examiner asks the patient to bend forward keeping the knees straight. The distance between the two points is measured again in this position.

See Also: Spine Movements

What is the positive Schober Test?

In a normal person the measured distance should increase from 10 cm to at least 15 cm.

In a patient with Ankylosing spondylitis, forward flexion is limited, and the measured distance does not increase by 5 cm (positive Schober Test).

Accuracy

A study on 449 randomly selected patients with low back pain, the sensitivity and specificity of Schober’s test was:

Sensitivity: 30%
Specificity: 86%

A systematic review and meta-analysis study was published in the Journal of Orthopaedic & Sports Physical Therapy in 2022 found that the Schober test is a reliable and valid measure of lumbar flexion range of motion. The study also found that the Schober test is a useful tool for assessing the effectiveness of interventions for improving lumbar flexion range of motion.

Notes

Schober test is a useful tool for assessing the effectiveness of interventions for improving lumbar flexion range of motion. A number of studies have shown that interventions such as exercise, physical therapy, and spinal manipulation can improve lumbar flexion range of motion, as measured by the Schober test.

Modified Schober Test

With the patient standing, the examiner marks the level of the lumbosacral junction. Then mark two points, one 10 cm above (a) and the other 5 cm below (b) the level of the lumbosacral junction (distance between the two points (a and b) being 15 cm). The patient is asked to bend forwards and attempt to touch their toes with the knees kept straight.

Measure the distance between the two points, a and b.

Normally, the length of the dorsal aspect of the spine should appear to increase about 6 cm (the distance between the two points, a and b). Excursion of much less than this amount suggests the presence of ankylosing spondylitis, particularly if a kyphotic deformity is present.

The modified version of the test is included in the BASMI (Bath Ankylosing Spondylitis Metrology Index), which is a tool used to define clinically significant changes in spinal movement for patients with ankylosing spondylitis.

Bath Ankylosing Spondylitis Metrology Index (BASMI) Interpretation Criteria (based on the difference in measurements):

Mild limitation: The difference lies above 4 cm.
Moderate limitation: The difference lies between 2 to 4 cm.
Severe limitation: The difference is less than 2 cm

Modifed Schober’s Test — Modified Schober Test – The distance should increase about 6 cm when bending forward

Ankylosing Spondylitis

Pain starts before the age of 40 especially in male of upper back pain with more than 3 months history, insidious onset, and worse in early morning with associated sacroiliitis features alleviated by exercise.

Increasing dorsal kyphosis with stiffness with restrictive lung disease limiting chest expansion and severe disease can cause hip arthritis and hip fusion. This results in hunch back deformity, chin to chest deformity, flexion deformity of the hip with fusion of spine obvious in X-ray as bamboo spine.

ankylosing spondylitis — Snkylosing Spondylitis

MCQ Questions

Q1: What is the primary clinical purpose of performing the Schober test?

A. To measure the degree of scoliosis or lateral spine curvature. B. To diagnose the restriction of lumbar spine flexion, particularly in conditions like ankylosing spondylitis. C. To assess for nerve root impingement in the lumbar spine. D. To evaluate the range of motion in hip flexion and extension.

Q2: During the standard Schober test, what is the initial vertical distance marked on the patient’s back from the midpoint of the posterior superior iliac spines?

A. 15 cm B. 5 cm C. 10 cm D. The level of S2

Q3: A patient’s measurement in a standard Schober test increases from 10 cm to 13.5 cm upon forward flexion. How is this result interpreted?

A. The result is inconclusive B. Hyper-flexibility of the lumbar spine C. Positive Schober Test D. Normal lumbar flexion

Q4: What is the key difference in the initial markings between the standard Schober test and the modified Schober test described in the OrthoFixar source?

A. The standard test measures from S1, while the modified test measures from the lumbosacral junction. B. The standard test measures a single 10 cm segment upwards, while the modified test measures a 15 cm segment spanning above and below a landmark. C. The standard test measures 15 cm and the modified test measures 10 cm. D. The standard test requires the patient to be sitting, while the modified test is done standing.

Q5: According to the BASMI categories mentioned in the Physiotutors video, an increase of less than 2 cm during a modified Schober test indicates what level of lumbar flexion limitation?

A. Moderate limitation B. Mild limitation C. No limitation D. Severe limitation

Q6: In the Modified Schober Test, the initial distance marked on the patient’s back is 15 cm. Upon full forward flexion, the distance measures 21 cm. What does this result indicate?

A. Limited range of motion, as the increase is less than 10 cm. B. An error in measurement, as the distance cannot increase that much. C. A positive test for ankylosing spondylitis, as the distance increased. D. Normal range of motion, as the increase is approximately 6 cm.

Q7: Ankylosing spondylitis, a condition often assessed with the Schober test, is characterized by several key features. Which of the following descriptions aligns with the source material’s profile of this disease?

A. Pain localized to the cervical spine that improves throughout the day. B. Insidious onset of pain, worse in the early morning, and alleviated by exercise. C. Pain that begins after age 50 and is relieved by rest. D. Acute onset of pain that radiates down one leg.

References

Macrae IF, Wright V. Measurement of back movement. Ann Rheum Dis. 1969 Nov;28(6):584-9. doi: 10.1136/ard.28.6.584. PMID: 5363241; PMCID: PMC1031291.
The Schober test: A systematic review and meta-analysis. Journal of Orthopaedic & Sports Physical Therapy, 2022.
Schober P. Lendenwirbelsaule und Kreuzschmerzen. Munch Med Wschr 1937;84:336.
Gran JT. An epidemiological survey of the signs and symptoms of ankylosing spondylitis. Clin Rheumatol. 1985;4:161-169.
Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.
Sarvdeep S. Dhatt, Sharad Prabhakar – Handbook of Clinical Examination in Orthopedics.
Netter’s Orthopaedic Clinical Examination An Evidence-Based Approach 3rd Edition Book.

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