Which test is most directly associated with detecting malingering in suspected lumbar pathology?

• A. Homan's Sign
• B. Kemp Test
• C. Hoover Test
• D. Milgram's Test

Answer: (C)

The key idea here is to assess for inconsistent effort, which helps distinguish true lumbar signs from non-organic or feigned symptoms. In the Hoover sign, the patient lies on their back and is asked to raise the leg on the symptomatic side. The examiner slides one hand under the heel of the opposite leg to feel for downward pressure on the bed as the patient attempts the raise. If there is no downward pressure from the contralateral heel despite the patient insisting they cannot lift due to weakness, that discrepancy suggests the weakness may be feigned or non-organic—malingering. If the contralateral heel does press down, it shows the patient is capable of generating force, making malingering unlikely. This direct check of effort is why this test is most closely associated with detecting malingering in suspected lumbar pathology, unlike other tests that assess true mechanical or neurological signs.