The Straight Leg raise Test..Hams or Neural?!
Reference:McCombe P, Fairbank J, Cockersole B, et al 1989 Reproducibility of physical signs in low-back pain. Spine 14: 908-918
The SLR is the most frequently performed neuro-dynamic test and has been shown to have reasonable validity to diagnose disc herniations (McCombe et al 1989).
There are many versions and modifications of the SLR test, however they all have the same goal ?to detect mechano-sensitivity of the Sciatic nerve
It?s often challenging to differentiate between neural sensitivity and hamstring tension during the SLR test, since both structures may produce symptoms in the posterior thigh.
Differentiating between Hamstrings and the Sciatic Nerve
- Slowly and passively flex the hip (starting with the asymptomatic side); be very sensitive and note the ROM at the onset of muscle tone.
- Stop at the first onset of resistance or pain or ?pulling? in the posterior thigh
- Slowly adduct and medially rotate the hip while in the SLR position. Then look at the patient and ask about the symptoms in the posterior thigh
- If the posterior thigh pain / ?pull? dramatically increases and the symptoms peripheralize?it is the Sciatic nerve!
- If there is no change in the posterior thigh pain / ?pull??it is the hamstring muscles
Clinical Relevance: If it is determined that the patient has mechano-sensitivity of the Sciatic nerve, then treatment must focus on the neural system (i.e. Neural Mobilizations)
If it is determined that the patient has simply hamstring tightness or increased tone, then treatment must focus on the muscular system (i.e. Stretching, Massage, Muscular Retraining)
Neural assessment and effective mobilizations are clearly reviewed in the APTEI course ?Lumbar Neural Tissue Pathodynamics?. Please visithttps://www.aptei.com if you wish to know about course dates & locations.
Posted on: October 11, 2003
Categories: Lumbar Spine