These questions are directed primarily at activity tolerance, not pain. The examination may further modify suspicions of tumor, infection, or significant trauma. A medical history suggestive of nonspinal pathology mimicking a back problem may warrant examination of the chest, abdomen, pelvis, pulses, or other areas. Neurologic Screening Identify any nerve root impairment, peripheral neuropathy or spinal cord dysfunction. Differences of 2 cm in measurements of the two limbs may be normal variation.
Performance testing involves having the patient lie in a supine position.
Place your hand over the anterior thigh and your other hand beneath the heel. Be certain that the leg is straight and ask the patient to relax. Gradually raise the leg at the heel while keeping the knee extended and allowing for simultaneous flexion of the hip. Ask the patient to state when the symptoms occur. Pain below the knee at less than 70 degrees of straight leg raising, aggravated by dorsiflexion of the ankle and relieved by ankle planter flexion or external limb rotation, is most suggestive of tension on the L5 or S1 nerve root related to disc herniation.