Numerous conditions, such as a herniated disc, spinal stenosis, or spinal injury, can cause sciatica. Myself personally, as author of this article, I’ve both suffered with it (for many years) and treated hundreds if not thousands of cases of sciatica over 20 years of working. We see it every day numerous times at our clinic at Surrey Physio. Sciatica is a very common problem, and can be very debilitating.

From the lower back, the sciatic nerve travels through the buttocks and down the back of each leg.

It is caused by pressure on the longest and widest nerve in the body, the sciatic nerve. We think this progression may reduce the number of false negatives, particularly in higher functioning patients such as athletes in whom the standard SLR is not a high enough test.Sciatica is a condition that causes lower back and leg pain, numbness, and tingling. You can avoid false negatives with appropriate progressions. The patient may then become a candidate for neurodynamic treatment when originally they were MISSED BY A FALSE NEGATIVE. If then the extended SLR (internal rotation) reproduces clinical pain when the standard test did not, the test fails the exclusion test and would then change the response from normal to abnormal. So internal rotation may be used as a reliable progression for patients in whom 'exclusion' is important at higher levels of function where their standard SLR is normal. If differentiation of clinical symptoms failed with the usual SLR (no hip rotation) and the problem were only mild, dorsiflexion would still be used for DIFFERENTIATION and internal rotation to INCREASE FORCE (a higher progression) and likelihood of detecting an abnormal response (more sensitive). CHOICE of movement would therefore be determined by the PURPOSE of the movement and would be based on patient features.īack pain could be differentiated with dorsiflexion, but internal rotation may not be necessary (or safe) in the patient with severe reproducible pain. That's all very well but how is this relevant to clinical practice and how can we apply this?Įven though found to be reliable, we must remember that hip rotation and dorsiflexion increase tension in the sciatic nerve. Discussion and Conclusions - When To Extend the SLR and When Not ToĪdding dorsiflexion and internal rotation to the usual straight leg raise was highly reliable in this population of lumbar nerve root compression from disc hernia.

Straight leg raise test for sciatica