Straight leg test instructions

The Straight Leg Raise is a passive test. The patient lies with the leg to be examined extended and the knee straight WHILE THE CONTRALATERAL HIP AND KNEE ARE FLEXED! This position rotates the pelvis and eliminates hamstring tightness, a finding often erroneously judged as a positive test. The examiner passively lifts the affected leg and a true positive test is the reproduction or exacerbation of the patient’s typical leg dominant pain. This would be considered a positive test and recorded as “abnormal” on the tool. The reproduction of back pain is not a positive test since it is merely a reflection of the mechanical back pain and not indicative of nerve root irritation-radiculopathy. This finding may be important and should be recorded in the “Additional Findings” column. The degree of leg elevation that triggers the reproduction of the typical leg dominant pain does not determine if the test is positive or negative. Obviously, pain occurring when lifting the leg to 30 degrees is more clinically significant than pain that is not felt until an elevation of 80 degrees, but both constitute a positive result. What is necessary is only the presence of the leg dominant pain. To correctly interpret the straight leg raise the clinician must understand that a patient with back dominant pain cannot have a positive straight leg raise test.A well leg lift is a passive straight leg raise performed on the unaffected leg. If this manoeuvre causes the typical leg dominant pain to be reproduced on the symptomatic side but not in the leg being lifted, the test is positive. It merely indicates a high degree of nerve root irritation in the painful leg. If while the clinician lifts the affected leg the patient feels leg dominant pain not only in the symptomatic leg (as you would expect) but feels pain in the other legs as well, we call this the “crossover” sign. Lifting one leg produces bilateral symptoms. This phenomenon suggests nerve root irritation from a centrally placed lesion and is one marker of an acute Cauda Equina Syndrome. It necessitates further investigation

The straight leg raise can be done in a sitting position as long as it is done passively. The lying position is often preferred since the alignment of the spine is fixed and the level of elevation can be more accurately assessed. The seated test rotates the pelvis and therefore reduces the likelihood of mistaking hamstring tightness for a positive test. The leg is still elevated by the examiner. Many clinicians will do both and compare result for consistency.