Alexander Bushell S0287741 CHIR20002

Reflection:

At the start of term, one of our mentors and lecturers, Dr Don Williams, posed a question to
the class concerning the Straight Leg Raise (SLR).
How would you identify and differentiate the terminating peripheral branches of the sciatic
nerve during this lower limb neurodynamic test?
Now my first thoughts were…crap; I cannot even remember the terminating branches of the
sciatic nerve; my second thought was even if I did know how to name them, how would I
differentiate them? So, I endeavoured to research the answer over the term.
I have since found out that there are three terminating branches to the sciatic nerve, named
the tibial, common peroneal and sural nerves (1). The tibial nerve supplies motor function to
the posterior muscles of the lower leg and knee joint, the common peroneal nerve supplies
cutaneous distribution to the lateral aspect of the leg (2), and the sural nerve supplies
cutaneous sensation to the posterior and lateral aspect of the lower leg and lateral foot (1,
3).

During a physical examination, the practitioner will place an increased load onto these
specific branches individually by setting the foot and ankle into certain positions. To test the
tibial nerve, the practitioner places the ankle into dorsiflexion with eversion, dorsiflexion and
inversion loads the sural nerve, and plantarflexion with inversion loads the common peroneal
nerve.
Why is this important for a practitioner to know? Suppose a patient reports pain within the
lower leg and ankle. In that case, the SLR test can be used to rule in or out SIJ, lumbar disc
pathology, sciatic nerve compression or peripheral contusion to one of the three distal
distributions and terminal endpoints sciatic nerve (4, 5).

During the term, I kept testing myself on this knowledge for rapid recall. At the start of the
term, it took sixty seconds to recall the three nerves and how to load them in the SLR (6). At
week eight, it takes thirty-five seconds. This shows an improvement over the course of the
term.

References:

(1-6)

1. Keith L. Moore AFD, Anne M. R. Agur. Clinically Oriented Anatomy. 8 ed: Wolters Kluwer;
2018.
2. Physiopedia. Common Peroneal Nerve [Available from: https://www.physio-
pedia.com/Common_Peroneal_Nerve.
3. Mallac C. Uncommon injuries sural nerve neuropathy: Sports Injury Bulletin; [Available
from: https://www.sportsinjurybulletin.com/unusual-injuries-sural-nerve/.
4. Magee DJ. Orthopedic Physical Assessment. 6 ed2014. 943-6 p.
5. Physiopedia. Straight Leg Raise Test [Available from: https://www.physio-
pedia.com/Straight_Leg_Raise_Test.

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Alexander Bushell S0287741 CHIR20002

6. Physiopedia. Neurodynamic Assessment [Available from: https://www.physio-

pedia.com/Neurodynamic_Assessment.