Injured Workers are both evaluated and treated within the Workers’ Compensation System for their work-related complaints. Workers suffering from back injuries will be physically examined in order to determine a proper diagnosis.
Lumbar Spine Physical Examinations require that the physician or examiner perform a variety of physical tests. One of these tests is the “straight leg.”
This article will discuss the “straight leg” test, what it means for a back condition, and what it means for Industrially Injured Workers.
Who Conducts Lumbar Spine Physical Examinations?
Physical Examinations are done by medical professionals in the capacity of Treaters, Qualified Medical Evaluators, and Agreed Medical Evaluators.
Specialties conducting physical examinations for the spine may include Chiropractors, Neurologists, Neurosurgeons, Nurse Practitioners, Occupational Medicine Doctors, Orthopedic Surgeons, Physical Medicine Doctors, Physician Assistants, Osteopaths, Primary Care Physicians, and Sports Medicine Doctors.
What is the Common Back Complaint Relevant to the “Straight Leg” Test?
The common back complaint, relevant to the straight leg test, is back pain which radiates down one or both lower extremities. The symptoms can include numbness in the lower extremities.
Are There Other Names for the” Straight Leg” Test?
Yes. The straight leg test has different names. This includes the names “Lasegue Test” and the “Straight Leg Raise Test.”
How is the Straight Leg Test Performed?
“The straight leg raise test is performed with the patient in a supine position. The examiner gently raises the patient’s leg by flexing the hip with the knee in extension, and the test is considered positive when the patient experiences pain along the lower limb in the same distribution of the lower radicular nerve roots (usually L5 or S1).” Camino Willhuber GO, Piuzzi NS. Straight Leg Raise Test. [Updated 2021 Feb 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539717/
In sum, when an Injured Worker is sitting, the examiner will take the worker’s leg and raise it upward.
What Makes a Positive Straight Leg Test?
“[A] positive straight leg raise test is determined when pain is elicited by lower limb flexion at an angle lower than 45 degrees. During the test, if the pain is reproduced during the leg straightening, patients usually request that the examiner aborts the maneuver and by flexing the patient’s knee, the buttock pain is usually relieved(Figure 1).” Camino Willhuber GO, Piuzzi NS. Straight Leg Raise Test. [Updated 2021 Feb 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539717/
Based upon a review of many medical reports, I have seen Injured Workers have positive straight leg findings with one examiner and not with others. Thus, in my opinion there is some variability concerning results.
What Is the Aim of the Straight Leg Test?
The straight leg test may indicate whether there is a “sciatic compromise due to lumbosacral nerve root irritation.” Camino Willhuber GO, Piuzzi NS. Straight Leg Raise Test. [Updated 2021 Feb 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539717/
It should be noted, however, that “there are multiple causes of a positive test such as facet joint cyst or hypertrophy.” Camino Willhuber GO, Piuzzi NS. Straight Leg Raise Test. [Updated 2021 Feb 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539717/
If the Test is Positive, What Will Happen?
If a test is positive, there is the possibility of nerve root irritation and possible entrapment. The positive straight leg test is simply the beginning of the process of making a comprehensive diagnosis. Thus, the Injured Worker may be requested to participate in additional testing which can include MRI testing, CT scans, X-Rays, and Nerve Conduction Studies.
In sum, a positive finding suggests the need for additional testing to rule out a herniated disc.
What Does a Positive Straight Leg Test Mean for Injured Workers?
For Injured Workers, a positive straight leg test will trigger the examiner to consider ruling out the possibility of a herniated disc injury in the lumbar spine. Thus, a thorough assessment will require additional testing to occur via imaging studies and nerve testing. A positive test may trigger a referral to an orthopedic surgeon or neurosurgeon.
What If I Need Advice?
If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for 27 years. Contact us today for more information.