Straight Leg Raise Test | Lumbar Radicular Syndrome

Straight Leg Raise Test (SLR) for Lumbar Radicular Syndrome

The straight leg raise test is one of the most commonly known orthopedic examination tests used in the assessment of lumbar radicular syndrome. What constitutes a positive test varies significantly within the literature, where some authors compare the angle of passive hip flexion between the affected and unaffected limb, and others describe the reproduction of the patient&#;s familiar leg pain as a positive outcome. To this day there is no consensus on normative hip flexion values for the test. Reporting the outcome as reproduction of the patient&#;s familiar leg pain, which is a hallmark sign of lumbar radicular pain, makes more sense from a pathoanatomical point-of-view with the test&#;s aim to tension the sciatic nerve to elicit such symptoms.

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A Cochrane review by van der Windt et al in and a systematic review from Scaia et al in report overall higher sensitivity than specificity for the test when compared to surgical findings of a lumbar disc herniation reaching negative likelihood ratios down to 0.27. Pretty much all primary studies have some sort of bias and &#;the reproduction of pain&#; was also not matched to the patient&#;s current symptoms in many of the studies. So, what can be said is that the test has no diagnostic value in confirming lumbar radicular pain due to lumbar disc herniation but may have at least moderate clinical value in excluding its presence.

To conduct the test, the patient lies in supine position flat on the bench. Standing on the affected side, you&#;ll grab a hold of the patient&#;s leg in a way that you ensure full knee extension during the test. Then, slowly lift up the leg to induce hip flexion while maintaining full knee extension and carefully observe the patient&#;s reaction.

Again, the test is considered positive if the patient&#;s familiar pain shooting down the leg is reproduced. As the aim of the test is to place tension on the sciatic nerve, step-wise modifications can be used to evaluate symptom reproduction. For example, including the addition of ankle dorsiflexion at a point of discomfort to amplify symptoms or asking the patient to flex the neck to increase symptom response.

Wrapping up, a special test is only as good as your clinical reasoning and the results have to be evaluated within the entire clinical picture.

Other common tests for lumbar radicular syndrome are:

21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE

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References

Van Der Windt DA, Simons E, Riphagen II, Ammendolia C, Verhagen AP, Laslett M, Devillé W, Deyo RA, Bouter LM, de Vet HC, Aertgeerts B. Physical examination for lumbar radiculopathy due to disc herniation in patients with low&#;back pain. Cochrane database of systematic reviews. (2).

Scaia V, Baxter D, Cook C. The pain provocation-based straight leg raise test for diagnosis of lumbar disc herniation, lumbar radiculopathy, and/or sciatica: a systematic review of clinical utility. Journal of back and musculoskeletal rehabilitation. Jan 1;25(4):215-23.

What are the benefits of the Straight Leg Raise Test (SLR Test)?

On its own, it is a cost-effective test to conduct.

As we mentioned earlier, you don&#;t need much to be able to perform this physical examination technique. It&#;s a non-invasive test, so you don&#;t need specific equipment. You just need a (comfortable) examination bed and your two hands! We also recommended having another person with you and a goniometer to measure the angle of the leg, but this is optional, especially if you are experienced enough to know the angle of the leg just by looking at it.

The instructions are also straightforward, and this test can easily be accomplished within five minutes!

The results can guide treatment decisions.

The results of the SLR Test can help healthcare professionals what to do next for the patient. The most common course of action is to endorse the patient for further examination to confirm the possible conditions that a patient has based on the SLR Test findings.

If other tests have confirmed the findings, the information can be used to determine how best to treat the patient. Should they simply attend physical therapy or rehabilitation sessions to improve the condition of the leg? Does the patient require surgery? You can answer these two questions by conducting and considering this test and other test results.

It can be used to monitor patients.

Let&#;s say you have already treated the patient and have implemented a care plan that has the patient attend routine check-ups to check on how they&#;ve been doing since they started following the care plan. This physical examination technique can check if they still feel pain in their legs or lower back. It&#;s a good way to check whether their condition is improving.

If they are in pain, but the pain is less than when you first performed this technique on them, that&#;s still progress, especially if subsequent check-ups show that the pain is becoming less and less, even if the progress is slow.

If the pain level seems to be the same or is worsening, the plan needs to be adjusted or overhauled.

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