The positions in descending order of pressure were seated, standing, side lying, and supine. The 4 positions used for radicular/sciatic tests were included in the study. Stress on the intervertebral disk as a result of patient posture or position has been measured by Nachemson et al, 8 who studied intervertebral pressure during different postures and activities. Thus, radicular/sciatic tests performed in the position that places the greatest stress on the disk would, in theory, increase the likelihood of confirming disk pathology as the etiology of nerve root irritation. Emphasis is placed on the understanding of maneuvers that comprise traditional radicular/sciatic physical tests to enhance learning and the use of the tests until more accurate and reliable methods are available.Įxamples of lumbosacral radicular/sciatic tests by position.ĭisk pathology is a common cause of nerve root/sciatic tension.
Despite the lack of reliability and limited evidence-based studies, these tests are imbedded in health care education and clinical practice. 1-4 Radicular/sciatic tests, like many orthopedic and neurological tests, are not the most dependable diagnostic tools. These inconsistencies are compounded in the trenches of clinical practice. Studies that are available are often skewed by inconsistencies in test performance, definitions of positive findings, and interpretations of results among participants. Examiners must consider these facts when performing and interpreting orthopedic and neurological tests.Īccuracy (sensitivity/specificity and intraexaminer/interexaminer reliability) of the maneuvers and tests described is not stressed, as most of the tests have not been the subject of accuracy studies. This leads to multiple tests that share a mechanism of performance, yet have different names and interpretations. The reactions vary depending upon which tissue is pathological. A single maneuver can produce multiple reactions. Most orthopedic and neurological tests stress multiple tissues, including nerves, muscles, tendons, ligaments, cartilage, bones, blood vessels, etc. In fact, it is naive to think that any orthopedic or neurological test only affects a single tissue or structure. It is naive to think that the maneuvers discussed below only affect the lumbosacral nerve roots or the sciatic nerve.
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