Instructor: The axial loading test is used to detect non-physiologic low back pain. Gentle, downward pressure is applied to the top of the standing examinee’s head. This should not cause or increase low back pain. Some examiners, to help avoid potential malpractice claims, have the examinee perform this test with their own hand. Reports of low back pain are non-physiologic.

Man 1: Okay. I’m going to do some other tests to understand your pain. I’d like you to take your hand, put it on your head. Now, press down, press down.

Man 2: Oh, yeah. Right into my back.

Man 1: It’s causing pain in your back when you press down?

Man 2: Yeah.

Man 1: Okay. You can relax. Let me just put your arms back down on the side.

Instructor: Truncal rotation is also known as en bloc rotation of the torso. It is often used in assessing low back pain. With the physician holding the standing examinee’s palms against his lateral hips, the torso, upper extremities, neck, and head are, as a unit, gently, passively rotated leftward and rightward. There is no motion of the lumbar spine since the rotation actually occurs at the hips. Reports of accompanying low back pain, therefore, suggest symptom magnification, deception, or malingering.

Man 1: Okay. So, I just want you to put your arms down the side, just like this. Okay. And just move.

Man 2: Oh, oh, oh.

Man 1: Where’s that bothering you?

Man 2: My back.

Man 1: Your back?

Man 2: Yeah. Yeah. That’s it. I don’t wanna do that anymore.