Adams Forward Bend Test

What is the Adam's Forward Bend Test?

The Adam's Forward Bend Test, also known as the Adam's Forward Bending Test or just the Adam's Test, is a physical examination developed to help healthcare professionals screen patients with scoliosis and determine whether they have functional or structural scoliosis.

Scoliosis is a spinal condition in which the spine has an abnormal lateral curvature, and the degree of the curvature varies depending on the person. If left unchecked, scoliosis can impact a person's quality of life and functional capabilities. Small curves indicating mild scoliosis are normally fine and do not cause any major problems except mild discomfort. However, extreme curves can adversely affect a person's body. Large curves can cause lung problems, can make ribs rub against the pelvis (which is something that definitely should not happen), and can even develop arthritis that damages the spinal joints, which can cause bone spurs to appear.

Scoliosis can be categorized into two main groups:

• Functional scoliosis: A temporary curve caused by factors like muscle spasms or leg length discrepancies. It becomes less visible or disappears when the patient bends forward.
• Structural scoliosis: A permanent spinal curve that remains present whether the patient is standing or bending forward.

While the Adam's Test is best used for differentiating between the two categories of scoliosis, it can also be done on individuals with no prior signs of scoliosis to screen them. In fact, it is a common part of school assessments and routine checks for adolescent idiopathic scoliosis, often done after a visual inspection to confirm suspected scoliosis. And since the test is extremely simple, it does not take a scoliosis specialist to do the test—school nurses, physical therapists, and family doctors routinely use it. It is best used with other tests for diagnosing scoliosis.

Have a look at this video to see a further explanation of the Adam's Forward Bend Test:

How to use our Adam's Forward Bend Test Template

Our Adam's Forward Bend Test Template provides healthcare professionals with fields to document observations and measurements while also including images to guide patients in taking the correct test positions. Follow these steps to use the template effectively:

Step 1: Access the template

Access the template by clicking the "Use template" button, which opens it in the Carepatron app for customization. Alternatively, you can click the "Download" button to save a non-customizable but fillable PDF version.

Step 2: Assess the patient

Begin by instructing the patient to stand upright with their shirt removed or wearing minimal clothing (such as a swimsuit) to ensure their back is fully visible. Evaluate their posture for signs of asymmetry and measure trunk asymmetry if needed using a scoliometer.

Step 3: Perform the forward bend

Have the patient bend forward at the waist, keeping their feet together, knees straight, arms hanging down with palms together, and head down. As the patient bends, look for signs like a characteristic rib arch or asymmetrical shoulders—important indicators for scoliosis.

Step 4: Document findings

Use the template to record your observations, including whether the scoliosis characteristics disappear (functional scoliosis) or become more pronounced (structural scoliosis). If you used a scoliometer, document the precise curvature measurements under the “Degree of rotation” field.

Step 5: Discuss results and next steps

After completing the test, explain the findings to the patient. If scoliosis is detected, guide the patient on the next steps, such as additional imaging tests for precise curvature measurements or consultations with specialists. Encourage patients to use the template themselves for monitoring, especially if undergoing treatment.

How to interpret the findings of the Adam's Forward Bend Test

Based on your visual inspection of the spine's curvature (lordosis/kyphosis), you can determine whether the patient is positive for scoliosis or negative. If you used a scoliometer during the Adam's Forward Bend Test, a reading of 7 degrees or more indicates the potential presence of scoliosis. If the patient is positive for scoliosis characteristics, when they bend forward, observe for other characteristics.

If the scoliosis characteristics become more pronounced when the patient bends forward—such as a rib hump or uneven shoulders—the test result is positive, indicating structural scoliosis. This type of scoliosis typically persists regardless of position and may require further imaging tests like X-rays to confirm the diagnosis and assess the degree of curvature.

The scoliosis is likely functional if the curvature decreases or disappears when the patient bends forward. Functional scoliosis often results from temporary factors such as poor posture, muscle imbalance, or leg length discrepancies.

What are the benefits of the Adam's Forward Bend Test?

The Adam's Forward Bend Test offers several advantages, making it practical and effective when screening for scoliosis and other spinal abnormalities.

Easy and effective

This test requires minimal equipment and can be performed quickly. Healthcare professionals observe the patient's back as they bend forward, looking for signs of asymmetry or rib humps. It is non-invasive and straightforward, often taking just a few minutes to complete.

Early detection of spinal abnormalities

The test enables early detection of spinal curvature issues, which is crucial because most patients are not diagnosed until they have experienced significant progression. If abnormalities are identified and categorized as functional, non-surgical interventions like bracing may help. Further imaging and specific treatments may be recommended in cases of structural scoliosis.

Monitoring of recovery progression

The Adam's Forward Bend Test can also be used to monitor scoliosis progression over time. It allows professionals to assess whether treatment plans, such as physical therapy or bracing, are effective or if scoliosis has worsened, indicating significant progression and a need to modify the treatment plan.