Schober Test

Original Editor - Shauni Van Overstraeten Top Contributors - Vidya Acharya, Kim Jackson, Jolien Wauters, Shauni Van Overstraeten, WikiSysop, Lucinda hampton, Kai A. Sigel, Chelsea Mclene and Anne Dixie Lim

Purpose

Schober’s test is classically used to determine if there is a decrease in lumbar spine range of motion (flexion), most commonly as a result of ankylosing spondylitis..

The measurement of this test is useful for

• Screening the status of ankylosing spondylitis disease
• Determination of progression and therapeutic effects of ankylosing spondylitis and other pathologic conditions associated with low back pain.

Technique

Schöber Test

• Patient is standing, examiner marks the L5 spinous process by drawing a horizontal line across the patients back.
• A second line is marked 10 cm above the first line.
• Patient is then instructed to flex forward as if attempting to touch his/her toes, examiner remeasures distance between two lines with patient fully flexed.
• The difference between the measurements in erect and flexion positions indicates the outcome of the lumbar flexion .

Modified Schober Test (eliminates the errors in identification of lumbosacral junction and makes sure that the entire lumbar spine was included

• Patient is standing, examiner marks both posterior superior iliac spine (PSIS) and then draws a horizontal line at the centre of both marks
• A second line is marked 5 cm below the first line.
• A third line is marked 10 cm above the first line.
• Patient is then instructed to flex forward as if attempting to touch his/her toes, examiner remeasures distance between the top and bottom line. .

Interpretation

For both versions of the test, an increase of less than 5cm is a positive test and may indicate ankylosing spondylitis (AS). (Image shows region of spine mainly involved in AS)

Positive Schober’s Test

Less than 5cm increase in length with forward flexion: Decreased lumbar spine range of motion, ankylosing spondylitis

Clinical Notes

This test is almost exclusively associated with Ankylosing Spondylitis but may also be positive due to a decrease in lumbar range of motion due to pain or congenital anomalies or segmental fusion.

Evidence

1. Original Schöber Test
   The validity against radiographs was according to Macrae. strong (r=0.90), according to Rahali-Khachlouf. moderate (r=0.68).
   The interclass (r=0.90) and intraclass (r=0.96) reliability was found to be excellent.
2. Modified Schöber Index
   The validity against radiographs was according to Macrae. strong (r=0.97), according to Rahali-Khachlouf. moderate (r=0.59).
   The interclass (r=0.92) and intraclass (r=0.96) reliability were found to be excellent.
3. Modified-modified Schöber Test
   The validity of the modified-modified Schober test is moderate (r=0.67) with an excellent interclass (r=0.91) and intraclass (r=95) reliability.