• 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  

• Patient presents with low back pain and nerve pain that radiates down the leg   

• Presence of hip disease  

• The maneuvers stretch the affected nerve roots and sciatic nerve  

Lying Straight Leg Raise Test:

1. Have the patient lay supine with legs extended
2. Place your hand beneath the lumbar spine to ensure there is no compensatory lordosis
1. Observe the lumbar spine during the exam because a change in the curve invalidates the test results
2. Also make sure the pelvis does not rise from the table
3. Ask the patient to relax their leg 
4. Grasp the ankle of the leg and place your other hand on the front of the thigh to maintain the knee in full extension
5. Slowly raise the leg until the patient complains of pain or maximal flexion has been achieved (60-120 degrees)
1. Assess the degree of elevation at which pain occurs, the quality and distribution of pain, and the effects of dorsiflexion
2. 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
3. The presence of a painful arc suggest a protrusion so small that the nerve root merely catches against it and slips over
6. Return the leg to the table carefully 
7. Results
1. Positive: inducing/reproducing the patients pain down the leg 
1. Changing the back pain is not a positive test
2. Negative: no pain is felt by the patient upon maximal flexion of the leg
8. Notes: 
1. The test has a sensitivity of 91% and specificity of 26%
2. Observe the patient for confirming ipsilateral calf wasting and weak ankle dorsiflexion, which makes the diagnosis of sciatica 5 times more likely
   

Crossed Straight Leg Test:

1. The test is the same as the straight leg test, the difference being that it is performed on the leg not affected by pain
2. Results
1. Positive: while performing the straight leg test on the unaffected leg the symptoms/pain are reproduced on the opposite (affected leg)
2. Negative: no symptoms/pain are felt on the opposite leg
3. Note: the test has a sensitivity of 28%-29% and a specificity of 88%-90% for nerve root impingement
   

Seated Straight Leg Raise Test:

1. Patient is seated on the exam table with knees bent to 90° and legs hanging freely
2. The examiner slowly extends one knee from the 90° starting position
3. Continue passively extending the knee until pain/reproduction of symptoms is achieved in the tested leg or full extension reached
1. Results
1. Positive: reproduction of symptoms prior to reaching full extension
2. 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
• Meningismus
• 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

Editor:

• Anthony J. Busti, MD, PharmD, FNLA, FAHA

Last Reviewed:  September 2016

1. Bickley LS et al. Bates' Guide to Physical Examination and History Taking. 11th ed. Philadelphia, PA: Lippincott Williams & Wilkins. 2013; 732-3.
2. 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.
3. Casazza BA. Diagnosis and treatment of acute low back pain. Am Fam Physician. 2012;85(4):343-50.
4. 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.
5. Cyriax J. Textbook of Orthopaedic Medicine. 8th ed. Vol. 1. London: Ballière-Tindall; 1982.
6. Dorman TA, Ravin TH. Diagnosis and Injection Techniques in Orthopedic Medicine. Baltimore, MD: Williams & Wilkins; 1991.
7. McGee S. Evidence-Based Physical Diagnosis. 2nd ed. St Louis: Saunders, 2005.
8. Orient, JM. Sapira's Art and Science of Bedside Diagnosis. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins. 2010;502-3.
9. 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 
10. 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.