Purpose of Straight leg raise test 1 – Basic: 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).

Patient position: Supine lying.

Examiner position: Standing beside the patient, at the side of the limb to be tested.

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 and adduction (to the end of the available range or until the patient reports radicular symptoms), having the knee 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. Lower the leg slowly until the radicular symptoms are relieved and hold the leg at this level,
4. Sensitizing position: (a) ankle dorsiflexion, (b) cervical spine flexion, and (c) medial hip rotation (5). The return of radicular symptoms during ankle dorsiflexion and/or cervical spine flexion with/without further straight leg raise (hip flexion) indicates a positive test.

Outcome: This 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. Petty NJ, Ryder D. Musculoskeletal Examination and Assessment E-Book: A Handbook for Therapists: Elsevier Health Sciences; 2017.
5. Breig A, Troup JD. Biomechanical considerations in the straight-leg-raising test. Cadaveric and clinical studies of the effects of medial hip rotation. Spine (Phila Pa 1976). 1979;4(3):242-50.