The Bragard's sign (also: Braggard's test) is used to evaluate whether lumbar and/or ischiadic pain originates from lumbosacral radiculopathy (e.g. disc herniation causing nerve root compression).
The patient is in supine position. The examiner lifts the straight leg passively into hip flexion until the familiar pain occurs (Straight Leg Raise test/Lasegue's Sign). Subsequent, the leg is lowered just below the pain threshold and the foot is pulled in dorsiflexion. If the familiar pain occurs again, the Bragard's sign is positive. This would indicate towards a nervous involvement in the patient's pain's origin.
In a study with 506 patients Homayouni et al. investigated the sensitivity and specificity of Bragard's sign for the differentiation of lumbosacral radiculopathy. They reported acceptable test performance especially in patients with symptom duration of less than three weeks, since the Straight Leg Raise test sensitivity and specificity decreased as sensitivity and specificity of the Bragard's test increased.
Testing in clinical practice
Clinical examination tests work best when used in a combination of three to five tests, this is especially true for sacroiliac joint dysfunction, lumbar and/or ischiadic pain. For a schedule of which signs to look for in different spinal diseases follow this link. Examples of further tests include for the lumbar region are
- Homayouni K, Halimeh Jafari S, Yari Hossein. Sensitivity and Specificity of Modified Bragard Test in Patients with Lumbosacral Radiculopathy Using Elecrodiagnosis as a Reference Standard. J Chiropr Med. 2018; 17:36-43.
- Petersen T, Laslett M, Juhl C. Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews. BMC Musculoskelet Disord. 2017; 18: 188.