Positive Well Straight Leg Raise Test (Large Herniated Disc)
ฝัง
- เผยแพร่เมื่อ 29 ก.ย. 2024
- This gentleman has a significant lumbar herniated disc with a positive well straight leg raise test. In this evaluation I test his deep tendon reflexes, sensation, muscle strength, and perform a straight leg raise test, Braggards's test and Well straight leg raise test.
✅ Support OEP: paypal.me/Orth...
✅ OEP Website: orthoevalpal.com/
✅ Online Coaching: orthoevalpal.c...
✅ OEP Podcasts: orthoevalpal.c...
▶▶ Like us on facebook: / orthoevalpal
▶▶ Follow on Instagram: www.instagram....
▶▶ Follow on Twitter: home
✔ Get our NEW downloadable 1.5 hour shoulder anatomy with cadaver dissection lecture: www.meorthopedi...
✔Get our NEW downloadable 7.5 hour cervical and lumbar continuing ed course: www.meorthopedi...
✔Get our NEW downloadable 6.0 hour shoulder continuing ed course: www.meorthopedi...
Interested in our Sponsor Product
EZ Slant (ezslant.com/)
Check out our new OEP merchandise: 👚👕☕️ / @orthoevalpal
#wellstraightlegraise #herniateddisc #LBP #lowbackpain #OrthoEvalPal #SpecialTests #Orthopedics #physicaltherapy #physicaltherapytests #athletictraining
![CAMPปลิ้น | EP.82[1/2] แก๊ง 3 สาวเพื่อนซี้บุก CAMPปลิ้นครั้งนี้ห้ามเสียอาการ](http://i.ytimg.com/vi/_6WUjXHe1TM/mqdefault.jpg)
I'd like to have someone like this as my teacher. Very concise straight to the point and so well explained! Thank you !
Thanks a bunch Valery! Lots more to come.
Hi Paul, My MRI shows that I have very small posterior disc bulge at L4 L5 and it's not doing any nerve compression. Also at L5 S1 there is a deyhatreted disc and board posterior bulge disc. This does not cause significant canal stenosis but disc contacts both transiting S1 nerve roots. I've had all the symptoms in my lumber and both legs. pain is not too much pain, but mostly numbness and burning in both legs. I cant sit for more than 15 mins. Ive just started to see PT, his working on traction, he had to strap me on machine that pulled both legs. Do you think traction is the best solution for my case. Also, I would like to know how bad is the situation and will i have the chance to recover permanently?? Thank you
Hi Tarak,
Sounds like you are heading in the right direction. I like core stability and cardio that doesn't increase your symptoms. Best of luck!
Fuck. This is the first time I have found someone with something similar to me. I’m 21, I’m from Scotland and saw every physio here. I’m fucked I need help. Please.
I’m pretty similar but 29 in Ohio, and it is so bad I’m using a cane. It has been over a month now. I hope you were able to get some help.
@@JM-ob7mb Hpw u doing man? I hope all is good now.
So an SI joint could cause all of these symptoms?
L4-L5 herniated disc here. There’s an impingement on the right side L5 nerve root, the pain is excruciating and at the moment there is no way to perform a straight leg test on me, I can’t even raise my legs while laying down but most of the pain is on my right leg, I can’t fully stretch my right leg out, I’m about 5 days in since it’s flared up, first couple days I was bedridden couldn’t even stand, couple days later I am able to get out from bed now(which is a struggle) and walk around with a cane, just to the wc, I hope this pain subsides soon it’s so depressing .
Did Sean get better? What was the result of the treatment?
EXCELLENT u made everything so clear
Hey Paul - I am having the exact same symptoms and every avenue of therapy I’ve tried has not helped. I’m at a loss and really wondering if this pain will ever subside. It’s been about a year now. Curious what your therapy program would be like for this injury. Feel free to let me know the best way to contact you if possible. Thanks!
Well what should he do about it then ?
I had an MRI that showed a 5.7 mmm herniated disk at L3-L4 and moderate stenosis, possible nerve impingement. Also L5-S1 (almost bone on bone) but no visible impingement. I had no pain whatsoever until 12/9 and I picked up a box of cat litter. It's seven weeks now of unrelenting pain. Sitting is relief. Standing and lying down, no matter what side, is hell. Have not been able to work. The pain is centralized at the sciatic notch in my right buttock, and an 8-9 on the scale. I feel bumps and knots all on my right buttock cheek when I palpate it. It radiates down in front of my thigh, skips my knee, and travels down my shin. No pain in the middle of my back, really. Also pain at the hip bone in front, that stringy muscle/tendon ? going from hip bone laterally. Pain hit my ankle one day, but mostly I don't have any symptoms in my foot. I landed in the ER. They gave me a shot, which did nothing. I am on opioids, muscle relaxants, anti-convulsants. Sedates me too much to work. Ortho put me on oral steroids. It's the second day. No difference yet. I am wondering if it's a muscle problem, as the sciatica described everywhere is not aligned with my pain. My docs say positive straight leg test, but it's false. I did it myself and I can raise my leg without problems. Doc didn't even touch me. What does reproduce the pain though is lifting my leg sideways. What also relieves my pain is bending to the left all the way. I can walk bent forward and bent to the left side.
How is your pain now? What was it? Did it improve?
After a positive straight leg test, i elected the microdisectomy. Surgery was successful, and i resumed working out, golf, swimming, running & hiking. After attempting to play hockey again after a 9 month break, I am now positive for the straight leg test again. Eliminating activities that cause re-herniation are important, as I may be due for another round of surgery.
did you have surgery again
@@ilkinbulbul did not have surgery again. Elected for steroid injections & discovered the benefits of Pilates. By far the best workout for protecting the low back and hips
I have disc herniation of 6.9mm what would I do
I have same exact problem like him, I have been diagnosed and following therapeutic yoga and exercises for more than 3 months, is there a cure for this LDP??
From India 🇮🇳
I hope you are well by now. What did cure you?
Very good but you explained very fast
Sorry for that. Very old video. I have learned to slow down since then. Thanks
did he recover with or without surgery?
i have sciatica due to disc bulge, pain also when sneezing, my knee is weak and have pain from buttocks to knee now on my first day of therapy my PT (who already saw my mri and xray) recommends me some stretching - leg raise and figure four stretch but it is giving me pain during exercise. is this normal? he was trying to stretch my leg even higher although there is pain on the knee
even my ortho agreed, i mean he is okay with the exercises he said that if the pain came after, that is the only time i should stop but if the pain is only during the stretching it's fine
Have herniated and bulged disc. Can not get both my legs straight. Almost 3 months now. Pain is not as excruciating but I can still feel nerve pain in calf and foot. Pain goes away while lying down and doing McKenzie exercise. Focusing on core exercises. I do not want surgery. Any thoughts? I really want to heal naturally
This reminds me my 9 painful months when I had L5S1 disc herniated. Not only straight leg raise was too painful to perform, but siting on normal position trying to straighten my leg also caused pain. Decided to do the microdiscectomy, it has been 6 years and I am grateful that I don't have to deal with that excruciating nerve pain no more..
Look young. Howd that happen? How is it now?
Bro how u fix it I need u bro
@@jamelturbay9356 I still need him
Hello doc, I’ve an injury from deadlifting which occurred 3 months ago and the effects are i feel extremely sore in my lower back waist area and there’s minimum pain on the right side but the left side hurts too much to bend probably with straight knees and when i move my left leg in a particular motion the bones in the left side of my lower back make a particular sound constantly kind of a cracking sound, pls help me as I’m too scared of the doctors to consult with this injury as it the solution seems probably with an injury
When I 'm lying flat on my back and they tell me to raise my leg nothing happens. I try to raise it up like 6 in we used to do in PE class, but nothing happens. However if I prop up on my elbows and I'm not lying completely flat I can do it. What does that indicate? I have DDD.
What if raising my right leg causes pain in the front hip/groin muscle
Does this injury require surgery? Im currently experiencing the same problem
Heyo!
I injured my lower back (pain around the tailbone area, right above bumhole) 9 weeks ago, and it's still not gone or going away/getting better.
When I lie down on my stomach on a flat surface, my bed for example, and then try to do some leg curls where I try to hit my butt with my feet, I get a sharp pain in that tailbone/lower back area.
Been getting acupuncture for weeks now because my physio thinks that's the way. She used a lot of tests on me. Straight leg raise, slump test, lying leg raise, etc. No pain. What do you guys think? Just want to get back into lifting so bad... :( Already lost so much progress for not wanting to lift in pain which has resulted in me not going.
If you can do these tests without any sciatica or lower back pain, does it mean you don't have a herniated disc, or would you have to pay for an MRI to really be sure?
Cheers! :)
i have lL4 L5 S1 mri send leveing left root my doctor hit with that relax hammer on my both kness noting move no reflex what do you think,
My pain is attached to right leg raise only and left is totally fine, lumbar area pains when bend forward with straight legs or raise my right leg.....
Can you tell me is it the same thing and what it is called so that I can get treated
when doing neural screen dermatomes what would the outcome be L1-S5 for this kind of patient?
What inidcates if the patient has problems with snezzing?
Pelvis stuff
My buttocks getting pain when I am sitting...
No longer practicing as a physiotherapist, but this was refreshing to see. Keep up the good work!
Thanks Rik!
what did you decide to move into after physio?
Sciatica pain is it same as herniated disc
well explained! concise and to the point
Thank you for the video doctor .
I have been exactly in the same situation but on my right leg , now pain is completely gone but I feel numbness, tingling and weaknesses on my right leg.
Can this be improved or show I proceed with the surgery?
That’s the thing , but I am worried about the numbness and wekness in my right leg
Hey Paul
Can you tell what was the management done for this patient?
Surgery
Helped me to get through my anatomy in med school. Love all the sign he demonstrated on the patients! THanks to the pts as well
You are welcome!! I'm glad I could help. More to come...
I get really bad, sharp pain when I lift my bad side's leg above my head while lying on my back. The pain radiates throughout my uppermost glute area, from the sacrum to the hip. The cobra pose makes that pain in the upper glute feel a really sharp pain as well. Do you think this is a glute issue, or do you think it stems from a herniated disc? I've seen several doctors and no one can provide a consensus diagnosis of what the main issue is. It also hurts in that upper glute area when I try to touch my toes while standing.
Hi Nick, a herniated disc hitting the L5 nerve root can present like this.
How do u feel now ? Do u get better? Did u go for surgery or study? I have similar problem .
@@kaiwang6016 I eventually avoided all extension exercises, and only did flexion stretches. The flexion stretches were game changers and eventually healed my badly herniated disc
@@nickerskine1586 thank you for the reply. It’s great to hear that you have healed. Hope u stay pain free!
I’m 2 week post my discetomy surgery, still in pain hope I can recovery over time.
Hello Paul, I have been dealing with a herniated disk for over a year now. I am doing nerve glides and other stretches, but it is very discouraging because it has been so long that I have been in pain. Is this something that will heal on its own over time with stretches and other care, or should I say will stretches, nerve glides, etc. be enough to help me permanently. I am 20 years old with this issue, and I don’t want to see this pain linger much longer.
How are you bro?
Hello Paul, I loved your video, very informative. I had a surgery done, the conventional way 3 months ago on my L5/S1 disc protrusion right side. Yet till this day I have the same issue as your patient there. Raising my left leg I get pain in my right and obviously the right does not go much higher. Did a mri and there is a very small protrusion still covering the S1 nerve. But it is so small that they can't believe I still have this much pain even when raising the opposite leg, laughing/coughing as well. U think it is still this disc? Everything else on the mri seems perfect.
Hi Giovanno, It sounds like you have a nerve gliding issue. Scar tissue can prevent the nerve from gliding well. Try this... th-cam.com/video/tr88uGR5w80/w-d-xo.html
Be gentle and start slow. Good luck!
Bro literally same thing have you fixed it yet? And if you have can you tell me how?
@@jamelturbay9356 Hey Bro, well I had a surgery done and it kind of stayed the same. After 3 months I went to a special therapist. Here we call it a Manual therapist and he concluded that indeed it was a gliding issue. So I got some stretching exercises and I have to tell u it's slowly starting to work. Incredible.
How do you treat
How do I fix this????
Real tests on real patients
I have problem in this excercise in which i take my leg up. My left leg giving me atention near my knee zone and thigh which problem i have
HI Parveen, I can't figure that out with this little information. Typically, pain in that area comes from L3-L4 but you should see medical provider to help sort that out. Good luck
Wow explanations are so smooth
i did the slump test, it seems like sciatic feels more intense in both of my legs in the morning, not shooting pain tho just tension like pain, seems to clear of as the day goes by, buy there is a lingering disconfort in my left leg, sometimes it shifts to the right one, never on both at the same time. Any a ideea? thx
How are you now??
Thanks Paul!
You are welcome! Stay tuned! I will be ramping up content like this in a big way soon. Best regards, Paul
My pain is on right side
Could sciatic pain be caused by a disc herniation even if this test didn't cause pain? There is significant tightness in the calf and hamstring but no nerve pain or tingling. This is well outside of my field of study, so if anyone has any thoughts I'd appreciate hearing them.
Hard to say without evaluating you. There are different reasons why you could have calf and hamstring tightness. It is possible to have a herniated disc without a positive straight leg raise test.
@@OrthoEvalPal I see, I'll have to get it checked out then. Thank you for your input!
I was digging through my comment history when I saw this post and decided it might be worth an update for anyone else experiencing what I'd described initially. It turned out to be tension in my piriformis muscle, which went away after a few days of stretching and icing the muscle.
In hindsight, I feel silly for having suffered for months only to have the pain subside after literally 2-3 days of stretching.
Hope this helps someone out there!
u cant tell if the herniated disk is large whiteout mri..
You are correct. Need the MRI for insurance to approve surgery
Very good informative video. I have a question I been diagnosed spinal stenosis and my leg wasn't hurting at that time. But now I start feeling pain occasionally I. One leg. I went to emergency room and the nurse hit my both legs with her hand open and not used a little hammer on sitting position and my legs moved. Also she told me to lay down and then sit on the bed, my lower back hurt me but I was not yelling just make a little noise because my pain. So she said leg raise was Negative. Is that possible? Because I have pain on one leg ccasionally. I feel like I have electricity on my leg come and goes. What can be my problem? Note my s4, s5 I have disk herniated and other things that I don't remember
Sounds to me like you are having nerve root compression issues. I would recommend seeing a provider who can do a thorough lower quadrant screen and match it up with an MRI. Good luck!
@@OrthoEvalPal I was Google about the technique that she used and I found the knee reflex test is just for S2, s3 and s4. So not for s5. Are people can have ciatica if the only problem is their s5. Thanks for respond faster
I am postive for sciatica pain
Sad
Get it checked soon
is surgery the only option for him?
Yes it was and he did great. These single level lesions can do very well with a minimally invasive surgery.
Ortho EVAL Pal With Paul Marquis Thanks. Did he recover most of his motor and reflex functions?
Question. I had a multiple knock to my lower back and with an MRI done just before Christmas, I was found to have a left posterior lateral disc bulge (L5-S1), displacing the (left) S1 nerve. I already had a small bulge (L3-4) touching the L4 nerve. I had a consultation with a neurosurgeon, who at the time didnt think surgery would benefit me because I wasn't getting sciatic pain. A few months later I was finding that my back was feeling much better and had much better movement and able to climb a few flights of stairs with little discomfort. However a further few months after, I got worse to where more recently I was getting bilateral symptoms including radicular pain around my lower back, with increasing numbness on my right side, such as feeling like a dead leg. I recently spent two nights in my nearest Emergency department because they wanted to do an MRI to rule out possible cauda equina syndrome. Interestingly the new MRI was showing what appeared to be the exact same thing as the one before Christmas. In the past couple of weeks my symptoms have increased, which include loss of some sensation such as around my bladder, to where I can't fully tell if my bladder is full or not most of the time. I have also started leaking more and more. I can however still control my bladder mostly, but am unsure if it is being completely emptied or not. My bowels have changed to where I'm finding it a bit of a strain to open them and have been getting pain at times. I can't put full pressure either, even with soft faeces. I've been getting pain around my groin, my bladder and even at times close to my back passage. I even get tingling and a lot of cold in my extremities and poor sensation in my feet, especially my right. What I want to know is does that sound right for being just an S1 displacement? Or is there likely more going on, such as something not picked up on the scan, it misread or even the wrong scan read? To me something doesn't sound right, especially the bowel and bladder issues I'm starting to seem to get.
Hello,I believe there is something else going on. I would definitely seek out medical attention and report these new findings. Good luck!
Ortho Eval Pal with Paul Marquis PT thank you for the reply/help
What do you mean that you got multiple knock?
Did some hit you?
Hello my name is Edward Jamerson I’m currently going through the exact same situation it has been 5 yrs help!?
How are you now?? Did you had surgery??
I’ve had this twice, L5-S1 Discectomy twice. Second worst pain of my life, second only to kidney stone.
This video has to be scripted because @2:47 I would have been in loud and profound agonizing pain and NOT calmly responding "right there"..."tell me when it starts to hurt" was the cue; notice how his leg is already fully raised.
Sorry, unscripted. Only scripted videos on this channel are the podcasts. I have although had patients who absolutely lose it as soon as I lift the leg and I don't have a chance to even ask the question. They don't all present the same and there are many reasons why tolerence to pain may be different. Best, Paul
I don't get it, i get realy bad pain in my lower back raising my legs but not leg pain that i can feel. ?
That is not all that uncommon Chris. I'd get it evaluated so that you can help to sort it out.
Chris Folmar hey did you ever get your pain sorted out because I’m going through the same situation
@@TeamRedWolf Did you? Im going through the same situation now
@@almin4989 yes and no I got the slipping rib syndrome taken care of but I still have spin pain so now I have to go to a neurosurgeon
@@TeamRedWolf what was your diagnose? Did u went on MRI scan?
Hello, when I do the straight leg test, I cant keep my leg straight past 45 degrees without feeling tingly in the calf region, I do get occasional lower back stiffness which I can release through gentle stretching of my hamstrings but I’m struggling to understand why I can’t get to 90 degrees with a straight leg, any ideas Doc ?
There are a few reasons for this Sanjay, but without a full evaluation it is difficult to know.
do like the process but it seems that research has shown that myotomal testing can be somewhat unreliable due to its poor sensitivity etc in research studies? could definitely provide evidence for radiculopathy etc but it might need further investigation than a physical Ax to accurately determine the level of herniation wouldnt you say?
Interesting you mention it. So there is a lot to look at with the neuro eval. I just had this conversation with my daughter who is in PT school. So the way I look at it is the more I diagnose clinically with an MRI finding to verify the better. The best way to test your eval skills is that when the patient has surgery for the exact spot you diagnosed and they are 100% better immediately after surgery for that exact diagnosis then you know your skills are getting better. Some of the vids I do are not all inclusive just so the patient doesn't have to sit through another full eval. Thanks for the comment!
You're top notch Paul! Thanks for the videos
Hi Alessandro, Glad to hear you are enjoying them. Spread the word! Thanks, Paul
why you test foot eversion?
HI John, testing the S1 myotome