The usage of a modified straight-leg raise neurodynamic test and hamstring flexibility for diagnosis of non-specific low back pain: A cross-sectional study.

Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE

Original Publication: San Francisco, CA : Public Library of Science

Low Back Pain*/physiopathology ; Low Back Pain*/diagnosis ; Low Back Pain*/diagnostic imaging ; Hamstring Muscles*/physiopathology ; Hamstring Muscles*/diagnostic imaging ; Magnetic Resonance Imaging*/methods; Humans ; Adult ; Cross-Sectional Studies ; Male ; Female ; Middle Aged ; Adolescent ; Young Adult ; Range of Motion, Articular/physiology ; Leg/physiopathology ; Leg/diagnostic imaging

Objectives: The main purpose of this research study was to compare mean modified straight-leg raise test (mSLR) and hamstring muscle length (HL) between chronic non-specific low back pain (LBP) and healthy subjects to understand the possibility of neuropathic causes in LBP population as it may impact the diagnosis and treatment of LBP. Another purpose was to compare mean mSLR between those with lumbar nerve root impingement and those without as determine by magnetic resonance imaging (MRI).
Methods: The design of the study is cross sectional and included 32 subjects with ages ranging from 18-50 years old. Clinical exam objective measures were collected such as patient questionnaires, somatosensory tests, HL range of motion, and a mSLR test, and were compared to the findings from a structural lumbar spine MRI.
Results: There were no significant differences in mean HL angulation and mSLR angulation between LBP and healthy subjects (p>0.05). There was no significant difference in mean HL by impingement by versus no impingement (38.3±15.6 versus 44.8±9.4, p = 0.08, Cohen's d = 0.50). On the other hand, there was a significant difference in mean mSLR angulation by impingement (57.6.3±8.7 versus 63.8±11.6, p = 0.05, Cohen's d = 0.60).
Conclusions: The mSLR test was found to be associated with lumbar nerve root compression, regardless of the existence of radiating leg symptoms, and showed no association solely with the report of LBP. The findings highlight the diagnostic dilemma facing clinicians in patients with chronic nonspecific LBP with uncorrelated neuroanatomical image findings. Clinically, it may be necessary to reevaluate the common practice of exclusively using the mSLR test for patients with leg symptoms. This study may impact the way chronic LBP and neuropathic symptoms are diagnosed, potentially improving treatment methods, reducing persistent symptoms, and ultimately improving disabling effects.
Competing Interests: The authors have declared no competing interests exist.
(Copyright: © 2024 Hermosura et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Mayo Clin Proc. 2013 Jan;88(1):56-67. (PMID: 23274019)
Sci Rep. 2021 Feb 11;11(1):3655. (PMID: 33574467)
PLoS One. 2018 Jun 14;13(6):e0199165. (PMID: 29902245)
Pain. 2004 Jul;110(1-2):461-9. (PMID: 15275799)
AJNR Am J Neuroradiol. 2015 Apr;36(4):811-6. (PMID: 25430861)
Eur J Pain. 2019 Nov;23(10):1826-1838. (PMID: 31325385)
Pain. 2010 Feb;148(2):227-236. (PMID: 20004060)
Lancet Neurol. 2010 Aug;9(8):807-19. (PMID: 20650402)
Pain Pract. 2016 Jan;16(1):31-7. (PMID: 25469881)
Pain. 2005 Oct;117(3):462-472. (PMID: 16154692)
Semin Arthritis Rheum. 2017 Aug;47(1):1-8. (PMID: 28320529)
Health Serv Res. 2007 Oct;42(5):1871-94. (PMID: 17850524)
Eur J Neurol. 2010 Aug;17(8):1010-8. (PMID: 20298428)
Best Pract Res Clin Rheumatol. 2002 Dec;16(5):761-75. (PMID: 12473272)
J Back Musculoskelet Rehabil. 2014 Jun 24;:. (PMID: 24968796)
Br Med Bull. 2010;94:81-144. (PMID: 20064820)
BMC Musculoskelet Disord. 2020 Aug 10;21(1):532. (PMID: 32778086)
Ann Rheum Dis. 2014 Jun;73(6):968-74. (PMID: 24665116)
Medicine (Baltimore). 2019 Apr;98(17):e15377. (PMID: 31027128)
Lancet. 2016 Oct 8;388(10053):1603-1658. (PMID: 27733283)
Musculoskelet Sci Pract. 2022 Apr;58:102501. (PMID: 35026497)
BMC Musculoskelet Disord. 2017 Feb 23;18(1):93. (PMID: 28231784)
Pain Med. 2014 Jan;15(1):4-15. (PMID: 24118776)
Clin J Pain. 2008 Jun;24(5):384-94. (PMID: 18496302)
Rev Saude Publica. 2015;49:. (PMID: 26487293)
Pain. 2011 Jan;152(1):14-27. (PMID: 20851519)
BMC Musculoskelet Disord. 2010 Sep 10;11:202. (PMID: 20831785)
J Orthop Sports Phys Ther. 2011 Sep;41(9):644-50. (PMID: 21885906)
Clin J Pain. 2009 Sep;25(7):632-40. (PMID: 19692806)
Yonsei Med J. 2017 Nov;58(6):1170-1176. (PMID: 29047241)
Spine (Phila Pa 1976). 2017 Apr 1;42(7):504-512. (PMID: 27428391)
BMC Musculoskelet Disord. 2016 Nov 2;17(1):451. (PMID: 27806703)
Healthcare (Basel). 2022 Aug 07;10(8):. (PMID: 36011141)
Spine J. 2019 Jul;19(7):1137-1142. (PMID: 30121324)
Physiotherapy. 2012 Jun;98(2):174-9. (PMID: 22507369)
Pain. 2019 Jan;160(1):28-37. (PMID: 30586068)
J Orthop Sports Phys Ther. 2008 Sep;38(9):A1-A34. (PMID: 18758050)
Exp Brain Res. 2015 Aug;233(8):2391-9. (PMID: 25963754)
Clin J Pain. 2009 Sep;25(7):555-61. (PMID: 19692795)
J Pain. 2019 Jan;20(1):60-67. (PMID: 30121357)
J Back Musculoskelet Rehabil. 2012;25(4):215-23. (PMID: 23220802)
Acta Clin Croat. 2018 Mar;57(1):16-21. (PMID: 30256007)
Physiotherapy. 1980 Aug;66(8):271-3. (PMID: 6450426)
Pain Med. 2016 Sep;17(9):1694-703. (PMID: 26893116)
Postgrad Med. 2011 Sep;123(5):134-42. (PMID: 21904096)
J Orthop Res. 2006 Sep;24(9):1883-9. (PMID: 16838375)
Spine (Phila Pa 1976). 2013 Nov 15;38(24):2098-107. (PMID: 24026153)
Am Fam Physician. 2006 Sep 1;74(5):803-5. (PMID: 16970025)
Lancet. 2018 Jun 9;391(10137):2356-2367. (PMID: 29573870)
Diabetes Care. 2001 Feb;24(2):250-6. (PMID: 11213874)
J Neurol Neurosurg Psychiatry. 1998 Nov;65(5):743-7. (PMID: 9810949)
J Diabetes Sci Technol. 2020 Jan;14(1):8-15. (PMID: 31113243)
Muscle Nerve. 2017 Oct;56(4):E33-E35. (PMID: 28561927)
Pain. 2006 Aug;123(3):231-243. (PMID: 16697110)
JAMA. 2016 Dec 27;316(24):2627-2646. (PMID: 28027366)
Neurology. 2008 Apr 29;70(18):1630-5. (PMID: 18003941)
J Pain. 2011 Oct;12(10):1080-7. (PMID: 21783428)
Arthritis Res Ther. 2018 Sep 27;20(1):215. (PMID: 30261907)
Diabet Med. 2004 Jun;21(6):563-7. (PMID: 15154940)
Curr Med Res Opin. 2006 Oct;22(10):1911-20. (PMID: 17022849)
Spine (Phila Pa 1976). 2002 Dec 15;27(24):2811-9. (PMID: 12486352)
Best Pract Res Clin Rheumatol. 2013 Oct;27(5):613-23. (PMID: 24315143)
Neurol Clin. 2013 May;31(2):343-61. (PMID: 23642713)
Osteoarthritis Cartilage. 2013 Sep;21(9):1236-42. (PMID: 23973136)
J Phys Ther Sci. 2014 Jan;26(1):57-61. (PMID: 24567676)
J Manipulative Physiol Ther. 2009 Mar-Apr;32(3):184-92. (PMID: 19362228)
Asian Spine J. 2015 Aug;9(4):535-40. (PMID: 26240711)
BMC Musculoskelet Disord. 2012 Dec 10;13:245. (PMID: 23227972)
BMC Musculoskelet Disord. 2021 Sep 21;22(1):808. (PMID: 34548049)
Man Ther. 2011 Jun;16(3):296-300. (PMID: 21339080)
Cochrane Database Syst Rev. 2010 Feb 17;(2):CD007431. (PMID: 20166095)

Date Created: 20240521 Date Completed: 20240521 Latest Revision: 20240523

20240523

PMC11108176

10.1371/journal.pone.0298257

38771839