Execution
- 1Position the patient so each key lower-limb movement can be compared side to side.
- 2Test L2 hip flexion, L3 knee extension, L4 ankle dorsiflexion, L5 great-toe extension, and S1 ankle plantarflexion or eversion.
- 3Test S2 hamstring or toe-flexion function when clinically indicated.
- 4Apply isometric resistance and grades weakness, pain inhibition, fatigue, or asymmetry.
- 5Check whether weakness matches dermatomal, reflex, and neurodynamic findings.
Positive outcome
Reproducible weakness in a myotomal pattern is positive. Pain-limited effort, fear, or local joint pain should not be interpreted as true myotomal weakness without corroborating signs. Pattern-matched weakness is more meaningful than isolated weak effort in one movement.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Tawa et al. (2017) — systematic review | NA | 13-61 | 60-98 | NA | NA |
| Suri et al. (2011) | NA | NA | NA | NA | NA |
CommentLower-limb myotome testing helps localize neurological deficit but is insensitive as a stand-alone screen for radiculopathy. Diagnostic value rises when weakness is root-consistent and supported by sensory, reflex, and neurodynamic findings. A normal myotome screen does not exclude radicular pain.
Low Clinical Value