If a straight leg raise test is negative, what is the most appropriate clinical interpretation?

• A. Disc herniation is ruled out.
• B. Disc herniation is less likely.
• C. Imaging is unnecessary.
• D. The test should be repeated.

Answer: (B)

The straight leg raise assesses nerve root tension from a lumbar disc herniation, particularly affecting the L5–S1 roots. A negative result means that, at least in this provocative position, there isn’t reproduced radicular pain suggesting a herniation. However, this does not rule out a disc issue entirely—some herniations don’t elicit a positive test, and other processes can cause leg pain without a positive SLR. So, a negative test makes disc herniation less likely, but not excluded. Repeating the test isn’t usually helpful, and imaging decisions should be based on the full clinical picture and red flags rather than this single test.