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While the patient is in a standing position the examiner makes a mark approximately at the level of L5 (fifth lumbar vertebra). The examiner then places one finger ~5 cm below this mark, and another, second, finger, ~10 cm above this mark. The patient is asked to touch his/her toes without flexing the knee joints. By doing so, the distance between the two fingers of the examiner increases. However, a restriction in the lumbar flexion of the patient reduces this increase; if the distance increases less than 5 cm, then there is an indication that the flexion of the lower back is limited. For instance, this test is diagnostically useful as part of a clinical diagnosis of syndromes such as ankylosing spondylitis.