Testing... 1, 2, 3: The Active Straight Leg Raise

An ongoing series highlighting helpful tests for the chiropractic practice.

By Jay S. Greenstein, DC, CCSP, CGFI-L1, CKTP

The Functional Movement Screen® (FMS), developed by Gray Cook, MSPT, OCS, CSCS, of Danville, Va., is a screening method to identify biomechanical and functional issues in patients and athletes. Previous articles have reviewed the deep squat, the hurdle step, in the in-line lunge and the shoulder mobility screen. You can find these articles at www.acatoday.org/archives. This article will review the fifth screen of the FMS®, the active straight leg raise (ASLR).

Purpose: The active straight leg raise tests the ability to perform separate movement of the lower extremity while maintaining stability in the torso. The active straight leg raise test assesses active gastroc-soleus and hamstring flexibility while maintaining a stable pelvis and active extension of the opposite leg.

Performing the Screen: The individual assumes the starting position by lying supine with the back and head flat on the floor.The board is placed under the knees. The examiner identifies the midpoint between the anterior superior iliac spine (ASIS) and midpoint of the patella. The dowel is then placed at this position perpendicular to the ground and adjacent to the thigh. Next, the patient is instructed to lift the ipsilateral leg (the test leg) with the ankle in dorsiflexion and the knee fully extended. Once the active end range position is achieved with the test leg and the malleolus is located past the dowel, then the score is recorded per the criteria. If the malleolus does not pass the dowel, then the dowel is aligned along the medial malleolus of the test leg, perpendicular to the floor, and scored per the criteria. The active straight leg raise test should be performed as many as three times bilaterally. During the duration of the screen, the opposite Knee should remain in complete contact with the board, the toes should remain pointed upward and the head should remain flat on the floor.

Tips for Testing:

  • The side being scored is the flexed hip.
  • Ensure that the opposite leg on the floor does not externally rotate at the hip.
  • Both knees remain fully extended, and the knee on the extended hip must touch the board throughout the duration of the screen.
  • If the dowel resides at exactly the midpoint, score low.

Use the following scoring system:

  • A score of 3 is given if the ankle/dowel resides between midthigh and ASIS.
  • A score of 2 is given if the ankle/dowel resides between midthigh and midpatella/joint line.
  • A score of 1 is given if the ankle/dowel resides below midpatella/joint line.
  • A score of 0 is given if there is pain in any portion of the screen.

See a test score of 3 at www.youtube.com/watch?v=irG013qcpZQ

See a test score of 1 at www.youtube.com/watch?v=jEzMqRKNqi0

Clinical Implications
The ability to perform the active straight leg raise test requires full femoral acetabular range of motion in flexion, hip flexor and knee extensor strength, trunk stability and functional hamstring flexibility, which is needed during training and competition.Obviously, active flexibility is different from passive, and the passive method has been commonly used to assess hamstring length as well as disc pathology/radiculopathy. The athlete also is required to demonstrate adequate hip mobility and motor control of the non-testing leg. Poor performance during this test can be the result of a multitude of factors. First and foremost, the individual may have a loss of functional hamstring flexibility. Second, the athlete may have poor mobility of the ipsilateral hip joint caused by capsular tightening and/or articular pathology/ degeneration. Further, there could be a loss of mobility in the opposite hip, stemming from iliopsoas tightness associated with an anteriorly tilted pelvis. If this limitation is significant, true active hamstring flexibility will not be attained. A combination of these factors will demonstrate the individual’s relative bilateral, asymmetric hip mobility. Like the hurdle step test discussed in earlier articles, the active straight leg raise test identifies relative hip mobility. However, the ASLR is more specific to the limitations imposed by the muscles of the hamstrings and the iliopsoas and relies less on glute strength and trunk stability.

When an athlete achieves a score less than 3, the limiting factor must be identified. Clinical documentation of these limitations can be obtained by Kendall’s sit-and-reach test, as well as the 90-90 straight leg raise test for hamstring flexibility. The Thomas test and modified Thomas test can be used to identifyiliopsoas flexibility. Previous testing has identified that when an athlete achieves a score of 2, minor asymmetric hip mobility limitations or moderate isolated, unilateral muscle tightness may exist. When an athlete scores 1 or less, relative hip mobility limitations are gross.

Corrective Exercises
If the individual scores a 2, one of the recommended exercises is the “single leg lowering,” which can be seen at www.youtube. com/watch?v=yKedcBUGaJs. An individual who scores a 1 can perform the “straight leg raise (PNF) with a partner” to improve hamstring flexibility.

Obviously, there is great opportunity for doctors of chiropractic to enhance hip function beyond the two exercises mentioned above. Understanding the functional and biomechanical deficits will help provide the patient with the right program to improve overall function. As stated earlier, appropriately directed extremity adjustments can have a tremendous impact. Remember, this is just one screen out of seven. Tying all the functional elements together is the difference between a “screener” and a “professional.” Good luck, and watch for screen No. 6 next month!

Dr. Greenstein is CEO of Sport and Spine Rehab/Sport and Spine Athletics (www.ssrehab. com). He is Graston Technique® certified and a Titleist Performance Institute certified golf fitness instructor.