Low Back Pain: Initial Evaluation and Management


Background Information
Physical Exam
Figure 1. Straight Leg (SLR)
  • Ask the patient to localize the pain by pointing.
  • At the point the patient feels pain, lower the leg and dorsiflex the foot to

  • reproduce sciatic n. pain.
  • A positive SLR is present when the patient experiences both back pain

  • and pain into the posterior thigh at 60 degrees or less.
  • A positive SLR at lower degrees of elecation is correlated with a higher

  • likelihood of HNP.
  • A positive crossover SLR (pain in the affected leg when unaffected

  • side is raised) is also correlated with HNP.


Hoover Test

  • The Hoover test is performed during the straight leg test: As the patient tries to 

  • lift the leg, he or she will put pressure on the calcaneous of the opposite foot
    (lack of pressure is suggestive that the attempt to raise the leg was not genuine).


Initial Studies

Initial Management

M. Harper, MD
updated 8/30/05

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