Straight Leg Raise

Aka: Straight Leg Raise, Lasegue's Test, Lasegue's Sign, Test of Lasegue, Crossed Straight Leg Raise, Slump Test

1. Technique
   1. Perform in two positions
      1. Supine Low Back Exam
      2. Sitting Low Back Exam
   2. Discrepancy between 2 positions suggests Malingering
   3. Flex hip from 180 to 90 degrees
2. Interpretation: Criteria for positive test
   1. Sciatic Pain at 30 to 70 degrees
   2. Aggravation of pain with dorsiflexion of the foot
   3. Relief of pain by knee flexion
3. Interpretation: What patient experiences
   1. Radiating pain into the legs
      1. Suggests radiculopathy
      2. Higher likelihood findings suggesting radiculopathy
         1. Excruciating Sciatica-like pain
         2. Pain occurs at 30 to 40 degrees of leg elevation
   2. Pain radiates into opposite leg (Crossed Straight Leg Raise)
      1. Indicates severe impingement
      2. Almost always is due to a large disk Herniation
4. Modifications
   1. Lasegue's Test
      1. Dorsiflex foot while performing Straight Leg Raise
   2. Slump Test
      1. Patient sits upright and then flexing at waist with head to knees, in slumped position
      2. Patient lifts leg
5. Efficacy: Predicting Lumbar Disc Herniation
   1. Straight Leg Raise
      1. Test Sensitivity: 80-98%
      2. Test Specificity: 40-60%
      3. Positive Likelihood Ratio: 2.0
      4. Negative Likelihood Ratio: 0.2 to 0.5 (high Negative Predictive Value)
   2. Crossed Straight Leg Raise
      1. Test Sensitivity: Up to 35-43%
      2. Test Specificity: 90-98%
      3. Positive Likelihood Ratio: 3.5 to 4.3 (high Positive Predictive Value)
      4. Negative Likelihood Ratio: 0.72
6. References
   1. Deyo (1992) JAMA 268(6): 760-65 [PubMed]