A proposed neuroanatomical basis of Waddell's nonorganic signs

Gordon Waddell's "Nonorganic Signs," published in 1980, indicates psychosocial factors that predict an unsuccessful surgical outcome for lumbar discectomy. Since then, they have been used by many to"prove" there is nothing physically wrong with such people, regardless of the site of injury, and even suggest they are faking. Although this was never Waddell's intent and there is no scientific basis for such belief, these signs continue to be used to discredit motor vehicle accident claimants. Recent advances in neuroanatomy now allow us to explain all these signs on the basis of known mechanisms and to understand that many are the result of maladaptive physical responses. They should be called behavioral responses to physical assessment and be used to promote more effective management.