Execution
- 1Position the patient supine and fully relaxed, then tests the uninvolved leg first.
- 2Keep the knee extended, positions the hip in neutral adduction / medial rotation, and passively flexes the hip.
- 3Stop when the patient reports back pain, leg pain, tightness, or reproduction of familiar symptoms.
- 4Lower the leg slightly until symptoms ease, then adds ankle dorsiflexion, cervical flexion, or both as sensitizing manoeuvres.
- 5Compare symptom reproduction, angle of onset, and sensitizing response with the opposite side.
Positive outcome
The test is positive when the patient’s familiar symptoms are reproduced in a sciatic or lumbosacral nerve-root distribution and are altered by sensitizing manoeuvres. Symptoms between about 35° and 70° are classically more suspicious for neural tension; pain after 70° is more likely lumbar or sacroiliac joint-related. Back pain alone may reflect a more central disc / thecal irritation pattern, while leg-dominant pain suggests more lateral neural tissue involvement.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Devillé et al. (2000) | NA | 91 | 26 | 1.23 | 0.35 |
| Vroomen et al. (1999) | NA | 85 | 52 | 1.77 | 0.29 |
| Majlesi et al. (2008) | NA | 52 | 89 | 4.73 | 0.54 |
CommentMagee describes SLR as a sequential neurodynamic test, with dorsiflexion and cervical flexion used to confirm neural sensitivity. Systematic reviews show high sensitivity but poor specificity when SLR is used for disc herniation, so it is better as a screening or rule-out component than as a stand-alone rule-in test. Diagnostic values vary because some studies use surgery, imaging, or clinical diagnosis as the reference standard.
Moderate Clinical Value