Straight Leg Raise Test

What is the Straight Leg Raise Test (SLR Test)?

The (or SLR Test, for short) is a physical examination technique that assesses a patient for certain problems stemming from their lower back to their legs, such as nerve root irritation, neural compression, disc pathologies like disc herniation and disc degeneration. This test can gauge patients for such problems in a non-invasive way!

The SLR Test has the physical therapist or adjacent healthcare professional having their patient lie down flat on their back on an examination bed. The professional will slowly raise the patient’s leg while keeping the knee extended. If the patient feels any pain when the leg has been raised and has reached a certain angle, they might be dealing with a certain lower back or leg condition, likely a herniated disc or nerve root compression. The possible conditions they might be dealing with will be discussed later in this guide.

To confirm the results of the Straight Leg Raise Test, it should be included as part of a comprehensive examination that involves other tests. False positives and negatives are possible, so as an extra measure, further tests will help confirm or refute suspicions based on the results.

How to conduct the Straight Leg Raise Test (SLR Test)

The Straight Leg Raise Test is one of the easiest physical examination techniques to perform. It doesn’t require any special equipment. The only things that you need are a comfortable examination bed and your two hands! We also recommend that you have a goniometer and someone who can use it since you will be busy handling the legs. Now, here’s what you need to do to perform it:

1. Prepare the examination bed.
2. Have your patient lie down on the bed in a supine position (lying face up). Make sure that their legs are straightened, and their feet are pointing upward.
3. Position yourself on the side of the patient (the side with the leg you are examining).
4. Use one of your hands to grasp the patient’s ankle.
5. Place your other hand on the knee to provide support.
6. Slowly lift the leg upward while keeping the knee extended. While doing this, observe the patient’s face to check for signs of discomfort.
7. Make sure to observe the angle of the leg. If the patient shows signs of discomfort or tells you they are in pain when you raise their leg and reach a certain angle, that may indicate the possible issue. If you have someone who can measure the angle with a goniometer while you perform the technique, that would be great!
8. Make sure to perform the test on the other leg.

How to interpret the findings of the Straight Leg Raise Test (SLR Test)

Earlier, we mentioned that if the patient shows signs of discomfort or reports that they are in pain when you raise their leg to a certain angle, that may indicate a certain possible condition. They are positive if they feel:

• Pain below the knee.
• Pain between 30-70 degrees of flexion. This may be indicative of a lumbar disc herniation.
• Pain when the flexion is over 70 degrees. This may indicate hip pathologies or sacroiliac joint pathologies, tightness of hamstrings, tightness of the gluteus maximus, or tightness of the hip capsule.

If the patient does not feel any pain or show any signs of discomfort throughout the test, they are negative.

In the event that your patient tests positive, the best course of action is to always have them endorsed for a more comprehensive examination that involves other tests. Other tests like MRIs and X-rays or even other physical examination techniques may confirm or refute the findings of the SLR Test.

Who knows? Other tests may confirm if the patient has disc herniation, disc prolapse, nerve root irritation, intraspinal tumor, or a pathology that puts pressure on their neurological tissue(s).

The SLR Test should not be the sole assessment to confirm any problems; rather, it should be used to check for the possibility of the patient having certain problems in their lower back and legs.

When is it best to conduct the Straight Leg Raise Test (SLR Test)?

If a patient meets up with you for a medical appointment and one of the things they talk about is pain in their lower back and/or legs, then you should perform the Straight Leg Raise Test on them! Of course, before you do so, check their medical records first. This is because the SLR Test should not be performed on people with severe lower back pain, spinal cord injuries, or other conditions that have a high risk of causing injury or discomfort if aggravated.

After checking their medical records, and they don’t have any of the aforementioned problems, they are in the clear to have this test conducted on them.

Do remember that this test works best when included as part of a comprehensive examination. It is often used to check for problems like nerve root irritation, neural compression, herniated disc, spinal stenosis, and sciatica, to name a few. However, while it can be used to help diagnose these problems, it should not be the only test conducted because false positives and negatives are possible. To reiterate, it’s always best to include this as part of a comprehensive examination that includes tests like other physical examination techniques that focus on the legs and hips, MRI, CT Scans, X-rays, and even Electromyography (EMG)!

Who can conduct the Straight Leg Raise Test (SLR Test)?

Since the Straight Leg Raise Test is a physical examination technique, it can be conducted by numerous healthcare professionals, such as:

• Orthopedists
• Neurologists
• Primary Care Physicians
• Osteopathic Physicians
• Physical Therapists
• Chiropractors

Orthopedists, neurologists, and primary care physicians are generally qualified to perform this examination technique on patients because they are (supposedly) highly educated and trained in the musculoskeletal system, physiology, and neurology. This means they have what it takes to efficiently identify, assess, understand, and treat potential causes of lower back pain and leg pain.

Physical therapists, osteopathic physicians, and chiropractors can also perform this technique because they are educated and trained enough to deal with these problems. Physical therapists can evaluate, treat, and even rehabilitate musculoskeletal conditions, which include lower back and leg pain. If chiropractors can surmise based on medical results that they can simply realign the patient’s musculoskeletal system, specifically the lower back, they can do so as well.

The SLR Test can be performed by any healthcare professional so long as they are highly trained and experienced in dealing with lower back and leg issues. They will know if the test is appropriate in the first place, and if they deem it to be appropriate, they can perform it safely so as not to aggravate any symptoms.

What are the benefits of the Straight Leg Raise Test (SLR Test)?

On its own, it is a cost-effective test to conduct.

As we mentioned earlier, you don’t need much to be able to perform this physical examination technique. It’s a non-invasive test, so you don’t need specific equipment. You just need a (comfortable) examination bed and your two hands! We also recommended having another person with you and a goniometer to measure the angle of the leg, but this is optional, especially if you are experienced enough to know the angle of the leg just by looking at it.

The instructions are also straightforward, and this test can easily be accomplished within five minutes!

The results can guide treatment decisions.

The results of the SLR Test can help healthcare professionals what to do next for the patient. The most common course of action is to endorse the patient for further examination to confirm the possible conditions that a patient has based on the SLR Test findings.

If other tests have confirmed the findings, the information can be used to determine how best to treat the patient. Should they simply attend physical therapy or rehabilitation sessions to improve the condition of the leg? Does the patient require surgery? You can answer these two questions by conducting and considering this test and other test results.

It can be used to monitor patients.

Let’s say you have already treated the patient and have implemented a care plan that has the patient attend routine check-ups to check on how they’ve been doing since they started following the care plan. This physical examination technique can check if they still feel pain in their legs or lower back. It’s a good way to check whether their condition is improving.

If they are in pain, but the pain is less than when you first performed this technique on them, that’s still progress, especially if subsequent check-ups show that the pain is becoming less and less, even if the progress is slow.

If the pain level seems to be the same or is worsening, the plan needs to be adjusted or overhauled.