Valsalva maneuver or Valsalva manoeuvre is performed to elicit radicular pain, to determine if this is the cause of patient’s lower back pain is due to herniation or if there are signs of inter-ventricular foramen encroachment.


Patient should be awake and cooperative to perform the Valsalva Maneuver.

  1. Patient may be seated or standing.
  2. Patient is instructed to take a deep breath and hold while bearing down as if “straining at stool.”

Patient takes a deep breath and bears down.


Positive Cascade Sign Test

Radicular pain possible space-occupying lesion: disc herniation, tumor, osteophyte interventricular foramen encroachment.

Clinical Notes

Some patients may experience vertigo or syncope while performing this test, therefore caution should be used.

This test increases intra-abdominal and intrathecal pressure.