Straight Leg Raising Test
- A passive test used to evaluate for lumbar nerve root (L4-S1) impingement/irritation (lumbosacral radiculopathy) and sciatic neuropathy
- Compression of the spinal nerve root as it passes through the vertebral foramen causes a painful radiculopathy with associated muscle weakness and dermatomal sensory loss, usually from a herniated disc
- Have the patient lay supine with legs extended
- Place your hand beneath the lumbar spine to ensure there is no compensatory lordosis
- Observe the lumbar spine during the exam because a change in the curve invalidates the test results
- Also make sure the pelvis does not rise from the table
- Ask the patient to relax their leg
- Grasp the ankle of the leg and place your other hand on the front of the thigh to maintain the knee in full extension
- Slowly raise the leg until the patient complains of pain or maximal flexion has been achieved (60-120 degrees)
- Assess the degree of elevation at which pain occurs, the quality and distribution of pain, and the effects of dorsiflexion
- Note whether the end-feel is abrupt or gradual; if gradual, continue gently as long as the pain is slight so as not to miss a painful arc, beyond which motion can continue without pain
- The presence of a painful arc suggest a protrusion so small that the nerve root merely catches against it and slips over
- Return the leg to the table carefully
- Positive: inducing/reproducing the patients pain down the leg
- Changing the back pain is not a positive test
- Negative: no pain is felt by the patient upon maximal flexion of the leg
- The test has a sensitivity of 91% and specificity of 26%
- Observe the patient for confirming ipsilateral calf wasting and weak ankle dorsiflexion, which makes the diagnosis of sciatica 5 times more likely
- The test is the same as the straight leg test, the difference being that it is performed on the leg not affected by pain
- Positive: while performing the straight leg test on the unaffected leg the symptoms/pain are reproduced on the opposite (affected leg)
- Negative: no symptoms/pain are felt on the opposite leg
- Note: the test has a sensitivity of 28%-29% and a specificity of 88%-90% for nerve root impingement
- Patient is seated on the exam table with knees bent to 90° and legs hanging freely
- The examiner slowly extends one knee from the 90° starting position
- Continue passively extending the knee until pain/reproduction of symptoms is achieved in the tested leg or full extension reached
- Positive: reproduction of symptoms prior to reaching full extension
- Negative: no pain is felt by the patient upon maximal extension of the leg
- Ankylosing spondylitis
- Disc protrusion impinging on nerve roots below L4
- Fractured sacrum
- Hematoma in the hamstrings
- Instraspinal lesions (e.g. tumor below L4)
- Ischiorectal abscess
- Malignant disease
- Osteomyelitis of the ilium/upper femur
- Tight hamstrings resulting from short leg/sacroiliac displacements
- Painless straight-leg raising does not exclude a disc lesion
- The discriminative power of the straight leg raise test seemed to decrease as age increased; thus, positive and negative results may be less conclusive in older patients
- Bickley LS et al. Bates' Guide to Physical Examination and History Taking. 11th ed. Philadelphia, PA: Lippincott Williams & Wilkins. 2013; 732-3.
- Capra F et al. Validity of the straight-leg raise test for patients with sciatic pain with or without lumbar pain using magnetic resonance imaging results as a reference standard. J Manipulative Physiol Ther. 2011;34(4):231-8.
- Casazza BA. Diagnosis and treatment of acute low back pain. Am Fam Physician. 2012;85(4):343-50.
- Chou R, Qaseem A, Snow V, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147(7):478-91.
- Cyriax J. Textbook of Orthopaedic Medicine. 8th ed. Vol. 1. London: Ballière-Tindall; 1982.
- Dorman TA, Ravin TH. Diagnosis and Injection Techniques in Orthopedic Medicine. Baltimore, MD: Williams & Wilkins; 1991.
- McGee S. Evidence-Based Physical Diagnosis. 2nd ed. St Louis: Saunders, 2005.
- Orient, JM. Sapira's Art and Science of Bedside Diagnosis. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins. 2010;502-3.
- Sandella BJ et al. Examination of Low Back Pain Technique. Jul 2012. (Last accessed 7 January 2014) http://emedicine.medscape.com/article/2092651-technique#aw2aab6b4b6
- van der Windt DA et al. Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain. Cochrane Database Syst Rev. 2010;CD007431.
Lying Straight Leg Raise Test:
Crossed Straight Leg Test:
Seated Straight Leg Raise Test:
Differential Diagnosis of a Positive Test