Spine Orthopaedic Test: Kemp’s Test

Kemp’s Test, also called the lumbar quadrant test or extension-rotation test, is a lumbar spine special test that combines extension, rotation and side flexion to provoke symptoms. It is commonly used to support assessment reasoning around lumbar facet-region pain, foraminal narrowing, extension-sensitive low back pain or referred lower-limb symptoms.

A positive test may include reproduction of familiar local low back pain, buttock pain or leg symptoms during the test position. However, evidence for Kemp’s Test as a stand-alone diagnostic test for lumbar facet joint pain is limited and indicates poor diagnostic accuracy. The result should be interpreted alongside history, symptom behaviour, neurological screening, lumbar range of motion, repeated movement testing, functional assessment and other relevant findings.

Introduction

Kemp’s Test is one of the most commonly described lumbar spine special tests. It is performed by moving the lumbar spine into extension, rotation and side flexion, usually toward the symptomatic side. This position can load the posterior elements of the lumbar spine and may reduce space around the intervertebral foramen on the tested side.

The test is often associated with lumbar facet joint assessment, but this should be interpreted carefully. Lumbar extension and rotation can provoke symptoms from several sources, including facet-region structures, discs, neural tissues, foraminal narrowing, muscular guarding or general extension sensitivity.

Because multiple structures are stressed at the same time, Kemp’s Test should not be used to confirm lumbar facet joint pain or any other condition on its own. The test is best used as a symptom provocation and movement-tolerance assessment within a broader lumbar spine assessment.

For Measurz users, the key is to record the exact variation used, direction tested, symptom location, pain score, whether symptoms were familiar, whether symptoms referred below the buttock, and how the finding fits with the broader assessment.

Quick Summary

Test name: Kemp’s Test / Lumbar Quadrant Test / Extension-Rotation Test
Region: Lumbar spine
Primary purpose: Provoke symptoms with lumbar extension, rotation and side flexion
Commonly associated presentations: Extension-sensitive low back pain, lumbar facet-region symptoms, foraminal-closing sensitivity, referred lower-limb symptoms
Positive finding: Familiar local or referred symptoms reproduced during the test position
Negative finding: No familiar symptoms and no meaningful side-to-side difference
Main limitation: Evidence indicates poor diagnostic accuracy for diagnosing lumbar facet joint pain when used alone.

What Is Kemp’s Test?

Kemp’s Test is a lumbar spine special test that combines:

• Lumbar extension
• Lumbar side flexion
• Lumbar rotation

The test may be performed in standing, seated or modified positions. The standing version is common because it loads the spine in weight-bearing. The seated version may provide more control and reduce balance demands.

The professional guides the client into a combined extension-rotation-side-flexion position and asks whether familiar symptoms are reproduced.

The test may be performed toward:

• The symptomatic side
• The opposite side
• Both sides for comparison

The result is based on symptom reproduction, symptom location, intensity, referral pattern and comparison with the other side.

Why It Is Used

Kemp’s Test may be used to support assessment reasoning around:

• Lumbar extension sensitivity
• Lumbar facet-region symptom provocation
• Foraminal-closing sensitivity
• Local low back pain
• Buttock or posterior hip-region symptoms
• Referred lower-limb symptoms
• Side-to-side symptom comparison
• Movement direction sensitivity
• Baseline and retest documentation
• Selection of further lumbar assessment tests

The test can help identify whether combined extension and rotation reproduces familiar symptoms. It should not be used as proof of a specific pain source.

What It Assesses

Kemp’s Test assesses symptom response to combined lumbar extension, side flexion and rotation.

It may provide information about:

• Lumbar extension tolerance
• Lumbar rotation tolerance
• Local low back symptom reproduction
• Buttock or thigh symptom reproduction
• Leg symptom reproduction
• Side-to-side symptom difference
• Movement irritability
• Directional sensitivity
• Possible foraminal-closing sensitivity

It does not directly assess:

• Facet joint pathology with certainty
• Disc pathology with certainty
• Nerve root compression with certainty
• Imaging findings
• Segmental mobility with precision
• Lumbar strength
• Trunk endurance
• Functional capacity
• Readiness for sport or work
• Treatment needs

Who It Is Useful For

Kemp’s Test may be useful for clients with:

• Low back pain
• Extension-sensitive symptoms
• Pain with standing or walking extension
• Pain with twisting or turning
• Buttock or posterior hip-region symptoms
• Referred thigh symptoms
• Possible neural or foraminal features
• Sport or work tasks involving lumbar extension and rotation
• A need for clear symptom provocation recording

It may also be useful for professionals learning how combined lumbar movements influence symptom response.

When to Use This Test

Consider using Kemp’s Test when:

• The client reports pain with extension or rotation
• Lumbar facet-region involvement is part of the assessment reasoning
• Foraminal-closing sensitivity is being considered
• You want to compare left and right extension-rotation response
• You need to record symptom direction and referral
• You are building a broader lumbar spine assessment profile

The test is best used after screening for irritability, neurological features and red flags, and after observing basic active lumbar movement.

When Not to Use or When to Be Cautious

Use caution or avoid Kemp’s Test when:

• Severe or worsening neurological symptoms are present
• The client has suspected fracture, infection, cancer or other red-flag features
• The client has acute major trauma
• The client has severe pain before testing
• The client cannot stand or sit safely
• Extension or rotation is highly irritable
• Symptoms are rapidly worsening
• The professional cannot control the movement safely

Stop the test if symptoms increase sharply, leg symptoms become concerning, neurological symptoms occur, the client feels unsafe, or the client asks to stop.

Equipment Required

Kemp’s Test usually requires no special equipment.

Optional equipment includes:

• Measurz app
• Pain rating scale
• Plinth or chair if seated version is used
• Notes field for direction, symptoms and referral
• Video recording for movement education where appropriate
• Neurological screen findings recorded separately if relevant

Step-by-Step Protocol / Practice

Setup

Explain the test clearly before performing it.

A useful explanation is:

“I am going to guide your lower back into a combined backward bend, side bend and rotation. Tell me if this reproduces your familiar symptoms, where you feel them and whether symptoms travel into the buttock or leg.”

Choose the standing or seated version and record it in Measurz.

Client position

For the standing version:

• Client stands upright
• Feet shoulder-width apart
• Weight evenly distributed
• Arms relaxed or crossed over the chest
• Professional stands close enough to support balance

For the seated version:

• Client sits upright on a plinth or chair
• Feet supported
• Arms relaxed or crossed over the chest
• Pelvis remains reasonably stable

Examiner/professional position

The professional stands behind or beside the client.

The professional should be able to guide movement, monitor symptoms and assist balance if required.

Hand placement

Hand placement may vary depending on the version used.

A practical method is:

• One hand monitors or guides the upper trunk/shoulder region.
• The other hand monitors the pelvis or lumbar region.
• The professional avoids forcing end range.

Stabilisation

In standing, monitor balance and avoid excessive movement speed.

In sitting, the pelvis may be lightly stabilised to focus movement through the lumbar spine, but the test should still be gentle and controlled.

Movement or force direction

Guide the client into:

1. Lumbar extension
2. Side flexion toward the test side
3. Rotation toward the test side

Some versions combine the movement in one smooth arc.

The test may be repeated to the opposite side for comparison.

Instructions

Tell the client:

“Move only as far as comfortable. Tell me if you feel your familiar symptoms, where they are and whether they spread anywhere.”

Positive finding

A positive finding may include:

• Familiar local low back pain
• Familiar buttock or thigh symptoms
• Familiar leg symptoms
• Reproduction of the client’s typical symptoms
• Clear side-to-side difference
• Symptoms increased by extension-rotation-side flexion
• Neurological-type symptoms provoked in a concerning pattern

Record the symptom location and whether symptoms stayed local or referred.

Negative finding

A negative finding may include:

• No familiar symptoms
• No relevant side-to-side difference
• No referred symptoms
• Movement feels comfortable or only mildly stretched
• No symptom reproduction

A negative finding does not fully exclude lumbar facet, disc, neural or other lumbar involvement.

Stopping criteria

Stop the test if:

• Pain increases sharply
• Symptoms travel below the knee in a concerning way
• Neurological symptoms appear or worsen
• The client feels unstable
• The client asks to stop
• The movement cannot be performed safely
• The test is not meaningful because of guarding

Safety notes

Kemp’s Test can be provocative. Use controlled movement and avoid forcing the spine into end range. Record symptom behaviour carefully.

Positive and Negative Test Interpretation

A positive Kemp’s Test may suggest that combined lumbar extension, rotation and side flexion is relevant to the client’s symptoms. If symptoms are local and familiar, the test may support assessment reasoning around extension-sensitive lumbar structures, including facet-region contribution. If symptoms refer into the buttock or leg, foraminal or neural sensitivity may be considered within a broader assessment.

However, a positive Kemp’s Test does not confirm lumbar facet joint pain, nerve root compression, stenosis, disc involvement or any specific condition. The test stresses multiple structures, and pain location alone is not enough to identify the source.

A negative Kemp’s Test may reduce suspicion that this combined extension-rotation position is a key symptom driver in that session. However, a negative test does not fully exclude lumbar spine involvement, especially if symptoms occur during walking, lifting, sustained standing, sport or repeated movement.

The result is more meaningful when interpreted with:

• History
• Symptom behaviour
• Red flag screening
• Neurological screen
• Lumbar range of motion
• Repeated movement testing
• Palpation findings
• Functional testing
• Hip and SIJ assessment where relevant
• Imaging or referral findings where appropriate

Sensitivity, Specificity and Diagnostic Accuracy

A systematic review by Stuber and colleagues evaluated Kemp’s Test for diagnosing lumbar facet joint pain compared with reference standards. The review found only five eligible diagnostic accuracy studies and concluded that the literature is limited and indicates poor diagnostic accuracy.

Key findings include:

Condition or presentation: Lumbar facet joint pain
Population: Low back pain populations across included studies
Test variation: Kemp’s Test / extension-rotation test variations
Reference standard: Facet joint blocks or other accepted reference standards depending on study
Sensitivity: Variable and not strong enough for stand-alone use
Specificity: Variable and not strong enough for stand-alone use
Negative predictive value: Pooled values in similar-method studies were approximately 56.8% and 59.9%
Positive likelihood ratio: Not consistently useful for stand-alone confirmation
Negative likelihood ratio: Not consistently useful for stand-alone exclusion
Key limitations: Small number of studies, methodological variation, different reference standards and limited applicability.

Plain-language interpretation:

• Kemp’s Test should not be used to diagnose lumbar facet joint pain on its own.
• A positive result may identify a provocative movement direction, but it does not confirm a pain source.
• A negative result does not reliably exclude facet-region pain.
• The test is best used as part of broader lumbar assessment reasoning.

Reliability and Validity

The validity of Kemp’s Test as a stand-alone diagnostic test for lumbar facet joint pain is poor based on available evidence. It may still have practical value as a movement provocation test if the goal is to record symptom response to extension-rotation rather than diagnose a structure.

Reliability may be affected by:

• Standing versus seated version
• Movement speed
• Amount of extension
• Amount of rotation
• Professional force
• Client fear or guarding
• Symptom irritability
• Whether local pain or referred symptoms are considered positive
• Professional interpretation

Reliability improves when the professional standardises the position, movement direction, symptom questions and recording method.

Common Errors and Limitations

Common errors include:

• Calling the test diagnostic
• Forcing lumbar extension
• Moving too quickly
• Not recording symptom location
• Not distinguishing local pain from referred symptoms
• Not screening neurological features
• Not comparing sides
• Ignoring hip contribution
• Ignoring irritability
• Using the test in highly acute or unsafe presentations

Limitations include:

• Poor diagnostic accuracy for lumbar facet joint pain
• Multiple structures are stressed at once
• Pain location is not specific
• Test technique varies widely
• Standing balance may affect performance
• Acute guarding may limit usefulness
• A single test should not guide decisions alone

Practical Applications

Kemp’s Test may be useful for:

• Recording lumbar extension-rotation symptom response
• Comparing left and right lumbar quadrant movement
• Identifying extension-sensitive presentations
• Documenting local versus referred symptoms
• Guiding further assessment selection
• Client education about symptom-provoking directions
• Measurz baseline and retest documentation

In Measurz, Kemp’s Test should be recorded alongside lumbar range of motion, neurological screen findings, repeated movement testing, Prone Instability Test, Toe Touch Test, hip testing, SIJ testing and functional movement results.

How to Record This in Measurz

Record:

• Test name: Kemp’s Test / Lumbar Quadrant Test
• Version used: standing or seated
• Side/direction tested
• Result: positive, negative, unclear or unable to test
• Pain score
• Symptom location
• Symptom quality
• Local or referred symptoms
• Whether symptoms were familiar
• Movement direction
• Range limitation
• Neurological symptoms if present
• Comparison side
• Irritability
• Guarding or compensations
• Reason for stopping if relevant
• Related findings
• Confidence in interpretation
• Further assessment or referral notes if appropriate
• Retest date if relevant

Recording these details improves repeatability, communication, client education, assessment reasoning, monitoring over time, team consistency and reporting quality.

Related Tests / Internal Links

• Toe Touch Test
• Prone Instability Test
• Pheasant Test
• Lumbar range of motion
• Repeated lumbar extension
• Repeated lumbar flexion
• Slump Test
• Straight Leg Raise
• Quadrant movement assessment
• Hip FABER Test
• Hip Scour Test
• SIJ provocation tests

FAQs

What is Kemp’s Test used for?

It is used to assess symptom response to combined lumbar extension, side flexion and rotation.

Is Kemp’s Test the same as the Lumbar Quadrant Test?

Yes, Kemp’s Test is commonly referred to as the lumbar quadrant test or extension-rotation test.

What is a positive Kemp’s Test?

A positive finding may include familiar local low back pain, buttock pain, thigh symptoms or leg symptoms during the test position.

Does Kemp’s Test diagnose facet joint pain?

No. Evidence indicates poor diagnostic accuracy for diagnosing lumbar facet joint pain when used alone.

Can Kemp’s Test provoke leg symptoms?

Yes. If leg symptoms are reproduced, the finding should be interpreted carefully with neurological screening and broader lumbar assessment.

Should the test be forced?

No. The movement should be controlled and stopped if symptoms increase sharply or become concerning.

Does a negative test exclude lumbar facet pain?

No. A negative test does not reliably exclude facet-region symptoms or other lumbar involvement.

What should Kemp’s Test be combined with?

History, symptom behaviour, neurological screen, lumbar range of motion, repeated movement testing, functional assessment and other relevant tests.

Key Takeaways

Kemp’s Test combines lumbar extension, rotation and side flexion.

It can help record symptom response to a lumbar quadrant position.

A positive test may identify a provocative movement direction but does not confirm a pain source.

Evidence indicates poor diagnostic accuracy for diagnosing lumbar facet joint pain.

A negative test does not reliably exclude lumbar involvement.

Measurz recording should include version, side, symptom location, pain score, referral pattern and comparison side.

References

Hancock, M. J., Maher, C. G., Latimer, J., Spindler, M. F., McAuley, J. H., Laslett, M., & Bogduk, N. (2007). Systematic review of tests to identify the disc, SIJ or facet joint as the source of low back pain. European Spine Journal, 16(10), 1539–1550. https://doi.org/10.1007/s00586-007-0391-1

Kreiner, D. S., Matz, P., Bono, C. M., Cho, C. H., Easa, J. E., Ghiselli, G., Ghogawala, Z., Reitman, C. A., Resnick, D. K., Watters, W. C., Annaswamy, T. M., Baisden, J., Bartynski, W. S., Bess, S., Brewer, R. P., Cassidy, R. C., Cheng, D. S., Christie, S. D., Chutkan, N. B., ... Toton, J. F. (2020). Guideline summary review: An evidence-based clinical guideline for the diagnosis and treatment of low back pain. The Spine Journal, 20(7), 998–1024. https://doi.org/10.1016/j.spinee.2020.04.006

Stuber, K. J., Lerede, C., Kristmanson, K., Sajko, S., & Bruno, P. (2014). The diagnostic accuracy of the Kemp’s test: A systematic review. Journal of the Canadian Chiropractic Association, 58(3), 258–267. PMID: 25202153

Traeger, A. C., Buchbinder, R., Harris, I. A., & Maher, C. G. (2017). Diagnosis and management of low-back pain in primary care. CMAJ, 189(45), E1386–E1395. https://doi.org/10.1503/cmaj.170527