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Biering-Sørensen Test: Spot Hidden Lumbar Deficits Early🦴🔬

 A physical therapist stands next to a male patient performing the Biering-Sørensen Test on an extension bench. The patient lies prone with his lower body stabilized on the table and his upper torso extended horizontally over the edge, keeping his arms crossed flat over his chest to test his trunk extensor muscle endurance.
A simple endurance test can reveal lumbar weakness long before pain becomes obvious. 📝

Why the Biering-Sørensen Test matters🧐

Recurrent low back pain is not always a strength problem.  In many patients, the bigger issue is poor trunk extensor endurance — a deficit that can stay hidden until symptoms flare.  The Biering-Sørensen test helps clinicians identify weakness early, before fatigue, compensation, or recurring pain take over. 🔍

A recent review indexed in PubMed Central supports the clinical value of endurance-based assessment for the evaluation and rehabilitation of low back pain.¹

What is the Biering-Sørensen Test?

The Biering-Sørensen test is a clinical endurance assessment used to measure how long a patient can maintain trunk extension against gravity. ⏱️

It is commonly used to evaluate:
✅Lumbar extensor endurance
✅Spinal stability
✅Postural tolerance
✅Risk of recurrent low back pain

Why it matters clinically

A patient can appear strong and still lack the endurance needed to maintain spinal control during sitting, standing, lifting, or sport.  That’s why this test can uncover deficits that traditional strength testing may miss. ⚠️

Why lumbar endurance matters more than raw strength💪

Strength matters — but endurance is often the missing piece in persistent or recurring low back pain. 🧱

When trunk extensor endurance is low:
✅The spine fatigues faster
✅Posture breaks down sooner
✅Passive tissues take on more load
✅ Symptoms may flare during everyday tasks
This is especially relevant for patients who sit or stand for long periods or repeatedly load the spine. 🪑

Prolonged sitting rapidly accelerates this fatigue, especially during long commutes or flights.  To protect your spine during your next trip, read our practical tips on How to Prevent Stiffness and Joint Pain During Air Travel

How to perform the Biering-Sørensen Test

Patient positioning

✅Patient lies prone on a treatment table or bench
✅The Anterior Superior Iliac Spine (ASIS) is aligned at the edge of the surface.  The ASIS is the prominent bony "hip bone" bump felt on the front outer edge of your pelvis.
✅Lower body is stabilized with straps or manual support

Test execution

✅Patient lifts the trunk into a neutral horizontal position
✅Arms are usually crossed over the chest
✅Timing begins once the trunk is level
✅The test ends if the torso drops below horizontal

What to monitor

✅Loss of neutral trunk position
✅Early fatigue
✅Pain reproduction
✅Lumbar compensation
✅Form breakdown before the hold time ends

Biering-Sørensen Test normative values🧮

Healthy hold times are often reported around 120 to 140 seconds, though interpretation should always be individualized based on age, symptoms, and clinical presentation. 📊

A side view shows a male athlete performing the Biering-Sørensen Test on a hyperextension machine in a gym setting. His legs are locked into the ankle rollers, his anterior superior iliac spine (ASIS) rests at the edge of the pad, and his unsupported upper body extends horizontally forward with arms crossed over his chest to measure spinal extensor endurance.

What a shortened hold time may suggest:

A patient who falls below the expected endurance range may demonstrate:
✅reduced lumbar extensor endurance
✅poorer postural tolerance
✅lower tolerance for sustained loading
✅greater risk of recurrent symptoms

What does a failed Biering-Sørensen Test mean?

A failed or shortened test does not diagnose one specific condition.  Instead, it suggests a clinically meaningful endurance deficit that may contribute to recurrent pain or reduced load capacity.

In practice, that can help shift rehab away from symptom chasing and toward a more targeted plan. 🎯

How to use the results in rehabilitation

If a patient demonstrates poor endurance on the Biering-Sørensen test, rehab may include:
✅progressive trunk extensor endurance training
✅lumbar stabilization work
✅hip and glute integration
✅graded exposure to sustained postures
✅return-to-load programming based on objective tolerance
The goal is to improve the body’s ability to hold position, control load, and delay fatigue. 🏋️‍♀️

Who should be assessed with the Biering-Sørensen Test?

This test may be especially helpful for patients with:
✅recurrent non-specific low back pain
✅postural fatigue
✅poor tolerance to sitting or standing
✅return-to-sport needs
✅suspected trunk endurance deficits

This endurance failure is exactly what happens when slouching in a recliner over time.  If you want to see how these endurance deficits manifest as everyday stiffness, check out our guide on The 'Dad Posture' Blueprint: The Simple Fix for Back Stiffness.

If you’re dealing with recurring low back pain or want to know whether a lumbar endurance deficit may be driving your symptoms, book a free 15-min physical therapy consult.

FAQ🤔❓

What does the Biering-Sørensen test measure?

It measures the endurance of the trunk extensor muscles that help support the spine against gravity.

What is a normal Biering-Sørensen hold time?

Normative hold times are often reported around 120 to 140 seconds, but results should always be interpreted in context.

What does it mean if a patient fails the Biering-Sørensen test?

It may indicate reduced lumbar endurance and lower tolerance for sustained spinal loading.

Is the Biering-Sørensen test useful for low back pain?

Yes — it can help identify endurance deficits that may contribute to recurring or persistent low back pain.

How can the results guide treatment?

They can help guide trunk endurance work, stabilization training, and progressive return-to-load programming.

Clinical takeaway🚀

The Biering-Sørensen test gives clinicians a simple way to uncover hidden lumbar deficits that may not appear on a basic strength screen.  When paired with a clear rehab plan, it can help reduce guesswork and support better outcomes. ✅

If you’re dealing with recurring low back pain or want to know whether a lumbar endurance deficit may be driving your symptoms, book a physical therapy consult.

While you are working on your lower-back endurance, don't ignore the upper-body compensations that come with desk work. If your upper back and shoulders also feel tight, read the Banded Shoulder Distraction for Tight, Pinchy Shoulders to restore your upper body mobility

🤔❓Not Sure Physio Is Right For You? 📞🖂Speak to a physiotherapist first or DM me.

Stay mobile,

Toni
tonithephysio™ 
Total Mobility.  Total Balance.  Zero Pain
Mend & Move|Pain-Free Movement Team

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🗣️📢Medical Disclaimer: This information is for general knowledge and is not medical advice.  Complete the free 2-min joint assessment before starting any new exercise routine.
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References

PubMed Central.  Article on the Biering-Sørensen test and lumbar endurance.  Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC9882630/

#BieringSorensenTest #LowBackPain #PhysicalTherapy #SpineRehab #BackPainRelief #ClinicalAssessment #CoreEndurance #SportsMedicine #BiomechanicalAssessment 

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Medical Disclaimer: This information is for general knowledge and is not medical advice. Consult with a healthcare provider or physical therapist before starting any new exercise routine.

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