Spine examination: the Adams forward-bend test and Schober test !

Maneuver

Bending forward reveals the rib hump of scoliosis (Adams), and measuring how much the low-back skin stretches shows whether the lumbar spine is stiff (Schober).

Updated 2026-11-01

See it in 3D: L1 vertebra · L5 vertebra · Ribs (back part) · Sacrum · T6 vertebra · T12 vertebra

What it is

The spine exam includes standing inspection, palpation, range of motion and two high-yield maneuvers. The Adams test shows the vertebral rotation of scoliosis as a rib or lumbar hump. The Schober test measures lumbar flexion and is classic in ankylosing spondylitis. Both are quick and done with the patient standing.

The anatomy it tests

In scoliosis the vertebrae shift sideways and rotate; as they rotate they carry the ribs, which form the hump on the convex side.
Bending forward brings the thoracic and lumbar spine horizontal and makes this rotation visible.
Lumbar flexion separates the spinous processes of L1 to L5 above the sacrum; if the joints are fused or inflamed, the skin stretches less.
In ankylosing spondylitis inflammation starts in the sacroiliac joints and climbs the spine; it also limits chest expansion.

How to do it

Patient standing barefoot with the back exposed; inspect from the front, back and side: shoulders, shoulder blades, iliac crests and curves.
Adams: feet together, knees straight, arms hanging with palms together; ask the patient to bend forward until the back is nearly horizontal.
The examiner stands behind, eyes at back level, and looks for one side of the chest or lower back sitting higher.
Positive Adams: an asymmetric rib or lumbar hump; rotation can be measured with a scoliometer.
Schober: mark the skin on the line joining the lumbosacral dimples, another mark 10 cm above and another 5 cm below.
Ask the patient to bend forward as far as possible with knees straight and measure the distance between the outer marks again.
Normal Schober: the distance grows by 5 cm or more; a smaller increase means limited lumbar flexion.
Finish with palpation of the spinous processes, motion in every plane and the neurological exam of the legs.

What a positive result means

Rib hump on Adams: structural scoliosis, most often adolescent idiopathic, usually with a thoracic curve convex to the right.
A curve that disappears on bending: postural scoliosis or a leg-length difference, not structural.
Left thoracic curve, significant pain or a neurological deficit: look for a non-idiopathic cause (tumour, syrinx, neuromuscular disease).
Schober under 5 cm: ankylosing spondylitis or another spondyloarthritis; also severe pain or vertebral fusion.
Back pain that improves with exercise, worsens with rest and causes morning stiffness: inflammatory pattern.
Fever, weight loss, a history of cancer, trauma or a neurological deficit with back pain: red flags.

Usefulness and limits

Adams: common errors are not asking for feet together and knees straight, or looking from too far away.
A leg-length difference can mimic scoliosis: level the pelvis before reading the test.
Schober: a wrong starting mark changes the result; radiographs confirm scoliosis (Cobb) and sacroiliitis.

Test yourself

Think of the answer, then tap the question to see it.

What finding makes the Adams test positive?

An asymmetric rib or lumbar hump on bending forward, from vertebral rotation in structural scoliosis.

What Cobb angle defines scoliosis?

Ten degrees or more on the radiograph.

How is the modified Schober test done and when is it abnormal?

Marks are placed 10 cm above and 5 cm below the line of the lumbosacral dimples; it is abnormal if the distance grows by less than 5 cm on flexion.

Which type of scoliotic curve calls for a search for a non-idiopathic cause?

A thoracic curve convex to the left, especially with significant pain or a neurological deficit.

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See it in 3D

The structures of Durgical's 3D anatomy where it is found.

← All of the clinical exam

Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis.

Sources: Adolescent Idiopathic Scoliosis: Diagnosis and Management (American Family Physician (American Academy of Family Physicians), 2014); Ankylosing spondylitis: MedlinePlus Medical Encyclopedia (MedlinePlus, U.S. National Library of Medicine, 2026); Musculo-Skeletal Examination – Lower Back Exam – Practical Guide to Clinical Medicine (UC San Diego School of Medicine, 2026).

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Representative model, for educational purposes only.