Rethinking the sit-and-reach test.

Injury prevention

Use of the sit-and-reach test in a pre-employment physical fitness battery needs to be reconsidered. Currently 13 out of 50 states still use it which means thousands of departments use it, and I cant find any research to validate its use. The best I can figure its used because of the Presidential Physical Fitness Challenge. The sit-and-reach test is based on the theory that perhaps sitting down and bending forward is a good measure of hamstring and low back extensibility. It only makes sense that screening for these qualities would be a good way to eliminate those who are predisposed to low back injury which is a significant source of missed days of work and disability retirement. Unfortunately this logic is not necessarily backed by research.    

My initial interest in validity of the sit-and-reach test comes from my personal experience. Ill make a long story short. When I was a bulletproof 21 year old who was aspiring to be a cop I CRUSHED the sit-and-reach test. Not that it was a competition, but I won most of them with scores reliably in the 20s (note: 15 is touching your toes). Fast forward in my life to my early years as a cop when I had to sleep on the floor and I was taking 800 mg doses of ibuprofen daily because my back hurt all the time. Before I was a cop I had a few episodes of “tweaking” my back. Usually it was an upper neck and thoracic area, and it would resolve quickly especially with a little chiropractic assistance. The pain I was having as a new cop was constant and chronic. Good pain-free days were outnumbered 5-1 with painful days. This always bothered me because I figured that being the flexible bendy guy that I was I should be immune to back issues. Obviously this notion was wrong. Either I was an exception to the rule and was predisposed to back pain despite my flexibility or maybe the sit-and-reach test isnt a valid predictor of predisposal to back pain.

I took some time to do the research; heres what I was able to find.

The sit-and-reach test appears to be a good measure of hamstring extensibility but may not be a good measure of low back extensibility. The sit-and-reach may not even measure what it is designed to measure.

Overall the SR tests have a moderate mean correlation coefficient of criterion-related validity for estimating hamstring extensibility, but they have a low mean criterion-related validity for estimating lumbar extensibility.

The sit-and-reach test is poorly correlated to back pain (This study also indicates that a the sit-up test is poorly correlated to pain).

In conclusion we found the sit-up and sit-and-reach tests lack criterion-related validity with LBP for inclusion in health-related fitness testes. Inclusion of such items should not be based on a presumed relationship between test performance and LBP

 The sit-and-reach test is a poor predictor of previous back injury in industrial workers.

The S&R test, among many collected, was performed according to the CPAFLA guidelines. History of low back discomfort (LBD) was categorized based on whether or not time was lost from work. The S&R test was unable to distinguish between those with a history of LBD and those without.

This is important because the best predictor of an injury is previous occurrence of an injury and its severity. Lets spin this backwards for a second. If the sit-and-reach test doesnt have a good correlation to the best predictor of a future injury then its probably not a good predictor at all.  

With all of this information going against the use of the sit-and-reach I did reach out to Dr. Stu McGill who brought his colleague Dr. Jack Callaghan into the conversation. For those who dont know, McGill is arguably the worlds foremost expert of the back and spine.  McGill literally wrote the text book on low back disorders. Both McGill and Callaghan were surprised to see the combination of the sit-and-reach and sit-up tests in use for pre-employment screening.

Dr.  McGill went so far as to say that he would have thought that American employment law would have forced a job-content valid testing procedure.

Callaghan echoed McGill’s criticism stating that “The link to the test being relevant for the job performance must be clearly demonstrated” 

McGill has criticized both the sit-and-reach and sit-up tests stating:

The sit-and-reach is more a test of arm length and had nothing to do with back health. Our studies have shown the more the flexibility the greater the risk of back disorders, also we have also shown that this mobility did not predict who would recover from back injury to return to work.”

In a T-Nation interview Dr. McGill mentions problems with the sit-up test arguing that repetitive spinal flexion delaminates the discs leading to back injury. The problem with having this in a test is that those being tested are likely to train for the test and do a bunch of sit-up and injure their backs.  

My real issue with the sit-and-reach test is simply this: We can do better and we are not. I dont know if there is a stand-alone screen that appropriately predicts future low back injury.  With the abuse that a cop will put their back through with extended periods of compromised sitting over 30 years, good backs will go bad without maintenance. If we cant reliably screen for the back problems, then time needs to be spent teaching cops how to take care of their back. You should within your first year of being a cop be taught how to optimize your body positions, identify mechanisms that are causing pain when it happens, and you should be given an evidence based physical practice to increase stability and appropriate levels of flexibility. This isnt a thing right now so for the sake of time Im going to let Dr. McGill lay down some knowledge.

The book thats promoted in the video is a game changer for understanding your back issues and developing strategies to get out of pain. Im not a one size fits all kind of guy but what I can tell you is that my back issues tend to correlate to my hip mobility and spine stability, and this appears to be true for most cops probably because we have similar environmental stressors. Ive done some writing on the hip mobility piece, but heres Dr. McGill again on some exercises to promote low back stability. Work them in today then go buy Stus book and thank me later.

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