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2022 paper by Pesonen et al.:
In this Update, we have an epic battle between two clinical tests for sciatica.
As I was reading this paper, I was reminded of a 90’s game show called Gladiators, where two athletes would try to knock each other off of a pedestal.
It was silly, a little ridiculous and rather corny.
So of course, I absolutely loved it.
Pesonen and colleagues released a 2021 paper that felt very much like two gladiators fighting it out.
They compared the straight leg raise test to the extended straight leg raise test in order to see which one was better at detecting the involvement of neural structures.
Here is how the extended straight leg raise differs from the normal straight leg raise:
1) Pain can happen anywhere between 0 and 90° (in SLR it has to be between 0 - 70°).
2) The pain doesn’t have to extend to beneath the knee (in SLR it does).
3) Once pain has been found, there is an added movement to the test.
If the pain extends to beneath the knee, then hip internal rotation is added (as seen in the left image).
If the pain is in the buttock and/or hamstring area then ankle dorsiflexion is added (as seen in the right image).
The reason for these added movements is to differentiate between neural involvement and other musculoskeletal structures.
But does this actually make a difference?
Turns out, it really does.
A positive extended SLR meant that you were 8 times more likely to have lumbar disc herniation and 5.6 times more likely to have nerve root compression.
Compare that to the traditional SLR, where it could only pick out 50% of the sciatica subjects and was less than half as accurate at picking out those with nerve root compression.
And the final blow that wins the battle:
Another 2021 study by Pesonen and colleagues found that the ESLR test could detect sciatic patients even when utilised alone without any knowledge of patient history or any other clinical data.
And the crowd cheers for the victor!
References
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Written by Kyle van Heerden
Online Educator at Research Raconteur
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