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.
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.
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.
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.
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.
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
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.
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.
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.
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
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.
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
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 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.
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.
Guide the client into:
Lumbar extension
Side flexion toward the test side
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.
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.”
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.
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.
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
Kemp’s Test can be provocative. Use controlled movement and avoid forcing the spine into end range. Record symptom behaviour carefully.
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
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.
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 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
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.
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.
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
It is used to assess symptom response to combined lumbar extension, side flexion and rotation.
Yes, Kemp’s Test is commonly referred to as the lumbar quadrant test or extension-rotation test.
A positive finding may include familiar local low back pain, buttock pain, thigh symptoms or leg symptoms during the test position.
No. Evidence indicates poor diagnostic accuracy for diagnosing lumbar facet joint pain when used alone.
Yes. If leg symptoms are reproduced, the finding should be interpreted carefully with neurological screening and broader lumbar assessment.
No. The movement should be controlled and stopped if symptoms increase sharply or become concerning.
No. A negative test does not reliably exclude facet-region symptoms or other lumbar involvement.
History, symptom behaviour, neurological screen, lumbar range of motion, repeated movement testing, functional assessment and other relevant tests.
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.
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
