Research Report Reliability of the Modified-Modified Schober and Double Inclinometer Methods for Measuring Lumbar Flexion and Extension Background and Purpose. The primary purpose of this study was to deter- mine the reliability of lumbar flexion and extension range-of motion measure- ments obtained with the modified-modified Schober and the double inclinometer methods on subjects with low back pain. Subjects. Fifteen patients (8 women, 7 men), aged 25 to 53 years (X=35.7, SD=99), with chronic low back pain were measured by three physical therapists with 3 to 12 years 01=8.3, SD=4.7) of clini- cal experience. Methods. The therapists used the modified-modified Schober and double inclinometer techniques to measure, in random order and on two occa- sions, the subjects' lumbar flexion and extension. Results. Pearson Product- Moment Correlation Coefficients for test-retest reliability for the modified-modified Schober technique varied from . 78 to .89 for lumbar flexion and from .69 to .91 for extension; for the double inclinometer method, Pearson correlation coeffi- cients varied from .13 to .87 for lumbar flexion and from .28 to .66for exten- sion. Analysis of variance-derived intraclass correlation coefficients for interrater reliability for the modified-modified Schober technique were . 72 for flexion and .76 for extension; for the double inclinometer technique, they were .60 for flexion and .48 for extension. Conclusion and Discussion. The modified-modified Schober method thus appears to be a reliable method for measuring lumbar flex- ion and extension for patients with low back pain, whereas the double inclinome- ter technique needs improvement. [Williams R, Binkleyf, Bloch R, et al. Reliability of the modified-modified Schober and double inclinometer methods for measur- ing lumbar flexion and extension. Phys Ther 1993;73:26-37] Key Words: Backache, Pain, Tests and measurements. Renee Williams Jill Binkley Ralph Bloch Charles H Goldsmith Terry Minuk Low back pain (LBP) is one of the most common medical conditions in the Western world, afflicting approxi- mately 85% of all persons at some time in their lives. 1 - 2 As LBP has been shown to alter lumbar range of mo- tion (ROM), 3 " 5 there is a need to identify reliable methods for assessing lumbar ROM in patients. Lumbar ROM is often used to evaluate spinal func- tion, select appropriate treatments, and monitor the patient's progress.^ 8 It is difficult to accurately measure spinal movement because bony land- marks are often difficult to palpate due to excess soft tissue, normal curves of the spine vary from individ- ual to individual, and the presence of hip motion may confound the spinal movement measurement. 9 One method of measuring spinal ROM is with the use of a tape mea- sure. 10 This technique, known as the skin distraction method, was origi- nally described by Schober. 11 This technique involves using a tape mea- sure held directly over the spine between points 10 cm above the lumbosacral junction with the patient in the neutral standing position. When the patient moves into full lumbar flexion, the increase in distance be- tween the marks gives an estimate of spinal flexion ROM. Macrae and Wright 12 modified the original Schober method by marking a point 5 cm below and 10 cm supe- rior to the lumbosacral junction. The rationale for this modification was an observation that on forward flexion, both the lumbosacral and 10-cm supe- rior skin marks tended to move supe- riorly relative to the spinous pro- Physical Therapy/Volume 73, Number 1/January 1993 26/33