Straight Leg Raise Test 6 – Modified for patients who cannot lie supine

Purpose of Straight Leg Raise Test 6: 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: Side-lying with a pillow in-between two legs, with the leg to be tested positioned at the top.

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 (as tolerated – flexion or extension (5-7)), while the patient is on side-lying,
2. Hip flexion (to 30 or 60 degrees (6,7) or up to 90 degrees (5)), having the knee flexed at 90 degrees (with the examiner’s one hand holding the medial aspect of the patient’s knee/distal thigh and the other hand holding the medial aspect of the patient’s ankle),
3. Sensitizing position: Extend the knee as far as possible and measure the knee position (range of motion) (5-7) to compare with the unaffected side.

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. Hall T, Hepburn M, Elvey RL. The Effect of Lumbosacral Posture on a Modification of the Straight Leg Raise Test. Physiotherapy. 1993;79(8):566-70.
6. Ridehalgh C, Moore A, Hough A. Sciatic nerve excursion during a modified passive straight leg raise test in asymptomatic participants and participants with spinally referred leg pain. Manual therapy. 2015;20(4):564-9.
7. Ridehalgh C, Moore A, Hough A. Normative sciatic nerve excursion during a modified straight leg raise test. Manual therapy. 2014;19(1):59-64.