Straight Leg Test Protocol for Back Pain Assessment

Can the straight leg test help find the cause of back or hamstring pain in individuals experiencing it?

Straight Leg Test

The straight leg raise test is often used to diagnose sciatica/radiculopathy, herniated discs, and other spinal problems. The healthcare provider giving the test performs most of the movement as they assess what’s causing the leg and/or back pain. The patient lies on their back with the legs straight. The provider will have the patient perform specific movements and inform them of how it feels. Then, they’ll raise the leg to see if and at what point symptoms begin to show. Providers often use this test alongside imaging studies.

• Potential causes include a herniated disc or spondylolysis and a stress fracture in the spine. (Casiano V.E. et al., Back Pain. 2023)
• Some studies suggest the straight leg test helps diagnose sciatica and other causes. (Pesonen J. et al., 2021)

Purpose

The straight leg raise is one of the most common manual tests done during physical exams. The straight leg raise test seeks to reproduce the pain or other symptoms in a controlled fashion to provide clues to what’s happening. It is a manual exam, and the healthcare provider will:

• Position the patient
• Moves the patient
• Create pressure to see how well the patient can resist it

This is often used alongside imaging tests, such as an X-ray or CT scan. (Allegri M. et al., 2016) Its goal is to check for nerve movement and sensitivity of nerve tissue to compression. The straight leg lift test is neurodynamic because it uses movement to diagnose nerve problems. (Baselgia L.T. et al., 2017)

During the Test

Expect to feel some pain during the test, as the whole point is to see what aggravates the symptoms. They may be caused by:

• Tight hip or back muscles
• Back muscle spasms
• Slipped disc
• Spinal instability

Most of the tests are passive, with the provider doing the lifting. The patient can help achieve the most accurate result by staying as relaxed as possible and being clear about what is felt. (Pande K. 2015) The procedure:

• The patient lies on their back with their legs straight.
• The provider will ask the patient to turn one of the legs in.
• This tells them what hip position affects the lower back symptoms.
• They’ll then ask you to bring the leg toward the body’s center.
• Then, they’ll lift the straight leg until the patient experiences symptoms.
• Pain suggests a herniated disc.
• If there is no pain, this also provides valuable information.
• The procedure is repeated with the other leg.

Modifications

It’s important to let the examiner know about any limitations. The straight leg raise test has modifications if the patient cannot lift their leg while it’s straight or if they have difficulty lying on their back, which can also help avoid an injury during the test.

Variations

The healthcare provider may repeat the test with the ankle in a dorsiflexed position/raising the foot. Then, they’ll have the patient do it with their chin tucked into their chest. (Young R. et al., 2013) These variations can help check for nerve involvement in specific locations, such as the spinal cord or the dura mater, the membrane covering the brain and spinal cord. (Venne G. et al., 2017) The spinal cord nerves are likely involved and affected if the usual pain is in the back or leg but not the chin, neck, or foot. (Camino Willhuber GO, Piuzzi NS. 2023)

Injury Medical Chiropractic and Functional Medicine Clinic

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and mitigate issues through adjustments that help the body realign itself. The clinic can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.

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References

Casiano, V. E., Sarwan, G., Dydyk, A. M., & Varacallo, M. A. (2025). Back Pain. In StatPearls. www.ncbi.nlm.nih.gov/pubmed/30844200

Pesonen, J., Shacklock, M., Suomalainen, J. S., Karttunen, L., Mäki, J., Airaksinen, O., & Rade, M. (2021). Extending the straight leg raise test for improved clinical evaluation of sciatica: validity and diagnostic performance with reference to the magnetic resonance imaging. BMC musculoskeletal disorders, 22(1), 808. doi.org/10.1186/s12891-021-04649-z

Allegri, M., Montella, S., Salici, F., Valente, A., Marchesini, M., Compagnone, C., Baciarello, M., Manferdini, M. E., & Fanelli, G. (2016). Mechanisms of low back pain: a guide for diagnosis and therapy. F1000Research, 5, F1000 Faculty Rev-1530. doi.org/10.12688/f1000research.8105.2

Baselgia, L. T., Bennett, D. L., Silbiger, R. M., & Schmid, A. B. (2017). Negative Neurodynamic Tests Do Not Exclude Neural Dysfunction in Patients With Entrapment Neuropathies. Archives of physical medicine and rehabilitation, 98(3), 480–486. doi.org/10.1016/j.apmr.2016.06.019

Pande K. (2015). The Use of Passive Straight Leg Raising Test: A Survey of Clinicians. Malaysian Orthopaedic Journal, 9(3), 44–48. doi.org/10.5704/MOJ.1511.012

Young, R., Nix, S., Wholohan, A., Bradhurst, R., & Reed, L. (2013). Interventions for increasing ankle joint dorsiflexion: a systematic review and meta-analysis. Journal of foot and ankle research, 6(1), 46. doi.org/10.1186/1757-1146-6-46

Venne, G., Rasquinha, B. J., Kunz, M., & Ellis, R. E. (2017). Rectus Capitis Posterior Minor: Histological and Biomechanical Links to the Spinal Dura Mater. Spine, 42(8), E466–E473. doi.org/10.1097/BRS.0000000000001867

Camino Willhuber, G. O., & Piuzzi, N. S. (2025). Straight Leg Raise Test. In StatPearls. www.ncbi.nlm.nih.gov/pubmed/30969539