Bowstring Sign

Original Editor - Manisha Shrestha Top Contributors - Manisha Shrestha, Kim Jackson and Kirenga Bamurange Liliane

Purpose[edit | edit source]

Bowstring sign is a passive provocative clinical test that is performed in patients presenting with low back pain to determine the lumbosacral nerve tension. It is also known as popliteal compression test or Posterior Tibial Nerve stretch sign.[1]

Technique[edit | edit source]

Patient Position[edit | edit source]

Patient in supine lying position without a pillow.

Therapist Position[edit | edit source]

Examiner stands at the tested side with a face facing towards patient's face.

Procedure[edit | edit source]

  • Initially, examiner performs Straight Leg Raise ( SLR) test in which the examiner lifts the leg with the extended knee. Examiner raises the leg to the point where the patient perceives pain along the distribution lumbosacral dermatomal level or when maximum flexion is got.
  • While performing SLR test, at the point of maximum pain (positive SLR) the examiner will slightly flex the patient’s knee approximately 20 degrees thereby reducing the pain.
  • Then examiner applies pressure (via thumb) on the popliteal fossa on sciatic nerve (Posterior Tibial Nerve).
  • If this elicits the same pain as the patient experiences during SLR, then Bowstring sign is said to be positive.[2]
  • This test should be performed in both leg,normal side being the first.


Evidence[edit | edit source]

  • The bowstring sign is one of the commonly used variants of the SLR test and a study published in 2020 suggests using SLRT, Femoral nerve tension test, Slump test, and bowstring test in combination. This takes about 2 minutes and could improve both the sensitivity and specificity of the physical examination for the diagnosis of sciatica.[4]
  • There is no evidence regarding psychometric properties of the Bowstring sign.

References[edit | edit source]

  1. Das JM, Nadi M. Lasegue Sign. StatPearls [Internet]. 2020 May 24.
  2. Kamath, S. U., & Kamath, S. S. (2017). Lasègue's Sign. Journal of clinical and diagnostic research : JCDR11(5), RG01–RG02.
  3. Sports Injuries And Rehabilitation. Bowstring test. Available from: [Lasted accessed: 26th Feb 2021]
  4. Berthelot JM, Darrieutort-Laffite C, Arnolfo P, Glémarec J, Le Goff B, Maugars Y. Inadequacies of the Lasègue test, and how the Slump and Bowstring tests are useful for the diagnosis of sciatica. Joint bone spine. 2020 Jun 16:105030.