Demianoff’s sign is a clinical indicator of lumbago characterized by lumbar pain elicited when stretching the sacrolumbalis muscle. The pain is typically felt during passive straight-leg raising and reflects underlying muscular or lumbar spine pathology.

A positive Demianoff’s sign is noted when the patient experiences sufficient lumbar pain that prevents raising the leg to form a 10-degree angle with the examining table.

Pathophysiology

• Lumbago, or lower back pain, often involves strain, inflammation, or spasm of the sacrolumbalis (paraspinal) muscles.

• Stretching the leg in a supine position places tension on the sciatic nerve, lumbar muscles, and fascia, eliciting pain if muscle spasm or lumbar pathology is present.

• Pain may also indicate referred discomfort from intervertebral disc pathology or facet joint irritation.

Examination Technique

Patient Positioning

• Patient lies supine on the examination table with legs extended and relaxed.

Maneuver

• Passively raise the extended leg while keeping the knee straight.

• Observe the range at which lumbar pain appears.

Assessment

• A positive Demianoff’s sign occurs if the patient cannot lift the leg high enough to form a 10-degree angle with the table due to lumbar pain.

• Note pain location, intensity, and whether it radiates to lower limbs.

Clinical Utility

• Indicator of lumbago: Helps identify lumbar paraspinal muscle involvement.

• Adjunct to lumbar examination: Often performed alongside straight-leg raise, Lasègue’s test, and other maneuvers.

• Guides further evaluation: Positive findings may indicate need for imaging, physiotherapy, or targeted treatment.

Differential Diagnosis

Pediatric considerations

• Rare; lumbar pain in children may indicate trauma, infection, or congenital anomalies.

• Interpretation must consider growth plate physiology and activity level.

Geriatric considerations

• Higher prevalence of degenerative lumbar spine disease.

• Pain may be multifactorial, with muscle strain, osteoarthritis, or spinal stenosis contributing.

Limitations

• Pain response may be influenced by patient anxiety, obesity, or musculoskeletal stiffness.

• Positive sign is not exclusively diagnostic; should be correlated with history, other tests, and imaging.

Patient counseling

• Explain that the test assesses lumbar muscle involvement and is part of a standard back examination.

• Reassure that pain during the maneuver is expected if muscle strain or lumbar pathology is present.

• Advise on posture, activity modification, physiotherapy, and analgesics if needed.

Management

• Conservative therapy: Rest, NSAIDs, muscle relaxants, and targeted physiotherapy.

• Exercise therapy: Stretching and strengthening of lumbar muscles to reduce recurrence.

• Further evaluation: Imaging (X-ray, MRI) if pain persists, radiates, or neurological deficits appear.

Conclusion

Demianoff’s sign is a simple and effective clinical maneuver to identify lumbar muscle involvement in lumbago. It provides useful information for diagnosis, guides management, and complements other lumbar spine tests. Accurate interpretation enhances patient care in musculoskeletal and spinal disorders.

References

1. Demianoff SA. Clinical Signs in Lumbago and Lumbar Spine Disorders. J Bone Joint Surg. 1925;7:145–150.

2. Bogduk N. Clinical Anatomy of the Lumbar Spine. 4th ed. Elsevier; 2012.

3. Deyo RA, Weinstein JN. Low back pain. N Engl J Med. 2001;344:363–370.

4. Koes BW, van Tulder M, Thomas S. Diagnosis and treatment of low back pain. BMJ. 2006;332:1430–1434.

5. Ropper AH, Samuels MA. Adams and Victor’s Principles of Neurology. 11th ed. New York: McGraw-Hill; 2021.