Purpose of Bilateral Straight Leg Raise Test: To test if the tension along the sciatic nerve, tibial nerve, L4,5,S1 nerve roots (1), conus medullaris (2), and the adjacent dura to the spinal cord (3) contribute to the neurologic symptoms associated with radiculopathy (4-6).

Patient position: Supine lying.

Examiner position: Standing beside the examination table, facing the patient.

Procedure: Perform the limb/joint positioning sequence in the following order:

1. Neutral alignment at the cervical, thoracic and lumbar spine, while the patient is on supine lying,
2. Hip flexion (to 50 degrees (5) or up to 60 degrees (6)), having the knees at full extension (with the examiner’s one hand holding the anterior aspect of the patient’s distal thigh and the other hand holding the posterior aspect of the patient’s ankle),
3. Sensitizing position: Hip flexion (up to 90 degrees – as investigations (6-8) have shown that a large proportion of nerve root excursion occurs between 60 and 90 degrees of hip flexion).

Outcome: This test (Bilateral Straight Leg Raise Test) is positive if (a) the limb/joint positioning sequence reproduces symptoms associated with radiculopathy, (b) the sensitizing position reproduces symptoms, and (c) there is a repeatable and measurable asymmetry between both sides along with the reproduction of symptoms.

Reference:

1. Goddard MD, Reid JD. Movements induced by straight leg raising in the lumbo-sacral roots, nerves and plexus, and in the intrapelvic section of the sciatic nerve. Journal of Neurology, Neurosurgery, and Psychiatry. 1965;28(1):12-8.
2. Rade M, Shacklock M, Könönen M, Marttila J, Vanninen R, Kankaanpää M, et al. Normal multiplanar movement of the spinal cord during unilateral and bilateral straight leg raise: Quantification, mechanisms, and overview. Journal of Orthopaedic Research. 2017;35(6):1335-42.
3. Rade M, Könönen M, Marttila J, Shacklock M, Vanninen R, Kankaanpää M, et al. In Vivo MRI Measurement of Spinal Cord Displacement in the Thoracolumbar Region of Asymptomatic Subjects with Unilateral and Sham Straight Leg Raise Tests. PLoS ONE. 2016;11(6):e0155927.
4. Rade M, Kononen M, Vanninen R, Marttila J, Shacklock M, Kankaanpaa M, et al. 2014 young investigator award winner: In vivo magnetic resonance imaging measurement of spinal cord displacement in the thoracolumbar region of asymptomatic subjects: part 1: straight leg raise test. Spine (Phila Pa 1976). 2014;39(16):1288-93.
5. Rade M, Kononen M, Vanninen R, Marttila J, Shacklock M, Kankaanpaa M, et al. 2014 young investigator award winner: In vivo magnetic resonance imaging measurement of spinal cord displacement in the thoracolumbar region of asymptomatic subjects: part 2: comparison between unilateral and bilateral straight leg raise tests. Spine (Phila Pa 1976). 2014;39(16):1294-300.
6. Rade M, Shacklock M, Kononen M, Marttila J, Vanninen R, Kankaanpaa M, et al. Part 3: Developing Methods of In Vivo MRI Measurement of Spinal Cord Displacement in the Thoracolumbar Region of Asymptomatic Subjects With Unilateral and Bilateral Straight Leg Raise Tests. Spine (Phila Pa 1976). 2015;40(12):935-41.
7. Gilbert KK, Brismée J-M, Collins DL, James CR, Shah RV, Sawyer SF, et al. 2006 Young Investigator Award Winner: Lumbosacral Nerve Root Displacement and Strain: Part 1. A Novel Measurement Technique During Straight Leg Raise in Unembalmed Cadavers. Spine. 2007;32(14):1513-20.
8. Falconer MA, McGeorge M, Begg AC. Observations on the cause and mechanism of symptom-production in sciatica and low-back pain. Journal of neurology, neurosurgery, and psychiatry. 1948;11(1):13.