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Related Experiment Video

Updated: Dec 12, 2025

Exploring the Neural Correlates of Cognitive Reappraisal in Obsessive-Compulsive Disorder Using Task-based Functional Magnetic Resonance Imaging
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The flip test: a reappraisal.

Bruce Summers1, Viren Mishra, J Mary Jones

  • 1Department of Orthopaedics, The Princess Royal Hospital, Telford, Shropshire, United Kingdom. famsummers@btinternet.com

Spine
|July 1, 2009
PubMed
Summary

The flip test for sciatica is often misinterpreted. Pain on knee extension during the test, not a trunk "flip," is the most reliable indicator of nerve root tension in patients with limited straight leg raise.

Area of Science:

  • Neurology
  • Diagnostic Medicine
  • Orthopedics

Background:

  • The flip test is a common clinical maneuver for assessing nerve root tension in sciatica patients.
  • It's used to corroborate findings from the supine straight leg raise (SLR) test.
  • Despite its common use, the flip test lacks validation in scientific literature.

Purpose of the Study:

  • To evaluate the construct validity of the flip test in diagnosing nerve root tension.
  • To determine the reliability and interpretation of the flip test's results.

Main Methods:

  • A diagnostic study involving 67 sciatica patients with confirmed nerve root compression via MRI.
  • The flip test was performed, and patient responses were recorded.
  • Responses were compared to supine SLR results and statistically analyzed.

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Main Results:

  • Only one-third of patients exhibited the characteristic "flip" response.
  • A significant portion experienced pain upon knee extension (39%) or resisted extension due to pain (28%).
  • Painful responses were strongly associated with supine SLR angles below 45 degrees.

Conclusions:

  • The traditional interpretation of the flip test may be inaccurate.
  • The test is valuable for nerve root tension assessment, particularly in patients with supine SLR < 45 degrees.
  • Pain on knee extension is a more reliable indicator than the "flip" itself; "sitting SLR test" is proposed as a clearer name.