Back & Neck Pain Diagnosis Testing for the Cause of Back Pain When You Raise Your Leg By Anne Asher, CPT facebook linkedin Anne Asher, ACE-certified personal trainer, health coach, and orthopedic exercise specialist, is a back and neck pain expert. Learn about our editorial process Anne Asher, CPT Medically reviewed by Medically reviewed by Arno Kroner, DAOM, LAc on July 06, 2020 facebook twitter linkedin Arno Kroner, DAOM, LAc, is a board-certified acupuncturist, as well as an herbalist and integrative medicine doctor. He operates a private practice in Santa Monica, California. Learn about our Medical Review Board Arno Kroner, DAOM, LAc on July 06, 2020 Print If you can't do a leg raise without getting either back pain, sciatica, or a combination of the two, your doctor may suspect a herniated disc is responsible. The straight leg raise test is one common manual test used to determine if a herniated disc or another spine-related malady is at the root of your symptoms. Eliza Snow / E+ / Getty Images Purpose of the Straight Leg Test Sciatica has a number of possible causes, from a tight piriformis muscle to more common causes including herniated disc, spinal stenosis, or spondylolisthesis. For patients dealing with sciatica, the first step is diagnosis. A straight leg raise test is one of several tools doctors use to determine whether leg symptoms are due to a herniated disc, slipped disc, spinal instability, extra tight hip or back muscles, or something else. A manual exam procedure is one in which the testing practitioner uses her hands to position you, move you and/or give pressure against which you resist. This is a much different approach to determining the source of pain or of a spinal problem than diagnostic imaging tests, which use machines. Generally speaking, both methods are employed during the diagnostic process. The straight leg raise test is one of the most common manual test procedures performed during a physical exam. Like many of its kind, the goal is to check for nerve movement and sensitivity of nerve tissue to compression. In fact, there's a name for this type of manual test, which is neurodynamic. Neurodynamic testing includes not only the straight leg raise but others as well. During the Straight Leg Raise Test The straight leg raise test seeks to reproduce your pain or other symptoms, so be prepared to experience them for a moment or two while your provider evaluates you. The test is a passive one; you can help her achieve the most accurate result by staying as relaxed as possible and giving an honest summary of what you feel as your leg is lifted. Procedure: To start, the person examining you will ask you to lie on your back with your legs straight. They will then ask you to turn one of your legs in. It’s important to turn the entire lower extremity. This is so the examiner can accurately correlate the position of your hip and low back with the symptoms you report. The examiner will also ask you to bring your leg in towards the center of your body. Next, the examiner will lift your straight leg up until you complain of pain. If you don’t have pain during the straight leg raise, great. But if the maneuver does cause discomfort, this may be a sign that a herniated disc is responsible for your back or leg symptoms. Depending on the angle of your hip when your symptoms start as you're being tested, your practitioner may determine that something other than a herniated disc is the cause. Both legs are tested in a straight leg raise test, so the steps are repeated with the other leg. Variations The examiner may repeat the test with your ankle in a dorsiflexed position, and again with your chin tucked into your chest. (Dorsiflexion is the movement that occurs at your ankle joint when you raise your foot. It is the opposite of pointing your toes.) These variations may help the examiner check for nerve involvement in specific locations, including the dura mater, or covering, of the spinal cord and/or the spinal cord itself. A positive sign for nerve involvement from the spinal cord or its covering would present itself as your usual pain in your back or leg, but not in your chin, neck, or foot. Connecting the Spinal Cord and Motor Neuron Diseases Modifications If you are unable to lift your leg up while it's straight, or you have difficulty lying on your back, take heart. The straight leg raise test has modifications. This is why it’s vitally important to speak up and let the examiner know your limitations. Another reason to speak up is to avoid an injury during the testing. Lower Extremity Special Tests Your PT May Use Accuracy Unfortunately, not much research has been done on neurodynamic tests in general. A 2017 review that looked at the accuracy of neurodynamic tests on predicting radiculopathy, i.e., symptoms that most of us call sciatica, but that are only caused when a spinal nerve root is compressed or irritated in some way. The study found that researchers have yet to reach a consensus as to whether the straight leg raise test is effective for detecting herniated disc and/or spinal nerve root compression. The straight leg raise test is also widely used to determine how stiff a patient's hamstrings are. But a 2018 study published in the International Journal of Sports Medicine found that hamstring stiffness is not actually an underlying factor in the results of most or all straight leg raise test results. Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Koes BW, van Tulder MW, Peul WC. Diagnosis and treatment of sciatica. BMJ. 2007;334(7607):1313–1317. doi:10.1136/bmj.39223.428495.BE Camino Willhuber GO, Piuzzi NS. Straight Leg Raise Test. [Updated 2019 Sep 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Davis D, Vasudevan A. Sciatica. [Updated 2019 Feb 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Allegri M, Montella S, Salici F, et al. Mechanisms of low back pain: a guide for diagnosis and therapy. F1000Res. 2016;5:F1000 Faculty Rev-1530. Published 2016 Jun 28. doi:10.12688/f1000research.8105.2 Coppieters MW, Stappaerts KH, Everaert DG, Staes FF. Addition of test components during neurodynamic testing: effect on range of motion and sensory responses. J Orthop Sports Phys Ther. 2001;31(5):226-35. doi:10.2519/jospt.2001.31.5.226 Pande K. The Use of Passive Straight Leg Raising Test: A Survey of Clinicians. Malays Orthop J. 2015;9(3):44–48. doi:10.5704/MOJ.1511.012 Miller KJ. Physical assessment of lower extremity radiculopathy and sciatica. J Chiropr Med. 2007;6(2):75–82. doi:10.1016/j.jcme.2007.04.001 Young R, Nix S, Wholohan A, Bradhurst R, Reed L. Interventions for increasing ankle joint dorsiflexion: a systematic review and meta-analysis. J Foot Ankle Res. 2013;6(1):46. Published 2013 Nov 14. doi:10.1186/1757-1146-6-46 Venne G, Rasquinha BJ, Kunz M, Ellis RE. Rectus Capitis Posterior Minor: Histological and Biomechanical Links to the Spinal Dura Mater. Spine. 2017;42(8):E466-E473. doi:10.1097/BRS.0000000000001867 Ellis RF, Hing WA. Neural mobilization: a systematic review of randomized controlled trials with an analysis of therapeutic efficacy. J Man Manip Ther. 2008;16(1):8–22. doi:10.1179/106698108790818594 Miyamoto N, Hirata K, Kimura N, Miyamoto-mikami E. Contributions of Hamstring Stiffness to Straight-Leg-Raise and Sit-and-Reach Test Scores. Int J Sports Med. 2018;39(2):110-114. doi:10.1055/s-0043-117411 Additional Reading Magee DJ. Orthopedic Physical Assessment. 4th ed. St. Louis, MO: Elsevier Saunders; 2014.