Adam's Test (Forward Bend Test) for Scoliosis: How to Do It

Adam's test at a glance

The Adam's test, also called the Adams forward bend test, is a quick visual check for scoliosis and scoliotic posture. You need no equipment, only a second person, good light and a bare back. It takes a few minutes and works for children and adults alike.

Stand behind the person so that you look at their back at a right angle; feet hip-width apart, arms relaxed, back bare.
The person slowly lowers the head, then the chest, and bends forward vertebra by vertebra into a deep forward bend.
Look along the contours of the back: is one half higher or more prominent, does the spine deviate to one side, is there a rotation?
Check the shoulder blades, shoulders, waist and buttocks for differences in height and shape.
On the way back up, check once more for any unevenness on the trunk.

The full explanation, a video and a checklist follow below.

What is the Adams test?

The Adams forward bend test is used to detect scoliosis in children and adults alike. It is a simple test you can do at home. During the test we watch the child's back while they bend forward and look for any unevenness. This makes it easy to find out in a home setting whether a child has scoliosis or scoliotic posture. Stand behind the child so that you look at their back at a right angle. The child stands with feet hip-width apart and arms relaxed. Their back should be bare so that you can see the curvature of the spine clearly. Now the child slowly lowers the head, then the chest, and bends vertebra by vertebra through the whole back into a deep forward bend.

Meanwhile we observe the contours of the back. We look for any deviations that are uneven. This may be a difference between the left and right half of the back, any sideways deviation of the spine, or an outright rotation. The rotation forms in the ribs and the spine and pushes one half of the chest backwards and the other forwards. In the forward bend this shows as a change in the shape of the back. Most scoliotic curves deviate in the left lumbar or right thoracic area, but it can be anywhere. We also check whether one shoulder blade sits higher than the other and whether both have the same shape, whether the shoulders are level, and we watch the shape and height of the gluteal muscles. We also check whether the waist is more indented on one side than the other. The greatest difference between the right and left half of the back is usually visible in the full forward bend. On the way back up we check once more for any deviation or unevenness on the trunk. Another indicator of scoliosis in children can be a markedly flat foot or asymmetric ankles.

What to look for during the Adams test:

can you see any difference between the left and right half of the back?
is the spine deviated to one side or the other?
are the shoulder blades at the same height?
do the shoulder blades have the same shape?
are the shoulders level?
are both buttocks at the same height?
do the buttocks have the same shape?
is one foot noticeably flat?

With a non-scoliotic spine you should see no difference at all. If you do see marked differences, it is likely that your child has at least poor posture.

Photographs showing how to perform the Adams test can be found HERE.

What to do if you see differences in the back is described in the article How to recognize scoliosis in children — from orthopaedics, a corset where needed, to rehabilitation. If you only suspect scoliosis or poor posture, we recommend seeing a physiotherapist. For an indicative measurement of spinal rotation at home you can also use the scoliometer in the Spiralista app.

What does a positive Adam's test mean?

In scoliosis the spine is rotated. The rotation forms in the ribs and the spine and pushes one half of the chest backwards and the other forwards, so in the forward bend it shows as a change in the shape of the back: one side stands out and a hump rises on one side. If you see a marked difference like this, the test is positive. That is a reason to see a specialist, not a diagnosis.

With scoliotic posture the situation is different. The asymmetry you see in the standing position, such as one shoulder higher or one shoulder blade sticking out, evens out in the forward bend, because the spine is not rotated around its axis, it is only held crooked.

What the Adam's test cannot tell you

The test shows that the back is uneven, but not how large the curve is. A scoliometer, a device that looks a little like a spirit level, complements the test with a more precise measurement of spinal rotation. A digital version is free in the Spiralista app: Free scoliometer in the Spiralista app. The exact curve is determined by a doctor at an orthopaedic clinic, usually with an X-ray of the whole spine.

Why check regularly

A scoliotic curve in a child can worsen quickly in a short time, and a paediatrician may not notice the change at occasional check-ups. That is why it is worth looking at the child's back at home regularly, especially while the child is growing. Early detection of a small curve is an important prerequisite for successful conservative treatment of idiopathic scoliosis in children, as described in the article Scoliosis in the child population.

What to do if the test is positive

If you see marked differences, do not wait to see whether the child grows out of it. The usual path, described in the article How to recognize scoliosis in children, has three steps:

Orthopaedics – an orthopaedic clinic takes an X-ray to determine the degree of the curve.
Corset therapy – if the X-ray shows a larger curve, a customised corset may be made.
Rehabilitation – a physiotherapist or doctor draws up a rehabilitation plan and shows you how to exercise at home.

If you only suspect poor posture, we recommend seeing a physiotherapist. How the Spiral stabilization method approaches exercise is described in Spiral stabilization, and you can browse the exercises in the exercise library.

Frequently asked questions

What is the Adam's test?

The Adam's test, or Adams forward bend test, is a simple visual check in which a person bends forward and the observer looks at the back from behind for unevenness. It is used to detect scoliosis and scoliotic posture in children and adults.

Can I do the Adam's test at home?

Yes, it is designed as a simple home test. You need a second person to look at the bare back from behind while the person slowly bends forward.

What does the Adam's forward bend test show?

It shows unevenness: a difference between the left and right half of the back, a sideways deviation of the spine, a rotation, shoulder blades, shoulders or buttocks at different heights, or a waist that is more indented on one side.

Is a positive Adam's test the same as scoliosis?

No. A positive test means the back is uneven. Whether it is scoliosis or scoliotic posture, and how large the curve is, is decided by an examination, not by the test alone.

What is the difference between the Adam's test and a scoliometer?

The Adam's test is a visual check of the back. The scoliometer measures the degree of spinal rotation during the same forward bend and gives a more precise value.

How often should I check my child's back?

Our articles recommend regular checks at home without fixing an interval, because a curve can change quickly and occasional check-ups may miss it. Ask your physiotherapist what is sensible for your child.