0916-801 1/81 /0203-0117$02.

00/0
THE JOURNALOF ORTHOPAEDlC AND SPORTSPHYSICALTHERAPY
Copyright O 1981 by The Orthopaed~cand Sports Physical Therapy Sections of the
Amerlcan Physical Therapy Association

The Straight-Leg-Raising Test:

A Review*
LAWRENCE M. URBAN,? BA, DPT

A positive unilateral straight-leg-raising sign is routinely interpreted as indicative of

a "disc lesion. A review of the literature was undertaken in an attempt to more
"

clearly illustrate the mechanisms and results of the straight-leg-raising test,Lt_l?lr2s

~
found that a positive strai ht-le -r
patient with herniated disc from-t.?
. '
. . a
with low back pain and sciatica.
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INTRODUCTION fied the stretching of the sciatic nerve as the

cause of the pain.''' De Beurmann in 1884
A review of the literature on straight-leg raising
explained that the pain produced by straight-leg
is made in an attempt to present a functional
raising was due to stretch of the sciatic nerve.I0,
interpretation of this commonly used test.
Copyright © 1981 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.

79 This theory differed from that of Forst and

An effort has been made to outline the mech-
Lasegue who felt that the pain produced was
anism of pain production during the straight-leg-
due to muscular compression of the sciatic
raising test. Since a positive straight-leg-raising nerve.10.23.79, 100
test is routinely interpreted as indicative of disc
A number of tests exist which are similar to or
protr~sion,'~ the bulk of the discussion has at-
complement the straight-leg-raising test. In
tempted to correlate this test with actual disc
1864, Vladimar Kernig, a Russian physician,
pathology.
described a test very similar to the straight-leg-
raising test to aid in the diagnosis of meningitis.
HISTORICAL NOTE
This maneuver was flexion at the knees and hips
Journal of Orthopaedic & Sports Physical Therapy®

In 1881, J. J. Forst described a test to provoke
pain in patients with sciatica. The involved lower
extremity of a supine patient is raised with the
knee extended. If pain is elicited the maneuver
is repeated, this time flexing the leg on the pelvis.
If this movement is then painfree, the test is
pOSitive.9.10. 23. 48. 79. 97. 100
The straight-leg-raising test just described
bears the name of Charles Ernest Lasegue, who
never published a description of the test. Forst,
a student of Lasegue, dedicated his doctoral
thesis23to Lasegue and thereby immortalized his
maSfer.1079. 97, 100
Actually, the straight-leg-raising test was
described by a number of individuals, both
before and after Forst's publication in 1881. In
1880, Lazarevic, a Yugoslavian physician, de-
scribed the straight-leg-raising test and identi-
Submitted to the School of Medical Rehabilitation. Universitv of
Manitoba, in fulfillmefit of the requirements for the course 68.409.
tStaff Therapist, Institute of Sports Medicine. Sports Physiotherapy
Centre, Winnipeg, Manitoba, Canada.
following passive flexion of the neck.g,'0.97 In
1901, Fajersztajn described an adjunct to the
straight-leg-raising test which he felt demon-
strated the mechanical mechanism of pain pro-
duction. In this test, the extended limb is raised
to the point where pain is first experienced, and
the ankle is then dorsiflexed, which fully mani-
fests the pain." Fajersztajn also described a
variation to the straight-leg-raising test known as
the "crossed sciatic sign" or the crossed
straight-leg-raising test, which provoked sciatic
pain in the affected hip or limb while utilizing the
straight-leg-raising test on the healthy
limb.lo. 44. 79
PROTOCOL OF TESTING
The straight-leg-raising test under discussion
within this article is as stated in the D ~ O ~ O Cfor
O~
of the straight-leg-raising test advo-
cated by Breig and Troup.' The patient should
 118
be positioned on a flat level couch with the neck
slightly extended. The hips should be neutral,
neither abducted nor adducted. Prior to starting,
explain to the patient what is about to happen
and that the patient should describe the location
of any pain experienced. The leg should then be
lifted slowly, maintaining the knee in an extended
position at the same time and keeping the limb
neutral, neither externally nor internally rotated.
When pain is felt, record the range of motion and
the site of pain.
ANATOMY AND PHYSIOLOGY
A brief discussion of the pertinent anatomy of
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the lumbar nerve roots and related structures
should aid in the understanding of the concepts
being presented.
Copyright © 1981 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
Journal of Orthopaedic & Sports Physical Therapy®
Fig. 1 . Dura-arachnoid sleeve of the nerve root in the intervertebral canal. A, level of the intervertebral foramen; B, gutter of
the transverse process; C, level at which the arachnoid attaches to the dura; D, level at which the nerve has only a dural
coating. Redrawn from Cailliet."
URBAN JOSPT Vol. 2. No. 3
Intervertebral Relations
The anterior and posterior nerve roots are
formed by the convergence of rootlets exiting
from the anterior and posterior aspects of the
spinal cord, respectively. As each pair of anterior
and posterior nerve roots proceed toward their
respective intervertebral foramina, they invagin-
ate the dura and arachnoid, forming a funnel-
shaped depression, and carry an individual and
separate bilaminar sleeve of dura and arach-
n ~ i d ~ ~ (Fig.
. " ~ 1' )~
. This sleeve continues as far
as the ganglion where it is strongly attached and
ultimately becomes the perineurial sheath." Just
distal to the spinal ganglion, the ventral and
dorsal nerve roots unite to form the spinal nerve
which passes through the intervertebral fora-
men. The spinal nerve then divides into a dorsal
and ventral r a m ~ s . The
~ ' nerve complex,8889as
D o r s a l Root
\ D u r a l Sheath
Root
7 Dura
 JOSPT Winter 198 1 THE STRAIGHT-LEG-RAISING TEST: A REVIEW
it transverses the intervertebral foramen, is sur-
rounded by loose areolar connective tissue con-
taining the spinal artery, its branches, veins,
lymphatics, and the sinuvertebral nerve. Dis-
agreement exists concerning the attachment of
the nerve roots within the intervertebral canal.
Wykeio3 citing Broda18states that the nerve roots
are firmly anchored to the wall of the ~nterverte-
bra1 foramina. Converse to this, Sunderland8%
and lnman and S a ~ n d e r sstate
~ ~ that the "nerve
complex" is not strongly attached but rather
lightly tethered, allowing movement within the
canal. What this means is that the integrity of
this system is due to the continuity of the nerve
sheath with the dural funnel, not to any strong
attachment of either nerve or dura to bone. Sub-
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sequently, movement of the nerve is transmitted
to the dura and vice versa. In the lumbar region,
as the roots descend in the spinal canal, they
cross the disc above the intervertebral canal by
which they will exit (Fig. 2). As a root exits the
foramina, the pedicle is superior. the ligamentum
Copyright © 1981 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
flavum posterior, and the vertebral body and the
intervertebral disc anterior. The nerve then
passes downwards, outwards, and forwards,
crossing the anrerlor aspect ot tne apophyseal
joint.89 Goddard and Reid27 state that both L4
Journal of Orthopaedic & Sports Physical Therapy®
Fig. 2 . Passage of the'lumbar nerve through the upper part
of the foramen where it is behind the vertebral body and
immediately below its pedicle. Note the proximity of the nerve
root to the articular process and the passage of the dorsal
ramus across the lateral surface of the articular process.
Redrawn from Sunderland.
119
Fig. 3. Angular course of the sciatic nerve. The nerve exits
the foramen, then follows an angular course over the ala of
the sacrum then downwards, backwards, and laterally to the
sciatic notch. Redrawn from Cram.13
and L5 roots impinge on the inferomedial aspect
of the upper pedicle and then on the superola-
teral surface of the pedicle below as they exit.
Therefore, the intervertebral disc, the pedicle,
the apophyseal joint including the capsule, the
ligamentum flavum, and the vertebral rim are all
closely related to the exiting nerve root. The
lumbosacral cordz7 or the continuation of the
upper band of the sacral plexus30 then follows
an angular course over the ala of the sacrum,
then downwards, backwards, and laterally to the
sciatic 30 (Fig. 3). This is somewhat dif-
ferent from Charnley'si2 description of a straight
descent. It then passes out of the greater sciatic
foramen and travels in direct contact with the
dorsal ischium into the posterior thigh to its lower
one-third, where it divides into the tibia1 and
common peroneal nerves.
Nerve Structure
A peripheral nerve is comprised of numerous
nerve fibers, each of which is suspended in an
endoneurial matrix which is bound by perineu-
rium into bundles known as funiculi. Each funic-
ulus is embedded in a loose areolar connective
tissue matrix known as epineurium (Fig. 4). The
epineurium contains collagen and elastic fibers
which maintain undulations in the nerve, thereby
permitting changes in length without the funiculi
being strained. The amount of epineurium varies,
greater amounts being found in the vicinity of
joints. Relatively small amounts of scanty epi-
neurium exist within the nerve root.86The loose
matrix structure of the epineurium provides pro-
tection to the funiculi from external pressure.
Within a peripheral nerve, the funiculi are ar-
ranged in a plexus configuration, while in the
nerve root, the root fibers run parallel.86*90
Each
funiculus is enclosed within a sheath, the peri-
neurium. The function of the perineurium is to
protect the nerve bundles which it encircles. It
 URBAN
Myelinated nerve
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Copyright © 1981 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
Fig. 4. Transverse section of a peripheral nerve (cat). Note the nerve fasciculi, the epi-, peri-, and endoneurial connec$&q
tissue sheaths. Redrawn from Gray.30
does this in two ways. Firstly, the tensile strength
and elasticity of a nerve trunk is largely due to
the funicular tissue.E6Secondly, the perineurium
is composed of two functionally distinct areas,
external and internal. The internal membrane or
Journal of Orthopaedic & Sports Physical Therapy®
perilernma constitutes a diffusion barrier55,"' E6
which prevents the passage of chemical and/or
septic irritants to the endoneurial space. Con-
versely, this barrier may also localize inflamma-
tory changes within the nerve when they occur.
~ u n d b o r points
g ~ ~ out that the endoneural blood
vessels acquire a perineural sleeve as they enter
the endoneurium and thereby provide a com-
bined barrier. The nerve root has no perineurium
and therefore does not benefit from its protec-
tion.
The endoneurium is the innermost layer of
connective tissue forming a delicate tube a-
round each individual nerve fiber. There is
evidenceE6, that the endoneurium is
responsible for both elastic and tensile proper-
ties but not to the same degree as the perineu-
rium.
From this, certain differences become appar-
ent when comparing peripheral nerves and
spinal nerve roots.
1) The spinal nerve root has a poorly devel-
.-
JOSPT Vol. 2, No. 3
l e u r ium
oped epineurium which makes it moresus-
ceptible ta compressive forces.
2) The spinal nerve root has no perineurium
which makes the spinal nerve root more
susceptible to:
a3 tension cdefam&on and its conse-
quences, e.g., microcirculation reduc-
t i ~ and
n ~ ~
b) chemical irritants secondary to irritation
or trauma, as well as to infection.
3) The fasciculi of spinal nerve roots run in a
parallel nonplexiform arrangement which is
not as resistant to tensile deformation as
the arrangement within peripheral nerves.
Circulation
Peripheral nerves are generally well-vascular-
ized structures with two integrated but function-
ally independent microvascular systems, extrin-
sic (nutrient a m m.
The extrinsic system originates from nearby
large arteries and veins. These enter the nerve
along its course at which point they divide into
ascending and descending branches which run
longitudinally within the epineurium. Vast num-
bers of anastomoses exist between these ves-
 JOSPT Winter 1981 THE STRAIGHT-LEG-RAISING TEST: A REVIEW 121

sels, some of which penetrate the interior of the
nerve, ultimately providing a rich intraneural net-
work within the perineurium and f a s i c l e ~ This
.~
intrinsic system is continuous throughout the
nerve.55'56
The lymphatic system within nerve trunks is
not fully understood, but the literature indicates
that a capillary network exists within the epineu-
rium which is not in communication with the
endoneurial spaces. This network is drained by
lymphatic channels which accompany the ves-
sels of the nerve trunk.87Overall, this contributes
to relatively poor lymphatic drainage.
~urphy~ citec
' unpublished dafa by Parke,
Gammell, and Rothman which deals specifically
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ies comprise the proximal set supplying the ven-
tral and dorsal roots, respectively, and the an-
terior and posterior radicular arteries comprising
the distal set again supplying the ventral and
dorsal roots, r e s p e ~ t i v e l y . ~ ~
Innervation
In the context of the straight-leg-raising test,
~ a i ncan arise from the following tissues: the
dura, the nerve root, the adventibl AxiaU pf,
the epidural veins, and the synoviat facetbints.
The spinal dura mater is innervated by
branches of the sinuvertebral nerve (recurrent
meningeal nerve).7. 17. 38. 45. 46, 50. 61, 67, 85 At the

with the microvascular anatomy of the lumbosac-
ral nerve roots. In the lumbosacral spinal nerve
roots, the intrinsic system is supplied by two
different types of "feeder" vessels, a proximal
set in which the blood flows distally and a distal
set in which the blood flows proximally with both
Copyright © 1981 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
lumbar level, one ramus usually connects a
spinal nerve to a sympathetic g a n g l i ~ n , ' ~ and
each nerve arises either near or with the ramus
communicans (Fig. 5). Each nerve enters the
spinal canal and proceeds toward the midline of
the posterior longitudinal ligament. Along its

meeting half way in an area of relative hypovas- course, branches are given off to ligament, peri-
cularity. The anterior and posterior spinal arter- osteum, blood vessels of the epidural space, and

Sympathetic ganglion
Journal of Orthopaedic & Sports Physical Therapy®

Rami
communicantes
Intercostal
nerve -Posterior
longitudinal

Fig. 5 . Horizontal section at a thoracic level showing the main branches of the spinal ganglion and of the dorsal ramus. A
paravertebral nerve plexus is illustrated arising from communications between the spinal and sympathetic ganglia and passing
through the intervertebral foramen into the spinal canal towards the midline of the posterior longitudinal ligament. Along its
course, branches are given off to ligament, periosteum, blood vessels, and the dura. Redrawn from S t i l ~ e l l . ~ ~
 122 URBAN JOSPT Vol. 2, No. 3

the dura mater including the dural

Considerable overlap of innervation has been
demonstrated,j7 the general pattern being fibers
from one segment are distributed to the segment
above and to two segments below.'7s50 The in-
nervation of the dura mater consists of a plexus
system of u n w mfifxrs- \Nlm a
much g m e n s i t y anteriorly than on the pos-
terior aspects of the dural s ~ e e v e T ~'03. ~ s ~ ~
'
Nerve trunks and spinal roots are both innerv-
ated with pain-sensitive tissues.44.77. 78 Accord-
ing to H r ~ m a d a nerve
, ~ ~ trunks receive a dual
innervation, firstly, axonal branching from the
axons and passing through the nerve and, sec-
ondly, from the perivascular plexuses. The epi-
Fig. 6. Sequence of events under normal circumstances. 1,
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neurium of the posterior spinal roots is supplied

by direct fibers from the spinal ganglion cells
while the epineurium of the anterior spinal roots
receive innervation from tiny roots in their vicin-
ity, probably fine twigs of the sinuvertebral nerve.
Numerous nerve ending types have been dem-
Copyright © 1981 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
almost immediately movement of the nerve at the greater
sciatic notch begin^;'^ 2, movement is seen more proximally
at the ala of the sacrum;273; the majority of movement at the
intervertebral foramen occurs;' '. ''. 27. 45 4, minimal movement
occurs with the development of tension along the entire
course of the nerve.". ", ". 45 Redrawn from Grieve3' and
Fahrni. 20

onstrated in the spinal nerve root, the majority

being free nerve endings44,77, 78 associated with
pain sensation.
The veins of the vertebral column form intri-
cate plexuses along its entire length, both inside
and outside the vertebral canal,30 as well as
within the intervertebral f ~ r a m i n a'03
. ~ The entire
venous system is enmeshed by "an advential
plexus of unmyelinated nerve fibre^.'"^*'^^ As
Journal of Orthopaedic & Sports Physical Therapy®
vertebral foramen. It is important to consider that
pressures developed at these distal points is
equal to that developed at the foramen and that
symptoms may arise at any of these points.
As pointed out by G r i e ~ e , ~the' effects of
straight-leg raising are not isolated to the spinal

well as acting as a "peripheral pathway"'03 for
noxious stimuli, this vast system is a potential
source of pain itself.
MECHANICS OF ROOT TENSION
Normal Conditions
During straight-leg raising, first tension, then
movement appears distally and then more prox-
imally along the nerve and nerve root as the
angle at the hip increases. As Breig and Troup6
point out, in the normal individual, tension in-
creased in any-part of the neuromeningeal path-
way spreads throughout the nerve until it is am-
stant throughout its length, subject to the com-
pliance of these tissues and their supporting
structures. This is opposed to Charnley's12view
that the sciatic nerve behaves as though it is
devoid of elasticity.
As illustrated in Figure 6, tension and move-
ment develop firstly at the sciatic notch, then
over the ala of the sacrum, then as the nerve
crosses over the pedicle, and finally at the inter-
nerve roots but affect the joints between the
vertebral bodies and also the synovial facet
joints. Mooney and Robertson5' found that, in
six of 20 patients whose facet joints had been
injected with irritant, straight-leg raising was lim-
ited to about 70°.
The amount of movement observed at the in-
tervertebral foramen is generally consistent
throughout the literature. Falconer et al.z' report
between 2 and 6 millimeters, lnman and Saun-
d e r 2~ to~ 5~millimeters, and Charnleyi2 4 to 8
millimeters. Goddard and Reidz7in a more pre-
cise study describe an average movement of 4
millimeters at the intervertebral foramen in sub-
jects 35-55 years of age. In the same study, it
was noted that the amount of movement was
found to be Inversely proportional to age due to
t h e m e a s e in density of adhesions tethering
the nerve along its course. As illustrated in Table
1, the amount of movement observed at the
intervertebral foramen is greatest at the L5S1
level, and this as well is supported by the litera-
ture.' 2,21.27,45
 JOSPT Winter 198 1 THE STRAIGHT-LEG-RAISING TEST: A REVIEW 123
TABLE 1 spondylosis whose symptoms cannot be attrib-
Average movement in subjects between 35 and 55 years of uted to foramen constriction only. Smyth and
age *
WrightE0demonstrated that even minimal tension
Movement (mm)
on an inflamed nerve root by a nylon thread
Roots at foramina produced intense radicular-type pain and that
L4 equal pressure on uninvolved roots produced
L5
minimal discomfort.
S1
As has been discussed already, the lymphatic
Lumbosacral cord at ala of sac- system within nerve roots is poorly developed,
/
rum predisposing difficulty in clearing of inflamma-'-
tory exudate. This contributes to the eventual
Nerve at sciatic notch formation of intraneural fibrosis. Murphy6' sug-
From Goddard and Reid." gests a self-perpetuating cycle of irritation once
fibrosis has been established, due to: alteration
Disc Prolapse in root mechanics predisposing further mechan-
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ical distortion, a reduction in intraneural circu-

At this point, it should be emphasized that the
above figures represent normal situations. Fal-
soner et a1.21observed that in situations where
straight-leg raising was markedly reduced only
a slight-degree of hip flexion was necessary70
Copyright © 1981 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
lation, and a disruption of axon transmission
properties.
S~nderland'~ suggests that reduction of the
dimensions of the foramen would have to be
considerable before the nerve complex would be

initiate movement ot rne n e r m i ar tnel'eyel of
thZ prolapse. Breig4and Breig and Troup6 ex-
plain tns, utlllzlng the concept of a "tissue bor-
rowing phenomena" (Fig. 7). Under normal con-
ditions, a certain degree of slack exists through-
out the neuromeningeal pathway which is sub-
sequently taken up during the straight-leg-rais-
ing maneuver. In the case of disc prolapse, some
0fJku-s slack is taken up even before the-test is
Journal of Orthopaedic & Sports Physical Therapy®
compressed and that the formation of adhesions
and friction fibrosis is a more tenable explanation
in the development of symptoms.
Adhesions may represent a primary cause of
limitation of straight-leg raising or may occur
concurrently with degenerative disc disease with '
or without actual protrusion.
Adhesions may exist epidurally or within the

initiated. The prolapse increases the restina ten-

sjon in the nerve root, in effect, priming it for the
subsequent test.

Inflammation and Adhesion Formation

In the next section, it will be shown that spinal

nerve root compression does not necessarily
involve pain. Considering this assumption, a
number of 31. 61. 69.89, 93
have sug-
gested that inflammatory changes possibly lead-
ing to intraneural fibrosis is a more tenable con-
sideration when discussing sources of pain.
Lindahl and R e ~ e cited ~ a~study involving 23
cases of sciatica examined postmortem, 78% of
which revealed pathologic changes. A study of
'their own related similar changes in 70% of the
cases studied, in some cases unaccompanied
I
by disc protrusion. O l ~ s o reqorted
n~~ inflamma-
tory reactiqn as a relatively re-non Fig. 7 . Tissue-borrowing phenomena. The disc protrusion
borrows relaxed tissue from the pelvis by drawing part of the
i v o n in the dog. FrykholmZ4de-
dura, nerve roots, and ganglia futher into the spinal canal
scribes periradicular fibrosis and root sleeve fi- and a small part of the plexus towards the intervertebral
brosis in patients with long-standing cervical canal. Redrawn from Breig.4
 124
dural pouch itself due to arachnoidal prolifera-
tion. This will alter the normal mobility of the
nerve within the foramen and dural pouch, re-
spectively. Adhesions of the nerve complex have
been described at different points along its
course.27 Lindblom and ~ e x e foundd ~ ~ that, in
some cases of dorsolateral protrusions, the gan-
glion and nerve were adhered to the protruding
disc by dense connective tissue. In some cases,
adhesions were the only finding. Proximally, the
nerve root may become densely bound to the
posterior aspect of the d i s ~ . ~ Fahrni20
~.~' de-
scribes patients presenting with classical signs
and symptoms of disc protrusion including
straight-leg raising limited to 30°. Lerman and
Drasnin5' describe patients again presenting
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with classical signs and limited straight-leg rais-
ing in which adhesions within the dural sleeve
binding the dura arachnoid and nerve root were
the only findings (Fig. 8). Goddard and
describe fibrous strands tethering the sciatic
nerve throughout its lumbopelvic course. These
Copyright © 1981 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
adhesions increase in density with age. A patient
Journal of Orthopaedic & Sports Physical Therapy®
0 e e o o OO oO b 0
d
c
O
o
b
o
O
Fig. 8. Schematic representation of the relations at the level of the entrance of the spinal nerve into the meningeal sheath. 1,
normal relations; 2, dot-like adhesion, 3, partial adhesion; 4, total adhesive incarceration of the nerve root. Redrawn from
Lerman and D r a ~ n i n . ~ '
URBAN JOSPT Vol. 2, No. 3
was described which presented with severe
backache and straight-leg raising limited to 50'.
Adhesions secondary to an adenocarcinoma of
the stomach were found anchoring the sacral
nerves at their foramina.
In cases where adhesions exist concurrent
with disc prolapse, inferolateral movement is
prevented by the prolapse, and cranial move-
ment is restricted by the transforaminal f a ~ c i a . ~
This, combined with immobility of the nerve
within the dural pouch, may lead to fibrosis, often
fixing the root even after the original cause has
been eliminated.
In cases where adhesions exist in the absence
of disc protrusion, m cnfhn nerve
..
compLex within the foramen is aaain cnmpro-
%hs
i produces local increases in tension
usually seen distal to the point of adhesion.
Apophyseal Joint Changes
Changes observed within the apophyseal
joints may be regarded in two categories,32898 as
Dura
Arachnoid
Sub-Arachno
space
Pia Mater
Nerve Root
 JOSPT Winter 1981 THE STRAIGHT-LEG-RAISING TEST: A REVIEW

a secondary pathological feature of lumbar spon-

dylosis (arthrosis) or as a primary disorder un-
related to disc degeneration (o~teoarthritis).~~
As was outlined earlier, the nerve root crosses
the anterior aspect of the apophyseal joint as it
exits the foramen. In spondylosis, as the disc
space narrows, the vertical diameter of the for-
amen is reduced by the approximation of the
p e d i c ~ e s(Fig.
~ ~ 9). This results in overriding of
the articular processes57 (Fig. 10) followed by
secondary arthrosis (10 years subsequent to
disc degeneration3') which tends to reduce the
transverse diameter of the foramen.37,39 This is
a slow process. - E 19 nd degener-
ative changes in the apophyseal join- in
pa&?& under 4 0 m g e .
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' H e ~ i t states
t ~ ~ that it is the reduction in the
transverse diameter of the foramen which is most
Fig. 10. Schematic representation of what happens as disc
likely to result in pressure effects. It would seem
space is lost. As the vertebral bodies approach one another,
then that, occurring together, spondylosis with the posterior joints override. Redrawn from Macnab. 58
subsequent apophyseal joint arthrosis contribute
to considerable overall narrowing of the interver-
Copyright © 1981 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.

tebral foramen. of testing. Cervical flexion has been shown to

Lindblom and R e ~ e foundd ~ ~that, in dorsolat-
era1 disc protrusions, the protrusion pushed the
nerve complex in the direction of the apophyseal
joint, and in cases where the joints were en-
larged by degenerative changes, secondary
compressive deformation was observed due to
the enlarged joint.
Adhesions of the spinal nerve root and the
Journal of Orthopaedic & Sports Physical Therapy®
increase tension i n p e lumbosacral nerve roots5
(Fig. I 1) as has medial tup-r~tation.~Therefore,
as stated in the protocol, the head should always
be slightly extended '%id the hip in a neutral
position. This will assure consistent reliable re-
sults.
Crossed Straight-Leg-RaisingTest

subsequent clinical manifestations are frequently The "crossed straight-leg-raising test" or

associated with apophyseal joint changes inde-
pendent of frank disc protrusion.
Adjunct tests
The effects of cervical flexion (Hyndman sign
or Brudzinski sign) and medial hip rotation will
"well-leg-raising test" is mentioned throughout
literatUre35,43,44.58,63,73. 74,82.99,101 usually as an
adjunct although many feel it to be more signifi-
cant than the ipsilateral variety.3543.44'73,74.82,99
The mechanics of the crossed straight-leg-rais-
ing test4.74.101 .~nvolvethe movement of the dura

-
and contralateral roots medially and distally
be discussed only as they relate to the protocol
when the unaffected limb is raised. w74
feels that this indicates a large more medially
a d prolapse ( F i g 3 7

COMPRESSION OF NERVE ROOTS

Limitation of straight-leg raising is often inter-

Fig. 9. Two adjaceni vertebrae and the intervening annulus
fibrosis. Note that, as the disc space narrows the annulus
bulges outward, the facets override, and the height of the
intervertebral foramen is reduced. Redrawn from Weinstein
et a/."
preted to indicate nerve root compression.
Compression can only occur in situations where
a thrust is resisted by an unyielding structure
producing intense local axial tension displacing
tissue element^.^ As has just been shown, limi-
tation of straight-leg raising is in most cases of
prolapse a tension sign rather than a sign of
compression. However, compression of spinal
 URBAN JOSPT Vol. 2. No. 3

I
A B C D
Fig. 11. Effect of pressure of a disc protrusion on the tension in the dura and a nerve root during changes in spinal posture.
A and D, normal biomechanical events; B and C, pathological events in the presence of a disc protrusion. White arrows in A
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and B, direction of axial tension induced by cervical flexion; white arrows in C and D, direction of relaxation induced by
cervical extension; black arrows, direction of pressure resulting in increased axial tension from disc protrusion. A, the dura,
root sleeve, and nerve root are under normal tension; 6,since the nerve root is tethered by fine fibers, it is drawn out to the
same extent as the dura and membrane; the amount to which the root is stretched is indicated by the white segment above the
reference line; C, the dura, root sleeve, and nerve root are slightly slackened, but the protrusion still sets up tension in the
nerve root; D, the dura, root sleeve, and nerve root are now greatly slackened. Redrawn from Breig and T r o ~ p . ~
Copyright © 1981 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.

osteophytosis secondary to degenerative disc

diseaseg8 which is followed by hypertrophic
Pedicle
changes in structures surrounding caudal nerve
roots. These changes include arthrosis of the
apophyseal joints together with thickening of the
laminae and the ligamentum flavum and primary
Prolapse narrowing of the disc space which approximates
the pedicles, thereby reducing the vertical di-
Journal of Orthopaedic & Sports Physical Therapy®

ameter of the intervertebral foramen.8g These

factors all contribute to reduce the dimensions
of the foramen which may compress spinal roots
and ganglia.
crossed straight-
leg raising Many feel that neither of these conditions are
Fig. 12.Mechanism of the crossed straight-leg-raising test. sufficient to actually compress the nerve com-
As the unaffected leg is raised, the movement of the roots is p l e ~ ~except
' . ~ ~in rare cases but, as will be
transmitted across to the other side. Redrawn from S ~ h a m . ' ~ shown later, slow diffuse intermittent54.75

compression may have very significant effects

nerve roots may follow acute herniation of the
disc into the epidural space or s p o n d y l ~ s i s . ~ ~
A dorsolateral protrusion may bulge toward
the intervertebral foramen pressing upon the
ventral root and then the spinal ganglion and the
on nerve root pathology.
Actual nerve root damage secondary to com-
pressive lesions is dependent upon magnitude,
rate, angle, and area of application, as well as
the duration of the compressive force.75-83, 98

spinal nerve, at the same time pushing the entire
complex up against the dorsolateral margin of
the intervertebral foramen near the apophyseal
joint of the same side. Lindblom and R e ~ e d ~more
found that, in protrusions of this type, the point
of compression was always somewhere on the
distal half of the spinal ganglion and the first
centimeter of the spinal nerve.
Lumbar spondylosis is defined as vertebral
The nerve may respond to injury in two ways:
focal demyelination and remyelination in a mild
injury or degeneration and regeneration in a
~ severe injury.75.83, 98
Slow diffuse intermittent compressive forces
would probably result in segmental demyelina-
tion at varying degrees of remyelination. This
has been demonstrated by Lindblom and
in human lumbar nerve roots. Severe
 JOSPT Winter 1981 THE STRAIGHT-LEG-RAISING TEST: A REVIEW 127

acute compression may lead to actual axonal source of pain, what then makes it pain-sensi-
interruption with subsequent regeneration of ax- tive?
ons and with possible misrouted regenerating The following theories have been advocated:
fibers leading to neuroma f o r m a t i ~ n . ~ ~ . ~hyperalgesia,
'.~~ the concept of the "artificial syn-
Dorsal roots are more sensitive to conduction apse" and the loss of afferent input, or the partial
block than are peripheral nerves.76S h a r p l e ~ s ~ ~ block theory.
has shown that pressures as little as 10 mm Hg
maintained for 10-30 minutes will reduce com- Hyperalgesia
pound action potentials. Much evidence exists
that this is due to mechanical deformation rather The concept of hyperalgesia5*.53. 68769. 74 'tn-
than ischemic d e f o r m a t i ~ n . ' . ~Under ~ ~ ~ ~ , ~ ~ changes in sensation, namely the lower-
~ . ~ ex- volves
perimental conditions, large-diameter fibers (mo- ing of the threshold for the production of pain,
tor, proprioception, and touch) were found to which is a regular concomitant of inflammation.
block first, due to mechanical deformation, and What this means is that pain will result from
smaller-diameter fibers (temperature and pain) normally nonpainful stimuli, i.e., straight-leg rais-
later. Conversely, anoxia appears to affect the ing, in areas of hyperalgesia.
Howe et al.4' found that chronic injury to dor-
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smaller fibers first.25,72. 76 It has been sug-

g e ~ t e dassuming
,~~ that the lesion is mechanical, sal roots markedly increased their sensitivity to
that it may be possible to monitor the degree of mechanical pressure and that repetitive firing
compression by monitoring the nerve function persisted as long as the stimulus was applied.
which has been lost, due to this serial blocking Lindblom and R e ~ e found
d ~ ~in their study that
of conduction. the damage inflicted during disc protrusion was
Copyright © 1981 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.

In cases of "compression," is the actual the result of repeated small trauma over a rela-
compression a prima;? source of x n d would tively large area. Injury secondary to friction
straight-leg raisina i m e it? In the past, ra- would be an example of chronic trauma.
dicular pain was attributed to compression of a Per168369 suggests that tissues subjected to
nerve root by a herniated int~ru.r&b& disc. unusual stresses could lead to inflammation and
More recently, Wall et a1.96and 47, 61. 76 subsequent liberation of substances4g capable
have stated that acute damage in itself does not of altering their excitability, thereby rendering
produce a chronic discharge of afferent im- these tissues responsive to stimuli which previ-
pulses. Most recently, Howe et al.40have found ously could not generate impulses (Fig. 13).
Journal of Orthopaedic & Sports Physical Therapy®

that: 1 ) as did Wall et al.96acute compression of Therefore, a situation exists where normal me-
dorsal roots and ~erieheraln e r w not pro- chanical stresses can evoke repetitive action
duce sustained repetitive discharge; 2) the dor-
-
sal root wnglion produced long periods of sus- NOXIOUS STIMULUS TISSUE DAMAGE
tained d i s ~ l l o w i n g ~ r e s s i o n ;
p n d 3) c h r o n i w r e d dorsal roots axons
(some)
n
exhibit increased mechanosensitivity and pro-
duced p r ~-g e s w h ? ? ~ f s t i m u l a t e d . AGENT FOR I N F L A M K ~ T I O N

PAlN AND PAlN MECHANISMS ACTIVA'L'ION OF

NOCICEPTORS
In the context of this discussion, the following
definition seems very apt: "Pain is that sensory
experience evolved by stimuli that injure or \ / INFLAMMATION

threaten to destroy tissue, defined introspec-

tively by every man as that which hurts."60 94
Specifically, when considering limitation of
straight-leg raising, the limitation is a reflex re- PERIPHERAL AND PRODUCTS OF
action to sensory input or a mechanism to pro- CENTRAL PATHWAYS INFL&PIATION
tect us from injury.14 FOK PAIN
It is important to remember that compres- Fig. 13. Representation of possible steps linking nociceptor
sing or stretching a normal nerve is not pain- activation to inflammation from trauma or disease. From
fU1.41.68,74.87 Assuming that the nerve is the Perl. 69
 URBAN
Large
fibres
I S m a l l and
(High
threshold)
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Fig. 14. The artificial synapse. Graphical representation of the possible mechanism of pain production in which neural activity
Copyright © 1981 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
in the spinal nerve is funneled into incoming small and unmyelinated fibers in areas of pathology. Redrawn from Murphy."
potentials in an area previously capable of pro-
ducing only transient burst potentials.
Artificial Synapse
It has been demonstrated that, under certain
conditions, axons within nerves can be stimu-
lated by the activity of adjacent ax on^.^^, 29. 7'
Journal of Orthopaedic & Sports Physical Therapy®
This means that under conditions such as local
injury the insulative property of the myelin sheath
in a nerve is lost or reduced, and neural activity
in one fiber may activate another (Fig. 14). Granit
et a1.28have shown that pain fibers are the most
susceptible to stimulation by this process and
that nerve impulses originating in motor fibers
can activate sensory fibers of the same segment.
This fiber interaction is termed an "artificial syn-
apse." The implied effect6' is a situation where
neural activity within a spinal root is funneled
into the pain-carrying fibers, thereby disrupting
the spinal internuncial pool and enhancing the
/sensitivity of the spinal root to irritation. Wallg3
states that this phenomena is of short duration
only.
Partial Block
Wallg3 and Wall et al.96, in their gate control
theory of pain, have suggested that the cells
which trigger pain reactions are subject to a
balance between excitatory and inhibitory
JOSPT Vol. 2, No. 3
unmyelinated
fibres
(Low
threshold)
-intraneural fibrosis
-ischaemia
forces.62 It has been suggested that damage to
a nerve might preferentially block inhibitory im-
pulses, allowing the excitatory impulses which
normally arrive from the periphery to bombard
the disinhibited central cells. The resulting in-
crease in discharge from these disinhibited cells
would render such an area tender and painful.
Per168points out that this proposal is inconsistent
with clinical observation in that sensory loss
and/or paresthesia should be a prominent fea-
ture when actual nerve root compression is pres-
ent.
Venous Distension
Wykeio3 states that pain associated with
straight-leg raising is not due to traction on nerve
roots. Since the epidural venous plexus is in
continuity with the veins of the retroperitoneal
and retropleural spaces,I6 pressure on these
vessels would impede flow from the epidural
veins causing them to distend. As was mentioned
earlier, the venous plexus is a potential source
of pain i t ~ e l f , ' ~ " ~and most certainly this ac-
'03
counts for one of the mechanisms producing
pain on coughing, sneezing, or straining, but the
increase in intraabdominal pressure during
straight-leg raising, especially when less than
30°, might be insufficient to produce the dra-
matic painful reaction often observed.
To summarize, t h e y s t r a i a h t -
 JOSPT Winter 1981 THE STRAIGHT-LEG-RAISING TEST: A REVIEW
leg raising would seem to be due to local in-
creases in tension on an hyperalaes~cnerve roo
In oQvious cases of disc protrusion, the se-
\
quence ot evenrs ieaaing to a painful state would
be 1) disc protrusion producing the local tension
changes> nonspeclt~cinflammation, 3 ) e s i -
bly epidural edZiTa, and 4 ) adhesion formation
and intraneural f i b r o ~ i s . ~
In' the absence of disc
Z t r u s l o n , aaneslon tormation frequently asso-
ciated with spondylosis and subsequent apo-
physeal joint arthrosis may alter the normal root
mechanics initiating the sequence just de-
scribed.
The sequence need not start with changes in
root tension. It has been suggested that a chem-
ical product of disc degeneration itself (the au-
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toimmune m e ~ h a n i s m ~ , 'might~) initiate inflam-
p a t i o n leading to adhesion formation and, ulti-
' mately, fibrosis, which then would alter root ten-
sion locally.
Whatever the predisposing factors, pain is per-
ceived when abnormal stresses are applied to
Copyright © 1981 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
abnormally sensitive structures.
INTERPRETATION
Charnley" has stated that, in its correct per-
spective, the straight-leg raising test, when re-
corded quantitatively in degrees, is of such im-
portance in the diagnosis of disc protrusion that
its value should be regarded as being greater
Journal of Orthopaedic & Sports Physical Therapy®
than all of the other clinical or radiological signs
put together.
In reviewing the literature, the previous state-
ment proves not be as conclusive as previously
believed.
Hakelius and Hindmarsh3' in a retrospective
study of 1,986 cases operated for suspected
lumbar disc herniation (Table 2) compared the
straight-leg-raising test to operative findings.
The conclusions drawn from this study were
that: 1 ) the degree of limita-
-
raising was inversely proportional to the per-
TABLE 2
comparison of straight-leg raising to operative findings *
Positive (%)
Lasegue t30° 85 (600/707)
Lasegue 30-60' 76 (629/835)
Lasegue 60-90" 63 (182/291)
Lasegue positive total 77 (141 1 /I833)
Lasegue negative 45 (56/126)
Lasegue crossed 87 (407/468)
* From Hakelius and Hindmar~h.~'
129
..
centaae w t i o n found at sur-
gerv:-2) disc herniation was found in 87% of
patients with positive cro- rais-
in&; 3 ) negative straight-leg raisylgwas-feund in
45% of the cases reviewed; 4 ) positive straight-
Tg \
raising was found i n p h of c a ~ e s m ~ c
hernigtlon; ana s ) d a i g h t - l e g raising
wax%mdTo be tn2 most definite clinical sign of
disc herniation.
In an earlier study, H a k e ~ i u s
found
~ ~ that uni-
lateral straight-leg raising was positive in 89% of
the cases reviewed. From this, it was concluded
that straight-leg raising alone did not provide any
guidance in the selection of patients for surgery.
SprangfortB4 in a study of 2,157 cases with
confirmed lumbar disc herniation found that: 1 )
positive straight-leg raising test was seen in
98.6% nf the patients; 2 ) t h e p c e of the
sign core-e
l level of hernia-
tion as one moved cranially; and 3 ) t h e s i g n
when correlated with age decreased constantly.
From this, it wasI-o
c young
people, the sign has no specific value for the
diagnosis of disc herniation; 2) in young people,
a negative straight-leg-raising test excludes the
diagnosis of lumbar disc herniation; 3 ) after age
30, positive straight-leg raising is seen less often
but its diagnostic value increases; and 4) after
age 30, a negative straight-leg-raising test no
longer excludes the diagnosis of disc herniation.
Spengler and Freeman8' in analyzing two
groups (50 and 23 cases) operated on for sus-
pected disc protrusion (Table 3) concluded that:
1) a positive ipsilateral straight-leg-raising test
had minimal value in differentiating a patient with
herniated disc from other patients with low back
pain and sciatica; and 2 ) the crossed straight-
leg-raising test was a much more specific crite-
rion for a disc protrusion.
~ u d g i n using
s ~ ~ the Vecchio formulag2for cal-
culating the predictive value [the ability of a test
to detect the presence (or absence) of a disease
when the disease is in fact present (or absent)]
Other (%) Negative (%I
8 (56/707) 7 (51/707)
16 (105/835) 16 (101 /835)
18 (53/291) 19 (56/291)
12 (214/1833) 1 1 (208/1833)
20 (25/126) 35 (45/126)
7 (32/468) 6 (29/468)
 130 URBAN JOSPT Vol. 2, No. 3

TABLE 3
Comparison of straight-leg raising to surgical findings *
Surgical findings
Unilateral straight-leg rais- Crossed straight-leg
Lateral re-
Complete
herniation
LE:Ed:!l cess steno-
sis
Normal Total
ing raising

Group 1 43 3 2 2 50 50 (average, 39") 30

Group 2 5 18 - 3 26 26 -
* Summarized from Spengler and FreemamS2

. .
5 ) after age YU, u n i l a _ t ~ a ~ ~ a i gis k t ~ g
seen less oftsn but its diagnostic value in-
ccreas
>vd 6) afier a g ~ 3 O ~ e-- pativ s6aight-
e
leq-- ralslnq- no longer
- excludes disc protrusion.
1
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Edgar and Park'" have demonstrated a rela-

Central
tionship between the pattern of pain on straight-
Intermediate
leg raising and the position of a disc protrusion.
Reference is made to two coordinates, horizontal
and vertical. Within the horizontal axis, the pro-
trusion may be located in a central, intermediate,
Copyright © 1981 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.

Fig. 15. Location of central, intermediate, and lateral protru-
sions in relation to the dura and nerve roots.
TABLE 4
Relation of position of protrusion as found at operation to
the pattern of pain produced by straight-leg raising in 50
cases of lower lumber disc prolapse *
Number of cases
or lateral position (Fig. 15). As illustrated in Table
4, centrally located protrusions produced low
back pain only, intermediate protrusions low
back and leg pain, and laterally located protru-
sions leg pain alone.
The centrally located protrusions contgicted
the dura only. lntermediate protrusions impi

Distribution of pain
.
upon dura and nerve roots while the lateral pro-
. t r u s l o n 8 c t e d the nerve-s
Journal of Orthopaedic & Sports Physical Therapy®

Position of lesion 1

Low back Lzrdq:gk Leg alone

The production of radiating= has already
been presented in preceding sections. The pro-
Central 7 1 0
duction of back pain in this context is probably
Intermediate 2 21 4 due to dural irritati~n."~ ' 0 3 Subtle variations may
Lateral 1 1 14 exist which contribute to back pain concurrent
* From Edgar and Park.''
with leg pain. Adhesions of the dura or dural
sheath in the spinal canal to the annulus fibrosus,
to the ligamentum flavum, or to the capsules of
for myelography in the diagnosis of disc protru- the apophyseal joints may all be responsible for
sion found that myelography was not necessary back pain during straight-leg r a i ~ i n g . ~
for patients who had good neurological signs or The vertical coordinate referred to the level of
a crossed straight-leg-raising test. The probabil- protrusion. Straight-leg raising was found not
ity of disc protrusion based on clinical examina- to be an accurate predictor of level of protru-
tion alone being 0.81 to 0.98. sion.'*~34
To summarize: 1) m h t - l e g rais- The crossed straight-leg-raising test produced
i n g p e c i a l l y in young -fit similar patterns (Table 5). These figures also
valye in the dmnosis of disc protysion; 2) confirm the observations of S ~ h a m who ' ~ stated
negative straight-leg raising, ewe-g that this test when positive is strong evidence
Eeople. usuallv excludes the diagnosis of disc
protrusion; 3) the dearee of limitation of straight-
- that the protrusion will be located more medially
(Fig. 12).
leg raising-ely proportional to the'pro- To summarize: 1 ) passive straight-leg raising
M r o t r u s i o n ; 4 )W s s e d may produce leg pain, back pain, or a combi-
straight-leg-raising test is a much more definite nation of both; 2) centrally located protrusions
 JOSPT Winter 1981 THE STRAIGHT-LEG-RAISING TEST: A REVIEW
Incidence of limitation of well-leg raising and pain pattern related to the position of the disc protrusion at operation in 50
Number with limitation
Site of protrusion Number of cases
of well-leg raising
Central 8 5
Intermediate 27
Lateral 16
* From Edgar and Park."
produce mainly back pain; 3 ) intermediately lo-
cated protrusions produce back and leg pain; 4 )
laterally located protrusions usually produce leg
\
JXWM&@~ EacK pain oDserved during straight-
leg raising is probably due to tension on sensitive
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dura: 6 ) leg pain observed during stra~ght-leg
raising is probablv Jue to tension on sensitive
nerve roots; 7) pain patterns &served during
sfFaight-leg raisingamw&-w accurate predictor
of the level of disc protrusion; and 8) a positive
. .
crossed i f s t usually indi-
Copyright © 1981 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
cates a more centrally located prolapse.
DISCUSSION
The straight-leg-raising test is routinely em-
ployed when assessing patients with low back
pain. In most cases, the test is recorded as either
positive or negative. In some cases, the degree
Journal of Orthopaedic & Sports Physical Therapy®
of limitation may also be recorded.
If asked to interpret the test, most clinicians
state that a positive straight-leg-raising test is
indicative of a "disc lesion." Considering the
data reviewed, this statement in many cases is
incorrect.
The data does suggest trends. In cases where
a disc lesion is present, straight-leg raising is
restricted. Conversely, where restriction of
straight-leg raising is absent, no disc lesion ex-
ists. But, at best, a positive unilateral straight-
leg-raising test only indicates stress applied to
abnormally sensitive tissues within the neuro-
meningeal pathway. A disc lesion is not a pre-
requisite of pain on straight-leg raising and, even
if present, need not necessarily have anything to
do with causing the pain other than possibly
making it ~ o r s e . ~ '
The crossed straight-leg-raising test appears
ble Tnndicamr of disc protrusion,
gree of limitation nor is any explanation volun-
131
TABLE 5
cases *
Pain distribution
Percentage
Low back Back and Opposite leg
site leg
13
4
teered as to why the crossed straight-leg-raising
test is more reliable than the unilateral variety.
SUMMARY
A brief historical review has been presented.
The pertinent anatomy and physiology of the
lumbosacral spinal nerve roots and related struc-
tures have been reviewed. The mechanics of
nerve root tension under normal and pathologi-
cal conditions has been described. The effects
of compression, inflammation, and apophyseal
joint changes have been discussed. Pain and
pain mechanisms have been outlined. Interpre-
tation and conclusions are as follows.
1) Unilateral passive straight-leg raising may
produce leg pain, back pain, or a combi-
nation of both but, especially in persons
under 30 years of age, has no specific
value in the diagnosis of disc protrusion.
2) Negative straight-leg raising, especially in
persons under 30 years of age, usually
excludes the diagnosis of disc protrusion.
3) The degree of limitation of straight-leg-rais-
ing is inversely proportional to positive disc
protrusion.
4) After age 30, unilateral straight-leg raising
is seen less often, but its diagnostic value
increases.
5) After age 30, negative straight-leg raising
no longer excludes disc protrusion.
6) The crossed straight-leg-raising test is a
much more reliable clinical sign of disc
protrusion.
7) In cases of proven disc protrusion:
a) centrally located protrusions produce
mainly back pain during straight-leg rais-
ing probably due to tension on sensitive
dura;
6) intermediately located protrusions pro-
duce back and leg pain during straight-
leg raising;
 132
c) laterally located protrusions usually pro-
duce leg pain only during straight-leg
raising probably due to tension on sen-
sitive nerve roots.
d) pain patterns observed during straight-
leg raising are not an accurate predictor
of the level of disc protrusion; and
e) a positive crossed straight-leg-raising test
usually indicates a more centrally located
prolapse.
Special thanks to the late Dr. J. A. Tata. Assistant Professor,
School of Medical Rehabilitation, University of Manitoba, Winnipeg,
Manitoba, Canada.
REFERENCES
1.. Bentley FH, Schlapp W: The effects of pressure on conduction
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in peripheral nerve. J Physiol (Lond) 102:72-78, 1943
2. Blunt MJ: Functional and clinical implications of the vascular
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3. Bobechko WP: Autoimmune response to nucleus pulposus in
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4. Breig A: Adverse Mechanical Tension in the Central Nervous
System; An Analysis of Cause and Effect, Relief by Functional
Neurosurgery. Stockholm: Almquist 8 Wiksell, International
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Publishers, 1978
5. Breig A, Marions 0: Biomechanics of the lumbosacral nerve
roots. Acta Radiol [Diagn] (Stockh) 1:1 141-1 160. 1963
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8. Brodal A: Neurological Anatomy; In Relation to Clinical Medi-
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21 :217-218, 1969
11. Cailliet R: Neck and Arm Pain. Philadelphia: FA Davis Co, 1976
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14. Culbertson J: Origins of low back pain-the intervertebral
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1977, pp 21 -34. Haywood. CA: Barbara E. Kent, 1978
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16. Eaton LM: Pain caused by disease involving the sensory nerve
roots (root pain); its characteristics and the mechanics of its
production. JAMA 117:1435-1439. 1941
17. Edgar MA. Nundy S: lnnervation of the spinal dura mater. J
Neurol Neurosurg Psychiatry 29:530-534. 1966
18. Edgar MA. Park WM: Induced pain patterns on passive straight-
leg-raising in lower lumbar disc protrusion. J Bone Joint Surg
56-B:658-667. 1974
19. Epstein JA, Epstein BS. Lavine LS, Carras R. Rosenthal AD,
Sumner P: Lumbar nerve root compression at the intervertebral
foramina caused by arthritis of the posterior facets. J Neurosurg
39:362-369, 1973
20. Fahrni WH: Observations on straight-leg-raising w ~ t hspecial
reference to nerve root adhesions. Can J Surg 9:44-48, 1966
21. Falconer MA. McGeorge M, Begg CA: Observations on the
cause and mechanism of symptom production in sciatica and
low back pain. J Neurol Neurosurg Psychiatry 1 1:13-26, 1948
22. Fisk JW: The straight-leg-raising test: Its relevance to possible
URBAN JOSPT Vol. 2, No. 3
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