What is the role of straight leg raising in the clinical evaluation of low back pain (LBP)?

Updated: Aug 22, 2018
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Answer

Answer

Straight leg raising with the patient supine should produce ipsilateral leg pain between 10° and 60° to be declared positive. Straight leg raising that produces pain in the opposite leg carries a high probability of disk herniation, and an investigation should be considered, especially if neurological evidence for radiculopathy is present. Nonspecific complaints, overtly excessive pain behavior, patient contraction of antagonist muscles that limit the examiner's testing, or tightness of buttock and hamstring muscles are commonly mistaken for positive results on straight leg raising.

Reverse straight leg raising may elicit symptoms of pain by inducing neural tension on irritated or compressed nerve roots in the mid-to-upper lumbar region. In addition, this maneuver helps the astute physician identify tightness of the iliopsoas muscle, which commonly contributes to chronic lumbar discomfort.


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