Bechterew Test

The Bechterew test, also known as the Sitting Straight Leg Raise Test, is a neurological examination technique used to assess nerve root irritation and sciatica in seated patients. It’s similar to the slump test.

It was named after the Russian neurologist Vladimir Bechterew, this test provides a practical alternative to the traditional straight leg raise test, particularly useful when examining patients who have difficulty lying supine or when a quick screening assessment is needed.

The Bechterew test emerged as a modification of more comprehensive neural tension tests, designed to evaluate nerve root compression and irritation in the lumbar spine. Its significance lies in its ability to reproduce radicular symptoms through mechanical stress on the neural structures, particularly the sciatic nerve and its roots (L4-S3). This test is valuable in identifying nerve root pathology associated with lumbar disc herniation, spinal stenosis, and other conditions causing neural impingement.

See Also: Slump Test

Anatomical Basis

The test exploits the biomechanical principles of neural tension. When the knee is extended in the seated position, it places tensile stress on the sciatic nerve and its tributaries. This tension is transmitted proximally through the nerve roots, potentially reproducing symptoms if there is nerve root irritation, inflammation, or mechanical compression. The neural structures involved include:

• Sciatic nerve (L4-S3 nerve roots)
• Posterior tibial nerve
• Common fibular nerve
• Associated nerve root sheaths and dural sleeves

How to Perform the Bechterew Test?

The Bechterew test follows a systematic progression designed to gradually increase neural tension while monitoring for symptom reproduction:

The patient sits comfortably on the examination table with both feet flat on the floor, thighs fully supported by the table edge, and hands resting on the table for stability.

Phase 1: Uninvolved Leg Testing The patient is instructed to actively extend the uninvolved (asymptomatic) leg at the knee, maintaining this position briefly before returning the foot to the floor.

Phase 2: Involved Leg Testing The patient then extends the involved (symptomatic) leg at the knee. The examiner observes for any reproduction of symptoms, compensatory movements, or inability to achieve full extension.

Phase 3: Bilateral Extension If no symptoms are produced during single-leg testing, the patient is asked to extend both legs simultaneously at the knee, which increases the overall neural tension and may elicit subtle findings not apparent during unilateral testing.

What is the Positive Test Finding?

A positive Bechterew test is indicated by one or more of the following responses:

Primary Indicators

• Radicular pain reproduction: Sharp, shooting, or burning pain that radiates below the knee, typically following a dermatomal distribution consistent with specific nerve root involvement.
• Limitation of knee extension: Inability to achieve full knee extension due to pain or neural tension.
• Tripod sign: The patient instinctively leans backward and braces themselves on the examination table with their hands, creating a tripod-like posture to reduce neural tension.

Secondary Indicators

• Reproduction of paresthesia (numbness, tingling) in the affected leg.
• Exacerbation of pre-existing back pain.
• Visible muscle guarding or protective positioning.

The Bechterew test should be interpreted within the broader context of the patient’s clinical presentation, history, and other examination findings. A positive test suggests nerve root irritation or compression but is not pathognomonic for any specific condition.

Differential Diagnosis

Positive Bechterew Test findings should prompt consideration of various conditions including:

• Lumbar disc herniation
• Spinal stenosis
• Piriformis syndrome
• Sacroiliac joint dysfunction
• Peripheral nerve entrapment

Advantages

• Quick and easy to perform
• Requires minimal patient positioning
• Useful for patients with mobility limitations
• Can be performed in various clinical settings

Limitations

• May be influenced by hamstring tightness
• Less comprehensive than full slump test battery
• Requires patient cooperation and understanding
• May not detect subtle nerve root pathology

References & More

1. Das JM, Dua A, Nadi M. Straight Leg Raise Test (Lasegue sign) [Updated 2024 Oct 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: PubMed