Bragard’s Test

What is the Bragard Test?

The Bragard Test, also known as Bragard’s Test or Bragard’s Sign, is a type of physical examination technique developed to gauge patients experiencing pain in their lower back and lower extremities. It specifically assesses if a patient’s lower back pain is caused by nerve root compression or irritation.

This particular physical examination technique requires the patient to lie down face up on a bed. The healthcare professional conducting the test will then move one of the patient’s legs upward and dorsiflex their foot to see if they will experience pain. If they do experience pain during this exercise, then there is a chance that the patient is dealing with lumbar radiculopathy.

Lumbar radiculopathy is characterized by pain, weakness, and/or numbness in the lower back or legs due to nerve root compression. The Bragard Test will help determine if the patient possibly has this condition; other lumbar-related tests and imaging tests can help confirm or refute the suspicion based on the results.

While the test is reliable in determining the possibility of this problem, it doesn’t confirm it. Other tests can help with confirming it. More on that later on in this guide.

Have a look at this video if you want to see how the Bragard's Test is performed:

How to perform the Bragard’s Test

Now that you know what the Bragard Test aims to do, it’s time to expound on what the healthcare professional conducting it needs to do to perform this test successfully.

Before anything, you should know that the Bragard Test requires only one thing besides your hands. You only need a comfortable examination bed or table for your patient to lie down on.

Once the examination bed is ready, have your patient lie on it supine (they must be facing up). Make sure that their legs are straightened as well.

As for you, you need to position yourself on the side of the patient, specifically by the legs. When you’re in position, you will do the following:

• You will lift the patient’s leg while keeping it straight.
• You will lift the leg slowly into hip flexion. As you are lifting the leg, tell the patient to tell you if they feel any pain or discomfort at any point while you lift the leg.
• Stop lifting the leg once the patient notifies you of any pain or discomfort.
• Lower the leg a bit. Five degrees should suffice.
• Next, it’s time for passive ankle dorsiflexion. Dorsiflex (bend) the ankle backward. Make sure it’s dorsiflexed firmly.

The Bragard Test is easy! These instructions should be enough to help you conduct it properly.

How to interpret the results of the Bragard’s Test

The instructions of the Bragard Test are easy to follow. Still, the most important part of the test is determining the possibility of lumbar radiculopathy in the patient’s lower back region.

You can make that assessment when you dorsiflex the ankle backward. Before that, the patient supposedly experienced pain or discomfort while lifting their leg, and then you lower the leg a bit (again, five degrees from the point of pain should be good).

If dorsiflexing their ankle backward reproduces the pain they felt earlier, then the test is positive. If the pain seems to be coming from the hip, then you know there is nerve root compression in the lumbar area, which is a sign that they might have lumbar radiculopathy. Again, make sure the ankle is dorsiflexed firmly.

If the patient doesn’t feel anything, they are negative.

If they are positive, the best action is to endorse them for a more comprehensive examination. If they are already undergoing a comprehensive examination, pass them on to the next person conducting another test if it’s not you. Share the results with them so they know what to consider and what they should do.

When is it best to conduct the Bragard’s Test?

The best time to conduct the Bragard Test is when a patient attends an appointment with you and discusses pains in their lower back and/or lower extremities. Suppose the patient has no pre-existing conditions based on their medical history. In that case, conducting this test as early as possible is a must so that you can have the opportunity to identify the possibility of particular problems, confirm it with other tests, and then proceed to find ways to provide early intervention and treatment!

Now, one of the points we made earlier is to endorse the patient for further examination if the Bragard Test results in a positive designation. This is because the test should not be the sole assessment to confirm that the patient has lumbar radiculopathy or other lower back problems. It simply identifies the possibility of the condition, not confirm it.

Other tests, like electrodiagnostic tests, can help build a case for it if the results are consistent and may even detect other problems the patient might have. Imaging tests like MRI can confirm all the suspicions that come up as part of all the other tests, and then the proper diagnoses can be made.

Who can conduct the Bragard’s Test, and for whom is it?

The Bragard Test is mainly for patients presenting pain in their lower back and extremities. However, it’s best not to use this for patients who have recently undergone back surgery or who have serious pre-existing medical conditions concerning their back because the technique might aggravate their lower back problems, especially if not done correctly.

That’s why the Bragard Test should only be performed by certain healthcare professionals, such as orthopedists, physical therapists, occupational therapists, chiropractors, and rehabilitation specialists.

These people are highly trained and experienced in assessing patients for musculoskeletal problems, diagnosing them with specific issues based on test results, and treating them.

They are aware of the risks of physical examination techniques. Hence, they know how to properly conduct them and ensure that the patient is receiving the best care possible and that they do not cause accidental injuries while they perform the technique.

Besides conducting the test properly and keeping the patient safe and as comfortable as possible, they can also correctly determine what designation they should give the patient after the test. They know the factors that go into a positive designation.

What are the benefits of the Bragard’s Test?

It won’t take up much of the professionals' and the patients' time.

The Bragard Test is one of the easiest physical examination techniques to perform. Healthcare professionals who use this can finish in a minute or two because the instructions are straightforward. It also guarantees immediate results because you can find out if the patient is positive as soon as you can replicate the pain that a patient felt before you dorsiflex the ankle backward.

The test is also inexpensive because you only need a comfortable examination bed.

It can help determine what exactly the problem is.

The Bragard Test will help professionals determine if the lower back pain that a patient is feeling is due to a nerve root irritation or compression. While it doesn’t specifically confirm the problem, it can at least identify that it is caused by compression or irritation.

Other tests can confirm which specific nerve root is compressed or irritated, and by confirming the specific nerve root, they can determine the actual problem. Is it lumbar radiculopathy or some other condition like lumbar spinal stenosis, degenerative disc disease, or disc herniation? You’ll find out by conducting other tests.

It can be used to check if the patient has recovered.

The Bragard Test doesn’t have to be a one-time, big-time thing. Let’s stipulate that your patient was diagnosed with lumbar radiculopathy, and your team developed and implemented a treatment plan. At a certain point, you will be conducting a routine check-up to see how they’re doing.

You can repeat this test to see if the pain is still present when you raise the leg and dorsiflex the ankle. If they don’t feel pain anymore, the treatment succeeds. Hopefully, it won't hurt as much if it’s still there. But if the pain is still there, you might need to adjust the treatment plan and see if the adjustments will work.