It is well recognised that asymptomatic disc herniation is present in up to 35% of a population aged under 40 years.1 2 Therefore, reliance on either MRI or CT as a sole method of diagnosing disc herniation, particularly as a method of discriminating those patients who may subsequently require surgery, is clearly inadvisable. Instead, clinicians will need to devise their treatment plans on the basis of correlation between any imaging results and their findings at clinical examination, with the overriding factor in a decision algorithm being the patient's own choice of treatment.

In this Cochrane review, Van der Windt and colleagues have sought to update previously available evidence on the diagnostic performance of tests carried out during physical examinations. They have also attempted to make quality assessments that will highlight optimal methods of determining those patients with substantive radiculopathy that might …