Which finding would support a positive straight leg raise test in a patient with back pain?

Which finding would support a positive straight leg raise test in a patient with back pain?

• A. Pain relief with leg elevation.
• B. Pain radiating down the leg between 40 and 70 degrees.
• C. Pain only in hip joint.
• D. Pain with knee flexion.

Answer: (B)

The straight leg raise tests neural tension in the lumbosacral nerve roots. A positive result is when lifting the leg reproduces the patient’s typical radicular pain along the sciatic distribution, due to irritation or compression of a lumbar nerve root, most commonly from a herniated disk. The classic finding is pain radiating down the leg that occurs as the leg is elevated into a moderate range, roughly 40 to 70 degrees. That angle indicates the neural tissue is being stretched enough to provoke the radicular pain without being overwhelmed by other structures. Pain relief with leg elevation would argue against radiculopathy and suggest another issue; pain confined to the hip joint points to hip pathology rather than nerve root irritation; and pain restricted to the knee area doesn’t reflect the radicular tract being stretched.

The straight leg raise tests neural tension in the lumbosacral nerve roots. A positive result is when lifting the leg reproduces the patient’s typical radicular pain along the sciatic distribution, due to irritation or compression of a lumbar nerve root, most commonly from a herniated disk. The classic finding is pain radiating down the leg that occurs as the leg is elevated into a moderate range, roughly 40 to 70 degrees. That angle indicates the neural tissue is being stretched enough to provoke the radicular pain without being overwhelmed by other structures.

Pain relief with leg elevation would argue against radiculopathy and suggest another issue; pain confined to the hip joint points to hip pathology rather than nerve root irritation; and pain restricted to the knee area doesn’t reflect the radicular tract being stretched.