How Pain When Lifting Your Leg Can Point to a Back or Hamstring Pain Diagnosis

Healthcare providers sometimes use a test called a straight leg lift (or straight leg raise) to help find the reason for back pain when you lift your leg. Possibilities include a herniated disc or spondylolysis, a stress fracture in the spine.

Some studies suggest the straight leg test is helpful in diagnosing sciatica and other causes. However, others indicate it may not be effective.

This article looks at why and how the straight leg lift is done, what it says about the cause of back pain, and how accurate it is in detecting problems.

Purpose of the Straight Leg Test

The straight leg raise test seeks to reproduce your pain or other symptoms, which gives the healthcare provider clues to what's going on. It's a manual exam, meaning your healthcare provider uses their hands to:

• Position you
• Move you
• Create pressure to see how well you resist it

This approach is often used alongside imaging tests, such as an X-ray or CT (computed tomography) scan.

The straight leg raise is one of the most common manual tests done during physical exams. Its goal is to check for nerve movement and sensitivity of nerve tissue to compression.

During the Straight Leg Raise Test

Expect to feel some pain during the test, as the whole point is to see what aggravates your symptoms. They may be due to problems including:

• Slipped disc
• Spinal instability
• Extra tight hip or back muscles

Most of this test is passive—your provider will do the lifting, and you can help them achieve the most accurate result by staying as relaxed as possible. Be honest about what you feel.

Here's how the procedure generally goes:

1. To start, you'll lie on your back with your legs straight.
2. The provider will ask you to turn one of your legs in. This tells them what hip position affects your low back symptoms.
3. They'll then ask you to bring your leg in toward the center of your body.
4. Next, they'll lift your straight leg up until you say it hurts. Pain suggests a herniated disc. If you don't feel any pain, that provides valuable information, as well.
5. They'll then repeat the procedure with your other leg.

Variations

The examiner may repeat the test with your ankle in a dorsiflexed position. That's what it's called when you raise your foot (the opposite of pointing your toes). Then they'll have you do it with your chin tucked into your chest.

These variations may help the examiner check for nerve involvement in specific locations, including the spinal cord, the spine, or the dura mater (a membrane covering the brain and spinal cord).

If you have your usual pain in the back or leg, but not in your chin, neck, or foot, it's likely that nerves from the spinal cord are involved.

Modifications

If you're unable to lift your leg up while it's straight, or you have difficulty lying on your back, try not to worry. The straight leg raise test has modifications.

It's important to let the examiner know about your limitations. That can also help you avoid an injury during the test.

Accuracy

A 2017 review of studies looked at the accuracy of neurodynamic tests on predicting herniated disc or radiculopathy, which is a pinched nerve root that often causes sciatica.

Researchers were unable to reach a consensus as to whether the straight leg raise test helps with a diagnosis.

The straight leg raise test is also widely used to determine how stiff your hamstrings are. But a 2018 study found hamstring stiffness isn't usually detected by straight leg raise test results.

Summary

The straight leg raise test is often part of the diagnostic process for sciatica/radiculopathy, herniated disc, and other spinal problem. The healthcare provider giving the test does most of the movement for you as they assess what's causing your leg or back pain.

For the test, you'll lie on your back with your legs straight. The provider will have you perform simple movements and tell them how it feels. Then they'll raise your leg up to see if and at what point you have symptoms.

Research suggests this test may not always be effective. Still, it's a very common test. Providers often use this test alongside imaging studies.