Persistent leg pain, tingling, or numbness can be frustrating and difficult to diagnose. Is the problem coming from your back, your hip, or the nerves that travel down your leg? As physiotherapists, one of the key tools we use to answer this question is the Lower Limb Tension Test (LLTT).
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What is the Lower Limb Tension Test?
The LLTT is part of neurodynamic testing, a specialised assessment that looks at how well your nerves move and function. The test uses gentle, controlled movements to put specific nerves in your lower body under a light stretch to assess their movement.
By assessing for protective responses such as muscle guarding through the test, or carefully reproducing your symptoms in a safe and measured way, we can determine whether irritated or restricted nerves are contributing to your pain. This gives us valuable information for creating a treatment plan that targets the true source of your symptoms.
Why We Perform the Lower Limb Tension Test
Your nerves need to glide freely as you move. When they become compressed, irritated, or tethered, you may experience symptoms such as:
- Shooting pain down the leg
- Tingling or numbness in the foot or toes
- A feeling of heaviness or weakness in the leg
- Pain made worse by certain positions or movements
The Lower Limb Tension Test helps us identify whether your nerves are at the root of these problems. This is especially important for conditions such as:
- Sciatica: Irritation of the sciatic nerve, often due to a lumbar disc problem.
- Lumbar radiculopathy: Nerve root compression in the lower spine causing leg pain, tingling, or weakness.
- Tarsal tunnel syndrome: Compression of the tibial nerve at the ankle.
- Post-injury adhesions: Nerves can become “stuck” after injury or surgery, limiting their movement.
- Muscle knots and joint stiffness in the lumbo pelvic region can also affect nerve movement.
The Different Types of Lower Limb Tension Test
Just like the Upper Limb Tension Test targets different nerves in the arm, there are variations of the LLTT that focus on specific nerves in the leg:
- Straight Leg Raise (SLR) – Sciatic Nerve Bias: The most well-known test, used to assess the sciatic nerve and its branches. The leg is raised while lying on your back, and foot/ankle movements are added to increase tension on the nerve.
- Slump Test – Sciatic Nerve Bias: Combines spinal flexion with leg extension and ankle movement to assess the sciatic nerve under more “real-life” conditions.
- Femoral Nerve Stretch Test: Targets the femoral nerve at the front of the thigh, performed with the patient lying face down while the knee is bent and hip extended.
- Tibial, Peroneal, and Sural Nerve Biases: Specific ankle and foot movements can be added to the SLR to highlight these individual nerves.
Using these variations, we can test different “branches” of the nervous system in your lower limb.
How We Perform a Lower Limb Tension Test
Here’s what you can expect when we carry out an LLTT:
- Preparation: You’ll be positioned lying down, either on your side, back or your front depending on the nerve being tested.
- Baseline testing: We often begin on the unaffected leg to establish what’s normal for you.
- The test: We slowly guide your leg through specific movements, adding components step by step (for example, hip flexion, knee extension, and ankle dorsiflexion in the SLR test).
- Symptom response: At each stage, we ask what you feel. If your usual symptoms appear, we pause the test. We also test for muscle guarding and other subtle protective responses from your nervous system.
- Structural differentiation: To confirm nerve involvement, we may add a small movement at a distant point (such as moving your neck or ankle). If this changes your symptoms, it strongly indicates a nerve origin rather than a muscle or joint issue.
This methodical approach ensures your comfort and helps us pinpoint the underlying cause of your pain.
What a “Positive” LLTT Means
A positive Lower Limb Tension Test means the test reproduced your familiar symptoms—whether that’s shooting pain, tingling, or numbness. When structural differentiation changes these symptoms, it confirms that the nervous system is involved.
A positive test can also occur if there is a subtle protective response from your nervous system, which can only be detected by a trained professional.
Importantly, a positive test doesn’t provide the full diagnosis on its own. We combine the results with your medical history, a full physical exam, including a whole body assessment, and other nerve tension tests to form an accurate, complete picture of your condition.
Conclusion
The Lower Limb Tension Test is a safe and reliable way to assess nerve-related problems in the leg. By gently assessing the movement of specific nerves, the Lower Limb Tension Test helps us uncover whether your pain or discomfort is caused by nerve irritation or restriction.
If you’re dealing with sciatica, leg pain, or nerve-related symptoms, our team at Northwest Physiotherapy Group can help. A thorough nerve tension test can provide the answers you need and guide you towards a treatment plan that addresses the root cause—not just the symptoms.
Take the first step toward recovery today by booking an appointment with our experienced physiotherapists.
References
- Shacklock M. Clinical Neurodynamics: A New System of Musculoskeletal Treatment. Elsevier; 2005.
- Butler DS. The Sensitive Nervous System. NOI Group; 2000.