Original Research

The Active Straight Leg Raise Test and Lumbar Spine

Stability
Craig Liebenson, DC, Amy M. Karpowicz, MSc, Stephen H. M. Brown, PhD,
Samuel J. Howarth, MSc, Stuart M. McGill, PhD

Objective: To determine the utility of the active straight leg raise (ASLR) test as a screen
of lumbar spine stability and abdominal bracing (AB) ability.
Design: A biomechanical study of the ASLR test as a clinical evaluation of lumbar spine
stability and AB.
Setting: Clinical research laboratory.
Participants: Fourteen participants who were currently asymptomatic for back pain and
leg pain were evaluated.
Methods: Spine posture, muscle activation, and pressure distributions underneath the
supine subject were determined.
Main Outcome Measurements: An estimation of lumbar spine stiffness, a direct corre-
late with spine stability, was obtained using an anatomically detailed spine model.
Results: AB during the ASLR reduced the center of pressure (CoP) movement on a
strain-based pressure mat in lumbar rotation (P ⬍ .0125) as well as reducing directly
measured lumbar rotation (P ⫽ .02). Active AB increased lumbar spine stiffness (P ⬍ .002).
Regression analysis between stiffness and CoP movement suggested that different partici-
pants used different strategies to control torso motion.
Conclusions: This study demonstrates that the ASLR has utility as a screen of lumbar
spine stability and AB ability. The ASLR maneuver can assess control of lumbar rotational
movements in the transverse plane. Finally, this study demonstrated that AB can measurably
improve the rotational (transverse plane) stiffness of the lumbar spine.

INTRODUCTION C.L. L.A. Sports and Spine, Los Angeles,

California, USA
The active straight leg raise test (ASLR) is suggested as a clinical indicator of lumbopelvic stability Disclosure: nothing to disclose.
[1-3]. Poor performance during the ASLR is associated with postpartum sacroiliac (SI) pain [3].
A.M.K. Spine Biomechanics Labs, Faculty of
Furthermore, O’Sullivan et al [4] suggested that altered kinematics of the diaphragm and pelvic Applied Health Sciences, University of Water-
floor are likely present in those with a positive test. A positive test has been reported to reproduce loo, Waterloo, Ontario, Canada
Disclosure: nothing to disclose.
the patient’s characteristic pain or demonstrate weakness on manual muscle testing or manual
resistance [2,3]. The test may be performed actively with or without manual resistance or S.H.M.B. Spine Biomechanics Labs, Faculty
of Applied Health Sciences, University of Wa-
abdominal bracing (AB). AB has been suggested as a maneuver to enhance the stability of the SI terloo, Waterloo, Ontario, Canada
joint and thus reduce pain when the ASLR test is positive [2,3], although the mechanism for this Disclosure: nothing to disclose.
has not been demonstrated. Clinical observation also suggests that lumbar axial rotation may S.J.H. Spine Biomechanics Labs, Faculty of
occur during the ASLR, and the inability to limit this motion may indicate inadequate lumbar Applied Health Sciences, University of Water-
control. Light AB has been demonstrated to stiffen the lumbar spine [5,6], and may serve to loo, Waterloo, Ontario, Canada
Disclosure: nothing to disclose.
improve the active control of lumbar spine motion. Thus, the purpose of this study was to
S.M.M. Spine Biomechanics Labs, Depart-
investigate the applicability of the ASLR test for evaluating lumbar spine stability in a rotational
ment of Kinesiology, Faculty of Applied Health
mode, and to determine whether AB can stiffen and improve lumbar control during this test. Sciences, University of Waterloo, 200 Univer-
It appears that pelvic girdle stability is influenced by muscular activation of surrounding sity Ave. West, Waterloo, ONN2L 3G1, Can-
ada. Address correspondence to: S.M.M.;
muscles [7,8]. Sapsford and Hodges [9] demonstrated that conscious contraction of the abdom-
e-mail: mcgill@uwaterloo.ca
inal wall led to concomitant activation of the pelvic floor muscles. Furthermore, patterns of Disclosure: nothing to disclose.
abdominal contraction creating hoop stresses [10] and pelvic ring compression [7,8] suggest a Disclosure Key can be found on the Table of
crucial role for the muscular control system in enhancing lumbopelvic stability. Increased Contents and at www.pmrjournal.org
muscle activation results in more stiffness, and this is directly linked to a system that is more Submitted for publication December 17,
stable and will deform less under a given load or perturbation [11]. 2008; accepted March 15, 2009.

PM&R © 2009 by the American Academy of Physical Medicine and Rehabilitation

1934-1482/09/$36.00 Vol. 1, 530-535, June 2009
530
Printed in U.S.A. DOI: 10.1016/j.pmrj.2009.03.007
PM&R Vol. 1, Iss. 6, 2009 531

Similar abdominal activation techniques that may assist in assessed during performance of the ASLR tests. The exclusion
pelvic stability also affect lumbar stability. AB, which acti- criteria were that all had to be currently asymptomatic for
vates the 3 layers of the abdominal wall (external oblique, back pain and leg pain, and symptom-free for the previous
internal oblique, transverse abdominis) and rectus abdomi- year. The subjects were of varying levels of fitness. Before
nis, with no drawing in of the navel, has been quantified to beginning testing, all participants read and signed an in-
enhance lumbar spine stability [5,6]. Relatively low levels of formed consent document that had been approved by the
abdominal wall co-contraction are needed to ensure suffi- Office of Research Ethics at the University of Waterloo.
cient stability during performance of many activities of daily Lumbar spine stiffness was quantified using an anatomi-
living [12]; much higher levels of activation may become cally detailed EMG-driven model of the lumbar spine in a
necessary as the demands of the task increase. Thus, the subsample of 7 participants [19,20]. Given the reliance of
activation state of the musculature is matched to the demands this approach on estimates of muscle activation, these 7
of the task to ensure “sufficient stability.” participants were chosen from the pool of 14 for having the
Although sufficient stability ensures that the spine will not most suitable EMG.
buckle, it also ensures that the spine will not give way under
imposed torque, including about the axial rotation axis
Procedures
(transverse plane). Lumbar spine axial rotation has been
suggested to be the most difficult movement to control [13]. For the ASLR test participants lay supine on a table and were
Not surprisingly, an inability to control rotation has been asked to actively raise their right leg from the table while
linked to occupationally related low-back disorders [14]. It keeping their knee straight (Figure 1). The right leg was
would be helpful clinically to assess the ability to control axial raised with hip flexion until the heel was 20 cm above the
rotation of the pelvis and lumbar spine. In this way the ASLR table and held for approximately 5 seconds. The ASLR was
test may have potential to serve as a clinically useful func- assessed in 2 separate randomly ordered trials, one with and
tional screening test. Individuals classified as being candi- one without AB. A brief rest of at least 10 seconds was
dates for stabilization training have been demonstrated to allowed between each test variation.
have aberrant lumbopelvic motion patterns [15,16]. Active AB was cued in the following manner: participants
The hypothesis tested in this study is that the ASLR test is were instructed to tighten their abdominal wall muscles by
linked to lumbar spine rotational stiffness, which is a surrogate contracting and stiffening them without holding their breath.
measure of lumbar spine stability [17]. Specifically, to assess Various verbal cues were used, such as “tighten your stom-
this, axial rotation and stiffness about the axial rotation axis of ach” or “stiffen your abdominals and your back.” No direct
the lumbar spine was quantified. It was further hypothesized verbal instruction was given to the participants to either
that AB would serve to increase spine stiffness and decrease axial hollow their abdominal wall or protrude it out. An additional
rotation of the lumbar spine during performance of the ASLR. facilitation of the active AB was performed. This involved
The majority of clinicians do not have the instrumentation to having the clinician introduce slow and fast rolling move-
measure quantities that are used for calculating spine stability. ments about the participants’ pelvis and torso in a rotational
For this reason several instrumentation approaches were used. axis while the participants were requested to stiffen their
Pressure distribution between the supine patient and the table torso sufficiently to resist these movements. These clinician-
was used given that this was believed to be a surrogate clinical induced movements were introduced about the pelvis and
indicator of stability years ago by Jull and colleagues [18]. done concurrently with verbal cueing until the subject was
Although they assessed pressure with a bladder sensitive to successfully able to offer a matched, isometric resistance
sagittal spine motion, it was not sensitive to lateral shifts. Nor sufficient to resist these perturbations. The use of such per-
could the approach indicate centers of pressure. For this reason sonalized verbal cues is a mainstay of the proprioceptive
a pressure-sensitive mat between the participant and the table neuromuscular facilitation method of Knott and Voss [21]. It
was used in this study. In addition 3-dimensional spine motion should be noted that the rolling perturbations were gentle
was quantified together with torso muscle activation profiles and the matched resistance by the subject was only the
captured with surface electromyogram (EMG). These ap- intensity required to stiffen the spine and not more. It was
proaches added insight into whether the ASLR may act as a necessary that all subjects maintained normal respiration
surrogate indicator of a form of stability, or at least postural while performing this AB maneuver sufficient to stiffen the
control, that is easily administered during patient examination spine against these perturbations.
in the clinical setting.
Instrumentation
MATERIALS AND METHODS Throughout the study, a pressure mat (Tekscan Inc, Boston,
MA) was used at the interface between the participants’
Participants
posterior pelvis and lumbar spine, and the table. Pressure
A sample of 14 participants (5 men and 9 women), average measurements were used to assess shifts in the center of
age of 26.9 years (SD, 13.8 years), average height of 168.8 cm pressure (CoP) for the participant’s lumbar spine during
(SD, 6.5 cm), and average weight of 68.4 kg (SD, 8.4), were performance of the ASLR. The sensor used is an ultrathin
532 Liebenson et al ACTIVE STRAIGHT LEG RAISE TEST

Figure 1. Picture of the participant’s positioning at the point of maximum hip flexion during the active straight leg raise test.

(0.004 inch, 0.10 mm) flexible Mylar sheet containing a [23]). For the abdominal muscles, each participant, while in a
printed circuit. The sensor mat had 2016 individual sensing sitting position and manually resisted by a research assistant,
elements or cells organized in a 42 ⫻ 48 array. Before the produced a maximal isometric flexor moment followed sequen-
study, the pressure mat was calibrated up to 200 PSI (equal to tially by a right and left lateral bend moment, and then a right
1379 kPa) using a uniform pressure applicator. Horizontal and left rotational moment. For the erector spinae and gluteus
displacement of the CoP was used as a surrogate measure for maximus muscles, a resisted maximum extension in the Biering-
axial rotation of the lumbar spine. The maximum range Sorensen position was performed. The LD MVCs were con-
(farthest left to farthest right) of movement was compared ducted in a standing position using manually resisted LD
between the ASLR with and without AB. This approach was pull-down maneuvers. The gluteus medius was targeted with
used to quantify the rolling movement of the torso that some resisted side-lying hip abduction (ie, “the clam”). Participants lay
clinicians try to palpate or observe [22]. on their left side with the hips and knees flexed to 90°. Keeping
Direct measurement of lumbar spine rotation about 3 their feet together, they abducted their right thigh to horizontal,
orthogonal axes was performed using a 3Space ISOTRAK and a research assistant restricted further movement. The MVC
electromagnetic tracking instrument (Polhemus Inc, Col- task protocol took about 20 minutes per participant, which
chester, VT). This instrument consists of a single transmitter allowed for sufficient rest to minimize any fatigue.
that was strapped to the pelvis above the pubis and a receiver The EMG signals collected during the braced and un-
strapped across the ribcage, over the xiphoid process. Thus, braced ASLR were full-wave rectified and low-pass filtered
the position of the ribcage relative to the sacrum was mea- with a second-order Butterworth filter and normalized to the
sured (lumbar motion). maximum amplitude obtained from the similarly treated
Fourteen channels of EMG were collected from electrodes MVCs. A cutoff frequency of 2.5 Hz was used to mimic the
placed over the following muscles bilaterally: rectus abdominis frequency response of the torso muscles [24].
(RA), external oblique (EO), internal oblique (IO), latissimus
dorsi (LD), thoracic erector spinae (longissimus thoracis and
Spine Model for Estimation of Muscle and
iliocostalis at T9), and lumbar erector spinae (longissimus and
Spine Stiffness
iliocostalis at L3); also, right-side gluteus medius and gluteus
maximus were recorded. The skin was shaved and cleansed Although a brief description of the modeling process is given
with a 50% water and 50% ethanol solution. Ag-AgCl surface here, readers who would like a more comprehensive descrip-
electrodes were positioned with an interelectrode distance of tion with mathematical rigor are recommended to read the
approximately 2.5 cm. The EMG signals were amplified and the previous literature, which outlines the process in more detail
analog signals were digitally converted with a 12-bit, 16-channel [12,19]. First, the spine was assumed to be in a posture that
analog-to-digital converter at 1024 Hz. Each participant per- was close to neutral, at least for the purposes of assuming that
formed maximal isometric voluntary contractions (MVC) of passive tissue forces would not contribute substantial stiff-
each measured muscle for normalization (after Brown et al ness or bending torques. Next, the low-pass filtered EMG
PM&R Vol. 1, Iss. 6, 2009 533

the control trial (no bracing) during ASLR from 6.9 to 2.6 cm
(P ⬍ .0125; Figure 2).

Lumbar Axial Rotation

Lumbar axial rotation was significantly different between the
ASLR with and without AB (P ⫽ .02; 5.4° without AB; 2.2°
with AB; Figure 3).

Muscle Activity
All recorded muscles had average activation levels of less than
10% MVC during the ASLR without AB. All muscles dis-
played increases in average activation level when adding AB
to the ASLR, and these differences were statistically signifi-
Figure 2. Horizontal displacement of the lumbar spine and cant (P ⬍ .05) for all muscles except the gluteus maximus
pelvis center of pressure (CoP) during the active straight leg
raise test with and without (control) abdominal bracing. A
and medius (Figure 4). The highest activation levels during
statistically significant difference was observed (P ⬍ .0125). the ASLR with AB were recorded in the right and left IO
(approximately 22% MVC in both), and activation levels
greater than 10% MVC were also documented in the right
signals from the RA, EO, IO, LD, and both levels of erector and left RA and EO, as well as in the right LD.
spinae, together with the lumbar spine angles measured
using the 3Space, were entered into an anatomically detailed
spine model representing 118 muscle elements as well as Lumbar Spine Stiffness
lumped passive tissues, spanning the 6 lumbar joints Lumbar spine stiffness about the axial rotation axis increased
(T12-L1 through L5-S1). Muscle lengths were measured as (more than doubled; P ⬍ .002) during the AB condition,
the distance between attachment points; for those muscles relative to the control condition (Figure 5). Regression anal-
with curving lines of action, nodal points along the path were ysis showed that horizontal CoP movement was inversely
used. Muscle force and stiffness were calculated as a function related to spine stiffness (r ⫽ ⫺0.6; Figure 6).
of the estimated number of attached crossbridges, based on
muscle activation, physiologic cross-sectional area, and stress
and length using the distribution moment method [19].
DISCUSSION
Muscle geometry, force, and stiffness were used to quantify The results from the current investigation illustrate that AB
the rotational stiffness of the lumbar spine (as per Potvin and significantly reduces CoP movement and lumbar spine rota-
Brown [17]) about each of 18 degrees of freedom (6 lumbar tional motion while increasing spine rotational stiffness dur-
joints and 3 orthopedic axes at each joint). The stiffness ing the ASLR. Interestingly, regression analysis revealed an
values were averaged across the 6 lumbar joints for each expected negative correlation, but scatter of participant data
orthopedic axis; only the stiffness levels about the axial points suggests that different participants used slightly differ-
rotation axis are presented here. ent strategies. Thus using CoP movement under the pelvis

Statistical Analysis
Lumbar spine stiffness, lumbar rotational motion, and mus-
cle activation levels were computed for an approximately
1-second period at peak hip flexion during the ASLR test, and
CoP displacement was measured as indicated in the previous
section. These variables were compared between the ASLR
with and without AB using a single-factor repeated measures
analysis of variance with an ␣ level of 0.05. Regression
analysis revealed the dependence of horizontal CoP displace-
ment on rotational stiffness.

RESULTS

CoP Movement Figure 3. Lumbar axial rotation during the active straight leg
raise test with and without (control) abdominal bracing. A
AB significantly reduced the lateral CoP movement (indica-
statistically significant difference was observed (P ⫽ .02).
tive of horizontal trunk rotational motion) compared with
534 Liebenson et al ACTIVE STRAIGHT LEG RAISE TEST

Figure 5. Lumbar rotational stiffness about the axial rotation

axis during the active straight leg raise test with and without
Figure 4. Average electromyographic activation levels re- (control) abdominal bracing. A statistically significant differ-
corded at peak hip flexion during the active straight leg raise ence (P ⬍ .002) was observed.
test with and without (control) abdominal bracing. LEO, left
external oblique; LIO, left internal oblique; LLD, left latissimus
dorsi; LLES, left lower erector spinae; LRA, left rectus abdominis;
LUES, left upper erector spinae; MVC, maximal voluntary con- inal pressure and pelvic floor compression [7,8]. It has been
traction; REO, right external oblique; RGMAX, right gluteus previously documented [5,6], and confirmed here, that AB
maximus; RGMED, right gluteus medius; RIO, right internal through light coactivation (ranging here between 13% and
oblique; RLD, right latissimus dorsi; RLES, right lower erector 22% MVC) serves to stiffen and stabilize the lumbar column.
spinae; RRA, right rectus abdominis; RUES, right upper erector
spinae.
Several limitations impact the interpretation of the results
presented here. This is a preliminary biomechanical study of
the ASLR as modified by AB. No attempt to distinguish
results in acute or chronic lower back pain patients or in
alone appears to be clinically limited as it is only roughly
asymptomatic individuals was attempted. Well-balanced
coupled with stiffness. The ASLR test has previously been
muscular contraction will not only serve to stiffen the spine
hypothesized to assess lumbopelvic and, in particular, SI
but will also increase its loading. The levels of muscular
stability during sagittal plane motions. The results of this
activation that served to stiffen the spine in this healthy
study suggest that this test is also strongly associated with
population were relatively low and most likely would not
lumbar spine stability involving control of lumbar axial rota-
create a risk for tissue damage as a result of excessive loading.
tion (transverse plane) motions. Previous studies have sug-
It is important, however, to consider with a clinical popula-
gested that pain during the ASLR that is reduced by AB is
tion that pain and tissue tolerance levels may be reduced, and
most likely of SI origin [2,3]. Results from this study suggest
muscular activation levels may need to be increased to
this interpretation may need to be refined to include the
achieve a stiffening effect similar to that demonstrated here. It
possibility of lumbar spine–related disease. Because AB in-
is thus imperative that a full clinical assessment and consid-
volves stiffening the lumbar spine, pain that is reduced by AB
could be of lumbar, SI, or pelvic origin when stability is
lacking. Clinically it is important to appreciate that this test is
not specific to the pelvis, as it could indicate a lumbar pain
generator.
There is little related literature for comparison to these
results. Although several reports have addressed the ASLR
test as an indicator of pelvic instability and related pain—for
example, restricting pelvic rotation has been shown to reduce
pelvic pain in a patient population [1]—no previous attempts
to specifically assess lumbar movement patterns and biome-
chanics during the test have been documented.
Activation levels increased in all recorded muscles when
adding the AB to the ASLR; however, these increases were not
statistically significant in the gluteus maximus or medius.
This indicates that the AB may not directly (through muscle
attachments) facilitate the stabilization of the pelvis; still, the Figure 6. Regression of rotational stiffness with horizontal cen-
ter of pressure (CoP) displacement in the control and braced
significant increases in abdominal muscle activity may serve
condition.
to stabilize the pelvis through the generation of intra-abdom-
PM&R Vol. 1, Iss. 6, 2009 535

erations of the mechanisms of pain and dysfunction (eg, 4. O’Sullivan PB, Beales DJ, Beetham JA, et al. Altered motor control
compressive intolerance versus instability) are undertaken strategies in participants with sacroiliac joint pain during the active
straight-leg-raise test. Spine 2002;27:E1-E8.
before a rehabilitation strategy is selected. Muscle coordina- 5. Vera-Garcia FJ, Elvira JL, Brown SH, McGill SM. Effects of abdominal
tion is certainly an issue because unbalanced or poorly cho- stabilization maneuvers on the control of spine motion and stability
sen activation patterns have the potential to compromise against sudden trunk perturbations. J Electromyogr Kinesiol 2007;17:
stability [10]. 556-567. Epub 2006 Sep 22.
The technique of performing an active AB is very simple. 6. Grenier SG, McGill SM. Quantification of lumbar stability using two
different abdominal activation strategies. Arch Phys Med Rehabil 2007;
The goal is for the patient to functionally stiffen their spine 88:54-62.
while maintaining normal respiration. Verbal cues are used 7. Snijders CJ, Vleeming A, Stoeckart R. Transfer of lumbosacral load to
such as “tighten your stomach” or “stiffen your abdominals iliac bones and legs. Part 1: biomechanics of self bracing of the sacroiliac
and back.” No verbal cue about drawing the abdomen in or joints and its significance for treatment and exercise. Clin Biomech
protruding it out are offered. Once the subject has attempted 1993;8:285-294.
8. Snijders CJ, Vleeming A, Stoeckart R. Transfer of lumbosacral load to
to actively “brace,” then slow perturbations in the transverse iliac bones and legs. Part 2: loading of the sacroiliac joints when lifting
plane are introduced. At first the patient is encouraged to in a stooped posture. Clin Biomech 1993;8:295-301.
allow them to occur, then he or she is instructed to maintain 9. Sapsford RR, Hodges PW. Contraction of the pelvic floor muscles
a locked position of the torso, spine, and pelvis against the during abdominal maneuvers. Arch Phys Med Rehabil 2001;82:1081-
clinician’s resistance. The perturbations are in a rolling direc- 1088.
10. McGill SM. Low Back Disorders: Evidence Based Prevention and Reha-
tion and are introduced gently. bilitation. 2nd ed. Champaign, IL: Human Kinetics Publishers; 2007.
11. Brown SHM, McGill SM. Muscle force-stiffness characteristics influ-
ence joint stability. Clin Biomech 2005;20:917-922.
CONCLUSION 12. Cholewicki J, McGill SM. Mechanical stability of the in-vivo lumbar
spine: implications for injury and chronic low back pain. Clin Biomech
The ASLR procedure can serve as a test for lumbar spine 1996;11:1-15.
stiffness, at least in the axial rotation axis. Furthermore, 13. Marras WS, Parnianpour M, Ferguson SA, et al. The classification of
AB reduced lumbar spine axial rotation, which suggests, anatomic- and symptom-based low back disorders using motion mea-
and is supported by prior investigations [5,6], that AB may sure models. Spine 1995;20:2531-2546.
14. Marras WS, Lavender SA, Leurgans SE, et al. The role of dynamic
be a suitable countermeasure for patients whose pain is three-dimensional trunk motion in occupationally-related low back
induced by excessive motion of the lumbar spine or pelvis. disorders. The effects of workplace factors, trunk position, and trunk
This will require further study comparing patients with motion characteristics on risk of injury. Spine 1993;18:617-628.
pain to asymptomatic patients. Because the ASLR has been 15. Hicks GE, Fritz JM, Delitto A, Mishock J. The reliability of clinical
shown to be a sensitive measure of lumbar stiffness and examination measures used for patients with suspected lumbar seg-
mental instability. Arch Phys Med Rehabil 2003;84:1858-1864.
therefore stability, future work may be directed toward 16. Brennan GP, Fritz JM, Hunter SJ, Thackeray A, Delitto A, Erhard RE.
assessing whether stability as measured with the ASLR test Identifying subgroups of patients with acute/subacute nonspecific low
predicts motor control during other commonly prescribed back pain: results of a randomized clinical trial. Spine 2006;31:623-
training exercises. 631.
17. Potvin J, Brown SH. An equation to calculate individual muscle contri-
butions to joint stability. J Biomech 2005;38:973-980.
18. Jull G, Richardson C, Toppenberg R, Comerford M, Bui B. Towards a
ACKNOWLEDGMENT measurement of active muscle control for lumbar stabilization. Aust
Physiother 1993;39:187-193.
Financial support of the Natural Sciences and Engineering
19. Cholewicki J, McGill SM. Relationship between muscle force and
Research Council, Canada (NSERC) is gratefully acknowl- stiffness in the whole mammalian muscle: a simulation study. J Bio-
edged. mech Eng 1995;117:339-342.
20. Ma S, Zahalak GI. A distribution-moment model of energetics in
skeletal muscle. J Biomech 1991;24:21-35.
REFERENCES 21. Knott M, Voss DE. Proprioceptive Neuromuscular Facilitation: Patterns
and Techniques. 2nd ed. Philadelphia, PA: Harper and Row; 1968.
1. Mens JM, Vleeming A, Snijders CJ, Stam HJ, Ginai AZ. The active 22. Vleeming A, Mooney V, Stoeckart R. Movement, Stability, and Lumbo-
straight leg raising test and mobility of the pelvic joints. Eur Spine J Pelvic Pain: Integration of Research and Therapy. Churchill Living-
1999;8:468-473. stone, London: Elsevier; 2007.
2. Mens JM, Vleeming A, Snijders CJ, Koes BW, Stam HJ. Reliability and 23. Brown SHM, Vera-Garcia FJ, McGill SM. Effects of abdominal bracing
validity of the active straight leg raise test in posterior pelvic pain since on the externally pre-loaded trunk: implications for spine stability.
pregnancy. Spine 2001;26:1167-1171. Spine 2006;31:E387-E393.
3. Mens JM, Vleeming A, Snijders CJ, Koes BW, Stam HJ. Validity of the 24. Brereton LC, McGill SM. Frequency response of spine extensors during
active straight leg raise test to measure disease severity in posterior rapid isometric contractions: effects of muscle length and tension. J
pelvic pain since pregnancy. Spine 2002;27:196-200. Electromyogr Kinesiol 1998;8:227-232.