Straight Leg Raise or Lasègue's Test for Lumbar Radiculopathy

[@Physiotutors]

+++NOTE+++ In the video, the patient's head is supported by a thin pillow. In the purest form of this test, the patient lies flat on the bench. This is fairly impractical in practice. Some might argue that placing a thin pillow under the patient's head will already put tension on the dura and alter the test results. Make sure that when you choose for a pillow, that you use a thin one and that you use this same position every time you reassess for symptoms!

[@Physiotutors]

Review assessments on the go with our e-book or app and solidify your clinical reasoning in our online course: Course: bit.ly/PTMSK Book: bit.ly/GETPT App: physiotutors.com/app

[@mariaelenacastroleo6756]

LEO Y Yazmin.❤❤

[@harshavardhan199]

Thank you very much for telling sensitivity and specificity of every test you demonstrate.

[@djwilliams4714]

I finally found an excellent Dr who finally after years diagnosed my SI issues... he did a similar test to this. When he picked up my right leg while I was lying flat, he pulled out slightly on it, and I literally jumped up and stood on the table. It Hurt that bad!!! He immediately could tell that my right SI joint was the main cause of my issues...

[@djwilliams4714]

After many Dr's, he was the 2nd to do a "physical exam", and the first to fully do one!! He was an AWESOME Dr!!

[@faithm2001]

I have been dealing with chronic body pain for almost a year now. I fell on a treadmill last early August and dislocated my pelvis/hip alignment and all of that. I thought I broke my hand at the same time however, so I continued to work out weightlifting like I had been doing before I fell on treadmill. Pain began to show up in lower left glue ham tie in/ischial tuberosity area, which I now know after seeing MANY doctors and a good PT that it is most likely hamstring tendonitis. The left leg butt/glute still flares up a little time and again but not horrible. I can usually deal with it with ice. As with any tendonitis, good PT and progressively challenging the muscle is essential. I have been doing that for about 3 months to address the left ischial tuberosity tendonitis and it has improved A LOT. Continuing issues however that I have been unable to resolve, and my current PT cannot seem to resolve, is chronic pain/muscle tightness/spasm in the right leg, which is quite odd considering I never directly injured that leg. Theories include incorrect gait walking due to pelvic/hip misalignment, hip flexor tightness, TFL tightness, IT band, the list goes on and on. I have tried every single type of therapy under the sun. Chiropractor, PT, acupuncture, electroshock therapy, massage therapy, percussion, etc. and my right leg continues to be tight like it is sore and I have worked my right quad to death. I also have chronic flare ups of neck pain/tightness, which is so bad some days that I have to stay in bed. No idea what causes it and it is nearly unbearable. Muscle relaxer pills/advil don’t help long term in the way that I need them too. I still feel pain even when I take them. I realize this is a lot of info and quite overwhelming but I just wanted to catch you up on my story and have you be able to get an idea about whether you can help me or not. Thank you for taking the time to read all this. Please respond, anything is appreciated. Do you think this could be a nerve tension problem? I did this test and it radiates/burns shooting pain throughout right leg along IT band outer thigh all the way into calf.

[@Physiotutors]

Hi Faith, we don't do counseling on KZbin and it's also next to impossible via text. We'd advise you to get in touch with our partner www.yourphysio.online to have individualized counseling via Skype.

[@sunny12solid3456]

Hi Faith, I also have ischial tuberosity tendinitis. Can you advise on how you resolved that pain? Thanks.

[@joelschmierer3544]

I have a similar (muscle/nerve?) pain in my left buttocks where it feels sore and worked to death when I am standing up normally and don’t move and the pain gradually builds over say 10min from 1/10 to 9/10 pain and I have to lay down (also happens when I sit in one position for 10min but less intensely). Problem started 2 years ago due to leaning back in a chair with no lower back support very uncomfortably for a super long time until something snapped. Let me know if you found the answer to your similar pain. Maybe nerve compression by spine disc etc. but also my left is tender when massaged so I think it must be a muscle problem also. The only one who has really helped (and will help again once I get a job again to get $150) at diagnosis and treatment is my accurate medium (psychic) but that’s all I’ll say about that unless asked…but she recommended downward dog yoga position which helped and said nothing would show up on x-ray (which it didn’t) and that a chiropractor and acupuncture would both help (have to relisten to recording to remember if she also said massage).

[@ayeeshamir]

Thank you so much for your extraordinary effort to educate us online.

[@ravindarbethi8675]

Excellent explanation. I advise all the viewers to follow the transcript as well, that is well edited in all your videos. Thank you so much for careful making of every video.

[@omg7218]

I'm a fysiotherapy student. These video's are really helpfull. Keep it up!

[@Physiotutors]

+omg7218 we made them especially for students! Glad you like them

[@johnyhansen1362]

you spelled wrong Physio..next generation of physiotherapists..

[@Physiotutors]

+Johny Hansen in the Netherlands physio is spelled "fysio".

[@beliedm]

To the point, Thanks.

[@raidenshogun5104]

Hello @physiotutors! I'm a big fan of your work here and I was just wondering if you could provide for every special tests the indications and contraindications of the special tests? It could really help alot. Thanks!

[@Physiotutors]

Hi Shanmikko, glad to hear! The indication (= when to use the test or what to detect) is mentioned in every video. There are not too many tests that have contraincidcations per se.

[@raidenshogun5104]

@Physiotutors I see. Then how about just those that could be closely related to it? 😊

[@Physiotutors]

If there is a real contraindication we'll mention it in the videos.

[@abirmohamed161]

Thank you so much, this is clear and simple

[@Physiotutors]

+Abeer Mohammed Happy to hear! Thank you for subscribing!!!

[@ryojinishimura53]

It's really simple and useful check. of course we have to put it on our routine.

[@Physiotutors]

No test without clinical reasoning 🙏🏼

[@nikkiburnett3422]

Hey Physiotutors, when performing these tests on your patients do you also perform the slump test? I'm reading mixed things whether you should perform both tests or just one.

[@Physiotutors]

If your hypothesis is "Radiculair pain" then we only do the SLR. In case of a suspected disc herniation with nerve root compression the Slump is too provocative as people do not like to flex their spine. Also performs better regarding validity. The Slump we only use in order to detect minor neurological impairments of the nervous system including the dura.

[@BhatAzhar]

Thanks for making this more easier to understand keep making more and more videos.

[@Physiotutors]

+Bhat Azhar you're welcome bhat! We will definitely continue! Thx for following!

[@sangmiiiiiin]

I love that korean sub ❤️ thanks for this video :)

[@Physiotutors]

Gotta thank the follower who translated them!

[@sangmiiiiiin]

Oh i know and i wanna more translated video that physio 🤤

[@cathrynp3491]

I've had lumbar ridiculopathy for 5 mo. much better now after 20 chiro visits and PT.

[@debbiemeko472]

Too good Physiotutors. Just need a clarification on added manoeuvres (dorsiflexion and neck flexion) in tension-free range. Are these manoeuvres done to elicit symptoms or provoke symptoms in order to have a positive sign? You mentioned, "elicit symptoms". How will the symptoms be elicited when tension is added by these additional manoeuvres? Your response will be very much helpful. Thanks.

[@seanymoseley]

to elicit something is to provoke it. either of those two movements may reproduce patient symptoms

[@snowaier]

Abnormally good quality content for KZbin. Lol

[@Physiotutors]

Thanks Leetle! We aspire to produce high quality content to the best of our abilities

[@hkg7611]

이영상은 한국어 자막으로 설명해 주시니 좋아요.

[@ME-li8mv]

Can taking analgesics before the test affect its sensitivity ? Mine was negative but I have been taking analgesics for a month.

[@ellea.8768]

You said @1:53 if "pain is elicited"...I just wanted to confirm WHERE would the pain be elicited. exactly. Thank you.

[@Physiotutors]

Sharp shooting, lacerating pain down the leg into the foot

[@ellea.8768]

@@Physiotutors thank you for clarifying! Love and appreciate all your videos!!!

[@amalsafi6317]

thank you for everything,, plz I'm so sorry I know it's not related to your media ,, I just would ask you if you know the mechanism of paralytic ileus,, and how the pelvic fractures complicated by paralytic ileus,, because I have exam in surgery after 10 days 😢😢😢😢

[@Physiotutors]

You're welcome and thank you for following! Sorry, not our expertise...

[@rorybray7356]

I have had very strong neural tension in SLR and SLUMP my whole life. I don't have pain at all except when doing movements like these. Not sure why...

[@Physiotutors]

We wouldn't worry about tension during these tests. They are meant to provoke and are only positive if they reproduce radicular pain.

[@rorybray7356]

Okay thanks for your response. Do you think this can be improved still? I want to improve hamstring flexibility, but when I stretch I am always limited by a similar neural tension sensation.

[@mdbelalquraishipt3042]

Your videos are very good. They are helping me in my exams. Can you please update on PASSIVE NECK FLEXION TEST. I'm very confused in that test.. Thanx for such a great initiative. Wish to become a good, knowledgeable physiotherapist like you.

[@Physiotutors]

Thanks a lot! Are you referring to the flexion rotation test? We have a video on that test on the channel: kzbin.info/www/bejne/iqvMfnSkbJyNiLc

[@fahadyousaf4230]

please add some videos for remote assessment. which tests can be performed remotely on audio/video consultation. thanks

[@anasmarey96]

which type of pain and where it will come from if the test is positive ?

[@nancyritsko2961]

Thank you for the information and demonstration.

[@helenhoover]

god bless physiotutors!

[@Physiotutors]

Thank you!

Same feelings of gratitude :) Thank you!!

[@ankitamotwani1697]

If the pain only radiates to gluteus from lumbosacral region in pivd case is the test comsidered positive?

[@simpleman4714]

You are amazing guys🖤

[@mohsinishfaq2554]

U ppl are just awesome 👍👍👍

[@Physiotutors]

thanks for the compliment Moshin, appreciate it and thanks for following!

[@singidisi4664]

In SLR what's the difference between active and passive examination ?

[@kean7525]

should the patient feel pain too in his/her unaffected leg when flexing the leg at hip joint in the range 35-70 degrees?

[@rockinshanel]

Isn't Laseque test when you raise the leg, find resistance due to hamstring tightness, so lower it to about 20 degrees and then perform passive dorsiflexion to provoke the pain?

[@Physiotutors]

It can be used to assess hamstring tightness, but how Lasèque officially describes it is a test for HNP with nerve root compression. So a positive outcome is shooting pain down the leg from 0-60 to 70 degrees. In order to confirm your finding your can perform a Bragard maneuver, which is when you reduce the painful hip flexion (5-10°) and perform dorsiflexion to increase tension on the sciatic nerve again to confirm that your positive finding was due to nerve tension and not hamstring tightness

[@rockinshanel]

Thank you so much for clearing my doubt. Great channel! Keep it up!

[@finnyboy82]

And the treatment?

[@alexmark8588]

is there a difference between the straight leg raising for lumbar radiculopathy and for dural stretch test ?

[@Physiotutors]

+alex mark Hi Alex, if by "dural stretch test" you mean the Slump test then yes! They are both sensitive tests to include/exclude lumbal radiculopathy and to test for nerve mobility, but their setup is different. I personally choose the Slump when my patient's main complaints are during sitting and flexed lumbar positions and the straight leg raise when my patient's main complaints are rather during walking and standing with the lumbar spine in extension. As far as I know, the straight leg raise test's sensitivity is a bit higher for lumbar radiculopathy, but I would have to look for the latest research to back this claim. Does that answer your question?

[@Jakobguldager70]

Could an SLR be positive even if there's not root preassure from a herniated disc? What if there is just a generel neural inflammation or ischemia (for whatever reason) that has caused allydonia in one of the nerves that are stretched? Could it be positive anyway?

[@Physiotutors]

Hey Jakob, the SLR is a pretty sensitive test, but not specific for a discus hernia which causes pressure on the nerve root. All it tests is if the sciatic nerve is mechanosensitive. So if there is peripheral inflammation the test might be positive as well, yes!

[@Jakobguldager70]

Thanks a bunch. I'm currently studying for an exam in which Neurodynamics are part of it. So this helped a lot!

[@Physiotutors]

+Jakob Guldager good to hear! Good luck with ur exam!

[@richardnorrismd]

Absolutely correct. The disk material contains enzymes (Phospholipase A) that is highly irritating to neural tissue. The disk need NOT contact or put pressure on the nerve to cause severe sciatic pain. Pressure on the nerve causes intra neural ischemia resulting in sensory or motor impairment. For example if there is pressure on a lumbar nerve root from compression by a synovial cyst (from a degenerating facet joint) one can have weakness and numbness WITHOUT much pain. R.Norris,MD Interventional Spine Medicine

[@Vicky-dw6gy]

Thanks for the video.

[@neilboles1679]

Thank you for the guidance!

[@Physiotutors]

You’re welcome 😊

[@mohamedrafi2671]

No blah blah straight to the point great

[@genx6619]

Thank you for the info ..my question to you is how accurate is SLR to diagnose slipped disc & what is SLR,seated leg raises,bend forward & backward , dorsiflexion tests are negative but still there is mild pain in right lower back & side thigh

[@Physiotutors]

It's pretty weak to confirm, but moderate to rule out nerve root compression. Crossed slr is better to confirm. History is more important in the diagnosis

[@anisarista7155]

If the patient has pain in the back of the thigh with straight leg test but not down to the leg or foot, is that called positive for sciatica pain? Can you please clarify Thank you ( 9/14/2024, 6:38 pm)

[@srivatsakatakam5644]

Thank you for the information ❤️

[@sailakshmi2347]

Thank u so much

[@BeautycMaseka]

Thank you, very helpful

[@ahmadalosman4110]

Thank you

[@moristhetiger]

Thank you very much. Very useful.

[@gabb5190]

what f the patient's pain does not reproduced during slr but appear during braggard? what does this means? thanks

[@Physiotutors]

If the SLR is not positive until 60-70° with shooting pain down the leg then it's negative according to Lasègue. Don't think shooting pain is suddenly provoked with the Bragard then in these case. Could however be a minor neurological dysfunction that is detected by further increasing tension.

[@dongrekapil]

very nice explanation

[@shash3567]

My SLR test was positive at 50 degree earlier.. now it comes positive at 80 degree.. I have a L4-5 posterocentral disc protrusion as per MRI.. so is my condition improving or is it a joint pain ?

[@thomasvibberstoft3019]

Hi Physiotutors. Love your work. In the start of the video, it's said that the SLR test has a sensitivity of 91%. In the end of the video, you conclude that "you can use the EXCLUDE lumbar radiculopathy". My point: how is this possible as the specificity is only 26%. Am i missing a point? High fives from Copenhagen.

[@Physiotutors]

Hi Thomas, happy to hear that you like our channel! Tests with a high sensitivity are generally better suited to rule out a certain condition. HOWEVER, at the end of the day it's all about the negative likelihood of a test and in this case we end up with LR- 0.34 which moderately decreases the chance of lumbar radicular pain. So yes, we can use it to exclude, but certainly cannot exclude it with a high degree of certainty. A good patient-history will be more important in any case.

[@too602]

Your eyebrow wiggle is cute.

[@ahammadnadaf3476]

Test is abnormal but pain was cames in continuing butuck in 4 months not recovery in any medicines and excise not use me so please send permanent solution

[@saraahmed-ff7ju]

\thanks

[@meecalung]

Type of pain during maneuver?

[@drtekchandsharma]

What about if pain is only felt in back during test becoz not all disc herniation will cause sciatic nervr compressiom

[@dr.irfananwararnab1925]

Just wonderful, Alas, I didn’t see ir earlier. Please keep up the good work.

[@DrMog7]

at 2:08 there is a miss conception about the sensitivity and specificity of a test. If a test is able to identify correctly those with the disease then this is called SENSITIVITY. If a test is able to correctly identify those without the disease then this is called SPECIFICITY. Thanks for the video.

[@Physiotutors]

We get this remark about 10 times a year and it's always that people get confused because of the definition of sensitivity and specificity (which you mention correctly). Watch our videos explaining the concepts of sens and specs and you will understand why a highly sensitive test is useful to rule out a disease

[@blackwolf4417]

thanks alot for this great video

[@svarrtjern]

Really enjoy the channel, just a question. Is the sensitivity and specitivity from the neri and baldar test the same as the normale version?

[@Physiotutors]

It's unknown

[@kawtheralhawsawi7106]

Woow , very helpful thank you very much

[@darshanithilanga8998]

Thank you so much

[@jliu2488]

Could a positive test indicate piriformis syndrome? Or only a disc issue?

[@TheYellowHood]

Hello and thank you for this informative video! Isn't 'Neri's sign' also referred to as 'Brudzinski's test' ?

[@Physiotutors]

Don’t know about that’s could be

[@aquabplatsch]

Good question, all signs for meningeal irritation might be easily confused. But Brudzinskis is a different test: When pain occurs during head inclination (= Lhermittes sign), hip and knee flexion brings relief, which is then called Brudzinski test.

[@jorginaalcer5421]

very informative, thank you!

[@pallasathene8071]

on both sides the same symptoms should occur ?

[@Physiotutors]

No, on the side that is raised - there is the crossed SLR in which the other side should give pain in case it's positive with a higher specificity and lower sensitivity!

[@kobiaviv8481]

very good videos, thank you

[@Physiotutors]

Glad you like them!

[@CamilaRodriguez-hv7ls]

Excelent! thank you

[@Physiotutors]

You are welcome!

[@sailakshmi2347]

Nice explanation 👍

[@alpanamishra7586]

I am unable to do that,it hurts a lot when i raise my leg straight upward,I am unable to do that

[@sanamalik7484]

What happened

[@뱃살공주-q8q]

감사합니당~^^ 그리고 한글 번역글 감사합니당~

[@mdfilms6893]

how to do treatment of this issue

[@CRuma-ut9hl]

great. thanks

[@BUTTA170]

Great information

[@loula3684]

Good one

[@Physiotutors]

thanks Loula!

[@harunorrashidrony229]

Please stages of SLR

[@macknumber9]

Can you explain what the sensitivity and specificity rating is exactly?

[@Physiotutors]

kzbin.info/www/bejne/i6Syp2N6mL2ebNk

[@aizenss2638]

i did this test, the pain only accrue in the left foot its positive or negative?

[@Physiotutors]

Has to be shooting pain down the leg

[@아어아-g1u]

good

[@Physiotutors]

Thanks!

[@dawoodaslam9919]

What is the solution of it???

[@galaxycat4971]

so we don't need to adductor the hip slide and internal rotation?

[@Physiotutors]

Not if you want to do the original SLR according to lasegue

[@huyquang1263]

Thank you so much!

[@maulikrushi5389]

After lifting leg where should be the pain

[@Physiotutors]

Shooting pain down the leg for hernia with nerve root compression.

[@maulikrushi5389]

@@Physiotutors hi nerve root means in the back

[@maulikrushi5389]

And also i dont feel shooting pain

[@Physiotutors]

Yes, there are not other nerve roots.

[@Physiotutors]

Good

[@abdodikna3958]

Thank u for ur comprehve video

[@Physiotutors]

Ur welcome Abdo!

[@2007dodi]

I am confused At uni They taught us to Dorsiflex and then internally rotate the tibia and adduct the thigh!! If there is reproduction of symptoms (Sensitising movements) the rest is positive. So is this the same ?

[@Physiotutors]

The important thing is to understand why they taught you the SLR like this. Do you know? The original description from Lasègue is without dorsiflexion, internal rotation and adduction and has to be positive with shooting pain down the leg (below the knee) before 60-70° of hip flexion. The added dorsiflexion or neck flexion is added to differentiate between a nerve mobility/sensitivity problem and hamstrings or other musculoskeletal condition. These movements are called Bragard and Neri.

[@2007dodi]

Yes We need to add the DF if there is no pain then add IR tibia then Add If the pain still there it means it's a neurological issue If the pain goes away it means hamstring tightness But I I think I need to ask if it's vice versa ( pain still there maybe hamstring)

[@Physiotutors]

Okay, so it's basically what we also explain in the video. You are using DF and neck flexion to further stretch the nerve, so in order to differentiate.

[@HeyIntegrity]

Why can't joint pain be in early rom?

[@gabb5190]

hi physiotutors, what does positive slr on both leg means?

[@YamatoXion]

Probable disc prolapse, lesion or herniation of lumbar spine.

[@Hsa008]

Please please answer me . I cant raise my leg more then 35°. I dont feel pain. Is it flexibility problem?

[@Physiotutors]

Impossible to say from afar but sounds like it

[@NanaMoiishii]

my question is neri sign is supposed to be with dorsiflexion or just simply doing neck flexion?

[@Physiotutors]

Neri=neck flexion Bragard=Dorsiflexion

[@ivanchacha7557]

Un excelente video, sigan así.

[@Physiotutors]

Thanks, Ivan - happy you like our video!

[@MrApple0214]

should you be standing on patient's right side instead in order to show the exemplary way doing the test?

[@Physiotutors]

+Jia Ping: That way he would be standing directly in front of the camera.

[@MrApple0214]

You can turn the bed instead so that the patient's head is on the other end. Hope it helps.

[@Physiotutors]

But why does it have to be the right leg for demonstration?

[@MrApple0214]

Dont you know that it's always have to perform examination on patient's right side? furthermore you are demonstrating exemplary physical examination, it's better to show do it on patient's right side.

[@Physiotutors]

First time I hear that! Who made that rule?

[@kainatali2802]

What’s the range in which muscles are involved????

[@Physiotutors]

All of it, if you want to learn more you may be interested in our upcoming course on the spine Stay tuned for it here: study.physiotutors.com

[@lorrancourts3055]

this is great thankyou

[@Physiotutors]

Glad you like it Lorran and thank you for following!

[@LakPak2000]

Great video!

[@엄석대-v6u]

Thank you! Very helpful video:)

[@Physiotutors]

Thanks! Glad you like it

[@최용훈-y8x]

thank you^^

[@nagmaansari3392]

Nice very helpfull

[@waleedkhalid6908]

nice work

[@Ozt94]

Hi guys, For somebody who is experiencing numbness in the thigh, weakness in the right leg and has had a previous L2-3 protrusion, which tests would be best to use for a suspected herniated L2, SLR or Slump test? Unsure of which one would be the better and more viable option to diagnose for that herniated lumbar disc, Thanks.

[@Physiotutors]

Patient history above all, but with higher lumbar level nerve root compression you'd have to do the prone knee bend test

[@mannyhood6024]

Good vid

[@robertoconner1948]

I have lower back pain on my left side and I cannot raise my left leg as it hurts my lower back.

[@Physiotutors]

Lifting the left leg creates tension in the low back which may explain your symptoms but we can’t say anything specific. Therefore we recommend you consult a physiotherapist or visit our partners at yourphysio.online for a remote consultation