Lhermitte's Sign: how to spot this cervical neurological red flag

Not every test in this guide is about "mobility" or "strength": Lhermitte's sign is, first and foremost, a neurological red flag. If a client describes it spontaneously or it's reproduced during a cervical assessment, it's one of those situations where your job isn't to "treat it," but to recognize it and refer.

Knowing it well helps you avoid overlooking it and explain to the client, without unnecessarily alarming them, why they need a medical evaluation.

What does this test measure?

Lhermitte's sign is the appearance of an electric shock or "tingling" sensation that travels down the spine and, often, into the limbs, triggered by neck flexion.

It's classically associated with cervical spinal cord pathology (for example, cord compression, multiple sclerosis, cervical myelopathy), so its presence is considered a neurological warning sign, not a "normal" musculoskeletal finding.

Equipment needed

• None

Step-by-step protocol

1. The client sits in a relaxed position
2. Ask them to actively flex the neck, progressively bringing the chin toward the chest
3. Ask whether any "electric shock," tingling, or pins-and-needles sensation travels down the spine, arms, or legs during the movement
4. If the client reports this sensation spontaneously (without needing to provoke it), record it as a relevant finding as well

Common mistakes

• Confusing simple local cervical tension discomfort with the characteristic electric sensation of Lhermitte's sign
• Not asking specifically about the nature of the sensation (electric/tingling vs. muscular pain)
• Continuing with the regular assessment without flagging this finding as a priority

How to interpret the result

Result	Interpretation
Positive: electric/tingling sensation traveling down the spine or limbs with cervical flexion	Neurological red flag — suggests possible cervical spinal cord involvement, requires priority medical referral
Negative: only local muscular discomfort or tension, no electric sensation	Not a red flag on its own, continue with the regular assessment

This is not a test for "keep training carefully": a positive Lhermitte's sign, especially if accompanied by other signs (weakness, gait disturbance, bowel/bladder changes), should prompt immediate referral for medical evaluation, as it can indicate spinal cord involvement.

Relationship with other tests

If a positive Lhermitte's sign appears, it makes sense to complete the examination (always within the framework of referral) with:

• Cervical Compression Test (Spurling) — to also assess a radicular component, although a positive Lhermitte's finding already warrants referral
• Cervical Distraction Test — to document the full picture before referring

Document and refer with Movalytics

With a finding like this, the most important thing is to document it properly and refer, not try to resolve it with exercises. With Movalytics you can log this type of warning finding along with the date and the recommendation given to the client, so it's clearly recorded in their history and you can follow up on whether they sought medical evaluation.

Frequently asked questions

Does Lhermitte's sign always indicate something serious? Not always, but it's considered a red flag that should be medically evaluated to rule out relevant spinal cord pathology, not something to "just keep an eye on." Can I keep training a client with a positive Lhermitte's sign while waiting for a medical evaluation? The prudent approach is to avoid exercises that trigger the sensation (especially sustained or loaded cervical flexion) until a medical evaluation clarifies the cause. Is this a test done routinely in every assessment? Not necessarily as an active "test" with every client, but it's essential to ask about this type of symptom if cervical involvement is suspected, and to recognize it if it appears spontaneously.