The Bragard Sign Test is a neurodynamic assessment used after a Straight Leg Raise. The examiner raises the leg until symptoms are reproduced, lowers it slightly below the symptom threshold, then dorsiflexes the ankle to assess whether familiar neural-type leg symptoms return. A positive finding may support suspicion of sciatic nerve or lumbosacral nerve-root mechanosensitivity when it matches the client’s history and neurological findings, but it does not diagnose lumbar radiculopathy, sciatica or disc herniation on its own.

Introduction

Low-back-related leg pain can be difficult to interpret. Pain may travel into the posterior thigh, calf or foot, and symptoms may be influenced by lumbar nerve roots, sciatic nerve mechanosensitivity, hamstring sensitivity, hip symptoms or other factors.

The Bragard Sign Test, also called Bragard’s Test or Bragard’s Sign, is a neurodynamic test commonly used as a sensitising variation of the Straight Leg Raise. The key feature is adding ankle dorsiflexion after the leg is lowered slightly below the point of symptom reproduction.

The test can help explore whether a client’s familiar posterior leg symptoms are influenced by neural loading. It should not be used as a stand-alone diagnostic test.

The broader diagnostic literature around lumbar radiculopathy highlights that physical examination tests can help estimate probability, but they should be interpreted alongside history, neurological examination and symptom behaviour rather than used alone.  

Quick Summary

• Test name: Bragard Sign Test
• Also known as: Bragard’s Sign, Bragard Test, Braggard’s Test
• Region: Lumbar spine, posterior thigh, sciatic nerve pathway
• Test type: Neurodynamic / symptom provocation test
• Common use: Low-back-related leg pain, suspected sciatic nerve mechanosensitivity, suspected lumbosacral radicular symptoms
• Positive finding: Familiar neural-type leg symptoms return or increase when ankle dorsiflexion is added below the SLR symptom threshold
• Negative finding: Ankle dorsiflexion does not reproduce familiar neural-type symptoms
• Best used with: Straight Leg Raise, Slump Test, neurological screen, dermatomes, myotomes, reflexes, symptom history and lumbar movement findings
• Key limitation: The test can support reasoning but does not confirm lumbar radiculopathy, sciatica or disc herniation

What Is the Bragard Sign Test?

The Bragard Sign Test is a Straight Leg Raise variation that uses ankle dorsiflexion as a structural sensitiser.

A common sequence is:

• The client lies supine.
• The examiner performs a Straight Leg Raise.
• The leg is raised until familiar symptoms or strong posterior tension occurs.
• The leg is lowered slightly below the symptom threshold.
• The examiner dorsiflexes the ankle.
• The test is considered positive if familiar neural-type symptoms return or increase.

The purpose is to assess whether adding distal neural tension reproduces the client’s familiar symptoms after reducing the original Straight Leg Raise response.

This is different from simply recording hamstring tightness. The most relevant finding is reproduction of familiar leg symptoms, especially symptoms that travel beyond the posterior thigh or match the client’s usual complaint.

Why It Is Used

The Bragard Sign Test is used to help determine whether posterior leg symptoms may have a neural component.

It may help professionals:

• explore low-back-related leg pain
• compare hamstring stretch symptoms with neural-type symptoms
• assess response to ankle dorsiflexion sensitisation
• support reasoning around sciatic nerve mechanosensitivity
• decide whether further neurological screening is needed
• monitor symptom irritability over time
• record reproducible findings in Measurz

It is most useful when combined with:

• Straight Leg Raise
• Slump Test
• neurological screen
• symptom distribution
• lumbar movement testing
• pain behaviour
• dermatomes
• myotomes
• reflexes
• function and activity tolerance

What It Assesses

The Bragard Sign Test may assess:

• neural mechanosensitivity
• symptom response to sciatic nerve pathway loading
• posterior leg symptom reproduction
• response to ankle dorsiflexion
• relationship between SLR symptoms and distal sensitisation
• irritability of low-back-related leg symptoms

It may be associated with:

• low-back-related leg pain
• sciatic nerve mechanosensitivity
• lumbosacral nerve-root irritation
• suspected lumbar radicular symptoms
• symptoms commonly described as sciatica

It does not directly assess or confirm:

• lumbar disc herniation
• nerve-root compression
• exact spinal level
• severity of neurological involvement
• tissue damage
• need for imaging
• readiness to return to sport or work

Who It Is Useful For

The Bragard Sign Test may be useful for:

• exercise professionals
• strength and conditioning coaches
• allied health support teams
• movement assessment professionals
• sport and performance staff
• students learning neurodynamic assessment
• professionals using Measurz or MAT for structured assessment recording

It may be relevant for clients with:

• posterior thigh symptoms
• calf or foot symptoms linked with back pain
• suspected neural-type leg pain
• symptoms provoked by SLR or Slump positions
• low-back-related leg pain
• leg symptoms affected by spinal position, sitting, bending or neural loading

Use within scope. If the client reports progressive neurological symptoms, severe weakness, saddle symptoms, bladder or bowel changes, unexplained severe pain or other red flags, further medical assessment is more appropriate.

When to Use This Test

Use the Bragard Sign Test when you want to understand whether ankle dorsiflexion changes familiar leg symptoms after Straight Leg Raise positioning.

It may be used during:

• low-back-related leg pain assessment
• neurodynamic assessment education
• comparison with Straight Leg Raise
• comparison with Slump Test
• reassessment of neural symptom irritability
• monitoring symptom response over time

It is most useful when symptoms include:

• radiating posterior leg pain
• posterior thigh, calf or foot symptoms
• pins and needles or altered sensation
• symptoms affected by sitting or bending
• symptoms provoked by SLR or Slump-like positions

When Not to Use or When to Be Cautious

Use caution or avoid testing when the client reports:

• severe or worsening neurological symptoms
• progressive weakness
• saddle anaesthesia
• bladder or bowel changes
• unexplained weight loss, fever or systemic symptoms
• recent significant trauma
• suspected fracture or serious pathology
• severe pain at rest
• highly irritable symptoms likely to flare with testing

Stop the test if:

• symptoms become severe
• symptoms spread unexpectedly
• neurological symptoms increase
• the client feels unsafe
• the client asks to stop
• the result would not change assessment reasoning
• further medical review is more appropriate

Equipment Required

No specialised equipment is usually required.

Useful resources include:

• plinth or firm surface
• pain rating scale
• body chart
• neurological screen record
• Measurz recording workflow
• optional goniometer or inclinometer for SLR angle
• optional symptom irritability notes

Step-by-Step Protocol / Practice

Setup

Explain the test before starting.

Example wording:

“We are going to raise your leg like a Straight Leg Raise, then lower it slightly and move the ankle to see whether that reproduces your familiar leg symptoms. This test does not diagnose the cause on its own, but it helps us understand how your symptoms respond to neural loading.”

Client Position

Position the client:

• lying supine
• head supported if needed
• pelvis level
• non-tested leg relaxed
• tested leg relaxed before movement
• arms resting comfortably

Examiner / Professional Position

Stand beside the tested leg.

Ensure you can:

• support the heel or ankle
• keep the knee extended
• control hip flexion
• lower the leg slightly after symptom onset
• dorsiflex the ankle smoothly
• stop quickly if symptoms increase too much

Hand Placement

A common setup:

• one hand supports the heel or distal lower leg
• the other hand stabilises above the knee if needed
• keep the knee extended during the SLR phase
• control the ankle when adding dorsiflexion

Avoid sudden ankle movement. The sensitising movement should be controlled and gradual.

Stabilisation

Maintain:

• controlled hip flexion
• knee extension during the SLR phase
• neutral pelvis where practical
• relaxed upper body
• consistent ankle position before sensitisation
• no bouncing
• clear communication throughout

Movement Sequence

Perform the test as follows:

1. Slowly raise the straight leg into hip flexion.
2. Ask the client to report when symptoms begin.
3. Identify whether the symptom is familiar.
4. Lower the leg slightly until symptoms reduce or ease.
5. Add ankle dorsiflexion.
6. Ask whether the familiar symptom returns or increases.
7. Record the response.

Force and Movement Direction

The movement components are:

• passive hip flexion with knee extension
• slight lowering below symptom threshold
• ankle dorsiflexion as the sensitising movement

The ankle movement should be:

• controlled
• gradual
• not forced
• stopped if symptoms escalate sharply

Instructions

Ask the client:

• “Tell me when you first feel symptoms.”
• “Where do you feel it?”
• “Is it your familiar symptom?”
• “Is it stretch, pain, tingling, numbness or something else?”
• “Tell me if symptoms increase too much.”

When adding dorsiflexion, ask:

• “Does this reproduce the same leg symptom?”
• “Is it the same location as your usual symptoms?”
• “Rate the symptom from 0 to 10.”

Positive Finding

A positive Bragard Sign Test is usually:

• reproduction or increase of the client’s familiar neural-type leg symptoms when ankle dorsiflexion is added after lowering below the SLR symptom threshold

Record whether symptoms are:

• familiar or unfamiliar
• local or radiating
• pain, tingling, numbness, burning or pulling
• posterior thigh only or below the knee
• changed by lowering the leg
• changed by ankle dorsiflexion

Negative Finding

A negative Bragard Sign Test is usually:

• no reproduction or increase of familiar neural-type symptoms when ankle dorsiflexion is added

The client may still feel:

• calf stretch
• hamstring stretch
• local ankle or calf tension
• non-familiar discomfort

These should not automatically be interpreted as a positive neural finding.

Stopping Criteria

Stop if:

• symptoms are severe
• symptoms spread or worsen significantly
• neurological symptoms increase
• the client reports distress
• the client cannot relax
• the position is not tolerated
• symptoms are unclear and repeated testing is not appropriate

Safety Notes

The test should be performed slowly and respectfully.

Avoid repeated provocation of severe symptoms. In highly irritable presentations, a gentler neurodynamic assessment may be more appropriate, or testing may be deferred.

Positive and Negative Test Interpretation

Positive Test

A positive Bragard Sign Test means ankle dorsiflexion reproduces or increases the client’s familiar neural-type leg symptoms after the leg has been lowered slightly below the Straight Leg Raise symptom threshold.

A positive result may increase suspicion of:

• sciatic nerve mechanosensitivity
• lumbosacral nerve-root involvement
• low-back-related leg pain with neural features
• radicular-type symptom behaviour

A positive result is more meaningful when it matches:

• posterior leg pain distribution
• symptoms below the knee
• neurological findings
• positive SLR or Slump Test
• symptom change with spinal position
• dermatomal or myotomal findings
• reflex changes where relevant
• history consistent with nerve-root irritation

A positive result does not confirm:

• lumbar disc herniation
• lumbar radiculopathy
• nerve-root compression
• sciatica diagnosis
• exact spinal level
• need for imaging
• need for surgery

Other factors may contribute to symptoms, including:

• calf muscle stretch
• hamstring sensitivity
• peripheral nerve sensitivity
• local posterior thigh pain
• hip-related symptoms
• high irritability
• fear or guarding

Negative Test

A negative Bragard Sign Test means ankle dorsiflexion does not reproduce or increase familiar neural-type symptoms.

A negative result may reduce suspicion of neural mechanosensitivity if:

• SLR is also negative
• Slump Test is also negative
• neurological screen is normal
• symptoms are not below the knee
• lumbar movement does not reproduce leg symptoms
• functional tasks do not reproduce neural-type symptoms

However, a negative result does not fully exclude:

• lumbar radiculopathy
• disc-related symptoms
• intermittent nerve-root irritation
• load-dependent leg symptoms
• symptoms that only occur in sitting, bending, fatigue or higher loads

Sensitivity, Specificity and Diagnostic Accuracy

The Bragard Sign Test should be interpreted carefully. Evidence is stronger for related neurodynamic testing than for using Bragard as a stand-alone diagnosis.

Modified Bragard Diagnostic Accuracy

A study of the Modified Bragard Test compared diagnostic accuracy with the Straight Leg Raise in people with clinical lumbosacral radiculopathy and electrodiagnostic evidence of L5 or S1 nerve-root compression. It reported that the Modified Bragard Test added diagnostic value in that selected population.  

This evidence is useful but should be applied cautiously because:

• it studied a modified Bragard version
• the population had clinical radiculopathy features
• electrodiagnosis was used as the reference standard
• results may not apply to general back pain or non-specific posterior thigh symptoms
• it does not mean the test confirms radiculopathy on its own

Bragard With Straight Leg Raise

A 2020 diagnostic validity study of 864 participants with suspected lumbar or lumbosacral radiculopathy examined eight neurodynamic or orthopaedic tension tests using MRI as the reference standard. The study reported that Straight Leg Raise and Bragard performed in a multiple parallel way had high sensitivity of 97.40%, high negative predictive value of 96.64% and a negative likelihood ratio of 0.05. The authors concluded this combination had clinical validity to help discard lumbar or lumbosacral radiculopathy.  

Important limitations:

• this applies to SLR and Bragard used in parallel, not Bragard alone
• MRI findings may not always match symptoms
• the study population was selected for suspected radiculopathy
• a high-sensitivity combination may be more useful for reducing suspicion when negative than for confirming a condition when positive
• the result does not replace neurological examination or clinical reasoning

Related SLR and Extended SLR Evidence

Straight Leg Raise is one of the most commonly used tests for low-back-related leg pain, but research shows variable diagnostic accuracy, with higher sensitivity and lower or heterogeneous specificity in many settings.  

A 2021 study of an extended Straight Leg Raise using structural differentiation movements, including ankle dorsiflexion, reported sensitivity of 0.61 and specificity of 0.75 for lumbar disc herniation, and sensitivity of 0.60 and specificity of 0.67 for nerve-root compression when MRI was used as the reference standard.  

Practical Diagnostic Accuracy Summary

For Bragard-style testing:

• Condition or presentation: suspected lumbar or lumbosacral radiculopathy / low-back-related leg pain
• Test variation: SLR followed by ankle dorsiflexion sensitisation; modified versions exist
• Reference standards used in research: MRI or electrodiagnostic evidence, depending on study
• Most useful role: supporting suspicion or reducing suspicion when combined with other findings
• Best interpretation: cluster with SLR, Slump Test, neurological screen and history
• Main limitation: not a stand-alone diagnostic test

Reliability and Validity

Reliability evidence for the exact Bragard Sign Test is less developed than for the Straight Leg Raise and related neurodynamic tests.

The 2020 MRI-based diagnostic validity study examined multiple neurodynamic and orthopaedic tension tests, including Bragard, and reported that only limited tests performed independently showed external validity, while the SLR and Bragard combination in parallel performed better for ruling out radiculopathy.  

A 2021 extended Straight Leg Raise study noted that adding structural differentiation movements such as ankle dorsiflexion was designed to help differentiate neural symptoms from musculoskeletal symptoms. It also reported that the extended SLR had previously shown almost perfect inter-rater reliability, although that evidence relates to an extended SLR protocol rather than traditional Bragard alone.  

Reliability is stronger when you standardise:

• SLR angle
• point of symptom onset
• amount the leg is lowered before dorsiflexion
• ankle dorsiflexion range
• speed of movement
• symptom criteria
• side tested first
• pain rating method
• whether symptoms must be familiar
• whether symptoms travel below the knee

Validity is stronger when the test is interpreted with:

• neurological screen
• Straight Leg Raise
• Slump Test
• symptom distribution
• reflexes
• myotomes
• dermatomes
• lumbar movement findings
• functional behaviour

Common Errors and Limitations

Common errors include:

• calling the test diagnostic on its own
• adding ankle dorsiflexion too aggressively
• not lowering the leg below the SLR symptom threshold
• recording calf stretch as a positive test
• failing to ask whether symptoms are familiar
• not recording symptom location
• not comparing with SLR or Slump findings
• not screening neurological status
• not recording SLR angle
• moving too quickly
• repeatedly provoking severe symptoms
• ignoring red flags or progressive neurological symptoms

Limitations include:

• diagnostic accuracy varies by population and reference standard
• modified Bragard evidence may not apply to all Bragard protocols
• positive findings may reflect non-neural structures
• calf or hamstring stretch can confuse interpretation
• symptom irritability can change results
• findings may vary between examiners
• a negative result does not exclude lumbar radiculopathy
• the test does not identify the exact spinal level or structure

Practical Applications

The Bragard Sign Test can support:

• low-back-related leg pain assessment
• neurodynamic assessment education
• comparison between hamstring/calf stretch and neural symptoms
• symptom irritability tracking
• structured Measurz recording
• clinical reasoning about whether further neurological assessment is needed

It may be useful in clients with:

• posterior thigh symptoms
• calf or foot symptoms
• symptoms affected by sitting or bending
• symptoms reproduced by Straight Leg Raise
• suspected sciatic nerve mechanosensitivity

It is less useful when:

• symptoms are local only
• ankle dorsiflexion creates calf stretch only
• symptoms are highly irritable
• neurological red flags are present
• the assessment question is return-to-sport clearance

How to Record This in Measurz

Record:

• test name: Bragard Sign Test
• side tested: left or right
• result: positive, negative, unclear or unable to test
• Straight Leg Raise symptom onset angle
• angle where leg was lowered before dorsiflexion
• ankle position before sensitisation
• ankle dorsiflexion response
• pain score during SLR
• pain score during ankle dorsiflexion
• symptom location
• symptom quality:
  • pain
  • burning
  • tingling
  • numbness
  • pulling
  • stretch
• whether symptoms were familiar
• whether symptoms travelled below the knee
• comparison side
• neurological findings:
  • dermatomes
  • myotomes
  • reflexes
  • neural symptoms
• related tests:
  • Straight Leg Raise
  • Slump Test
  • Bowstring Sign
  • lumbar movement assessment
  • femoral nerve tension test if relevant
• irritability
• compensations or guarding
• reason for stopping, if relevant
• confidence in result
• interpretation notes
• retest date
• referral or further assessment notes if appropriate

Recording these details improves:

• repeatability
• communication
• client education
• assessment reasoning
• monitoring over time
• team consistency
• reporting quality

Related Tests / Internal Links

• Bowstring Sign
• Femoral Nerve Tension Test
• FAIR Test
• FADIR Test
• Hip Quadrant Test
• Piriformis Test
• Gaenslen Test
• Spine Function Index-10
• Oswestry Disability Questionnaire

FAQs

What is a positive Bragard Sign Test?

A positive Bragard Sign Test is reproduction or increase of the client’s familiar neural-type leg symptoms when ankle dorsiflexion is added after lowering the leg slightly below the Straight Leg Raise symptom threshold.

Is Bragard the same as the Straight Leg Raise?

No. Bragard is usually performed after the Straight Leg Raise by adding ankle dorsiflexion as a sensitising movement.

Can the Bragard Sign Test diagnose sciatica?

No. It may support suspicion of sciatic nerve or lumbosacral nerve-root mechanosensitivity, but it does not diagnose sciatica on its own.

What does a negative Bragard test mean?

A negative test means ankle dorsiflexion does not reproduce or increase familiar neural-type symptoms. This may reduce suspicion in some contexts, but it does not fully exclude radiculopathy or low-back-related leg pain.

Is there sensitivity and specificity evidence for Bragard?

Evidence exists for modified Bragard and for Bragard combined with Straight Leg Raise. One MRI-based study found SLR and Bragard used in parallel had high sensitivity and a low negative likelihood ratio for helping rule out lumbar or lumbosacral radiculopathy, but this does not mean Bragard alone confirms diagnosis.  

Should calf stretch count as a positive test?

Not by itself. The most meaningful positive finding is reproduction of the client’s familiar neural-type symptoms, especially symptoms matching their usual posterior thigh, calf or foot complaint.

What should Bragard be paired with?

It should be interpreted alongside Straight Leg Raise, Slump Test, neurological screen, symptom distribution, lumbar movement findings, pain behaviour and history.

Key Takeaways

• The Bragard Sign Test is a neurodynamic test based on Straight Leg Raise plus ankle dorsiflexion.
• A positive finding is reproduction or increase of familiar neural-type leg symptoms.
• It may support suspicion of sciatic nerve or lumbosacral nerve-root mechanosensitivity.
• It does not diagnose lumbar disc herniation, radiculopathy or sciatica on its own.
• Diagnostic accuracy is stronger when interpreted as part of a test cluster.
• Reliability depends on standardised SLR angle, lowering point, ankle dorsiflexion and symptom criteria.
• Measurz should record side, SLR angle, dorsiflexion response, symptom quality, symptom location, neurological findings and related tests.

References

Cochrane. (2026). Physical examination for the diagnosis of lumbar radiculopathy due to disc herniation in patients with low-back pain and sciatica. https://www.cochrane.org/evidence/CD007431_physical-examination-diagnosis-lumbar-radiculopathy-due-disc-herniation-patients-low-back-pain-and

González Espinosa de los Monteros, F. J., Gonzalez-Medina, G., Garrido Ardila, E. M., Rodríguez Mansilla, J., Paz Expósito, J., & Oliva Ruiz, P. (2020). Use of neurodynamic or orthopedic tension tests for the diagnosis of lumbar and lumbosacral radiculopathies: Study of the diagnostic validity. International Journal of Environmental Research and Public Health, 17(19), 7046. https://doi.org/10.3390/ijerph17197046

Homayouni, K., Jafari, S. H., & Yari, H. (2018). Sensitivity and specificity of Modified Bragard Test in patients with lumbosacral radiculopathy using electrodiagnosis as a reference standard. Journal of Chiropractic Medicine, 17(1), 36–43. https://doi.org/10.1016/j.jcm.2017.10.004

NICE Clinical Knowledge Summaries. (2025). Sciatica lumbar radiculopathy: Assessment. https://cks.nice.org.uk/topics/sciatica-lumbar-radiculopathy/diagnosis/assessment/

Pesonen, J., Shacklock, M., Suomalainen, J.-S., Karttunen, L., Mäki, J., Airaksinen, O., & Rade, M. (2021). Extending the straight leg raise test for improved clinical evaluation of sciatica: Validity and diagnostic performance with reference to magnetic resonance imaging. BMC Musculoskeletal Disorders, 22, 808. https://doi.org/10.1186/s12891-021-04649-z

Scaia, V., Baxter, D., & Cook, C. (2012). The pain provocation-based straight leg raise test for diagnosis of lumbar disc herniation, lumbar radiculopathy, and/or sciatica: A systematic review of clinical utility. Journal of Back and Musculoskeletal Rehabilitation, 25(4), 215–223. https://doi.org/10.3233/BMR-2012-0333

Tawa, N., Rhoda, A., & Diener, I. (2017). Accuracy of clinical neurological examination in diagnosing lumbo-sacral radiculopathy: A systematic literature review. BMC Musculoskeletal Disorders, 18, 93. https://doi.org/10.1186/s12891-016-1383-2