Lower limb tests

Question 1

SLR

Answer 1

1. The patient lies supine (on their back)
2. The examiner passively lifts one leg, keeping the knee straight
3. The test is considered positive if pain radiates down the leg, usually past the knee, typically between 30°–70° of hip flexion

+ve test =
Sciatica (most commonly due to a herniated lumbar disc)
Lumbosacral radiculopathy
Nerve root compression

Question 2

Bilateral SLR

Answer 2

1. The patient lies supine
2. The examiner raises both legs together while keeping the knees extended
3. The test is considered positive if:
   Pain occurs in the low back or legs at a relatively low angle (e.g., <70°)
4. The pain is radicular, not just due to hamstring stretch

+ve test:
Pain at <30° Possible central disc herniation or spinal stenosis
Radicular pain bilaterally Large central disc herniation pressing on multiple nerve roots
Low back pain without radiation More likely mechanical (e.g., tight hamstrings or lumbar strain)

Question 3

Bragard’s & Sicard’s test

Answer 3

Brangard’s
1. Perform a Straight Leg Raise on the affected leg until pain is elicited

2. Lower the leg slightly (just below the point of pain)
3. Dorsiflex the foot

+ve test =
Reproduction or increase in radicular leg pain (not just tightness) during dorsiflexion.
Indicates sciatic nerve or L5/S1 root irritation.

Sicard’s
1. Perform a Straight Leg Raise just below the pain point

2. Instead of dorsiflexing the foot, extend the big toe (passive dorsiflexion of the hallux)

+ve test =
Reproduction of radicular symptoms (e.g., sharp pain radiating down the leg) with great toe extension.
Suggests sciatic nerve or lumbosacral nerve root irritation.

Question 4

Slump test

Answer 4

1. Patient seated upright, hands behind back
2. Slump forward through the thoracic and lumbar spine (flex the spine) while keeping the head up
3. Flex the cervical spine (chin to chest)
4. Extend one knee while maintaining the slump posture
5. Dorsiflex the ankle of the extended leg
6. If symptoms occur, have the patient extend the neck to see if symptoms lessen (which would suggest neural tension rather than muscular)

+ve test =
Reproduction of radicular symptoms (e.g., tingling, burning, sharp pain down the leg)
Pain is relieved when the neck is extended (reducing neural tension)

Question 5

Bowstring test

Answer 5

1. Start with a Straight Leg Raise:
   Raise the patient’s leg passively while they are supine, until radicular pain (sciatica) is elicited
2. Flex the knee slightly:
   This usually relieves the tension and symptoms
3. Apply gentle pressure to the popliteal fossa:
   Press over the tibial nerve behind the knee (in the popliteal space)

+ve test =
Reproduction of sciatic pain (sharp, shooting, or tingling) when pressure is applied behind the knee
Confirms that symptoms are due to neural tension, not hamstring tightness or other soft tissue problems