How would you perform the test to indicate a present Bragard Sign?

• A. Immediatly after a + SLR, lower leg until pain diminishes and dorsiflex the foot
• B. Lower the leg fully without any movement
• C. Flex the knee and relax the leg completely
• D. Dorsiflex the toes with the patient standing

Answer: (A)

The Bragard Sign is a test used to assess for nerve root irritation or herniated disc involving the lower back, particularly at the level of the L5 or S1 nerve roots. The test is generally performed after a Straight Leg Raise (SLR) has been done and is positive, indicating possible sciatic nerve involvement.

To perform the Bragard Sign correctly, the clinician lowers the leg to the point where the pain diminishes and then dorsiflexes the foot. This action serves to stretch the sciatic nerve, which may reproduce or exacerbate the pain, thereby confirming the presence of underlying nerve root irritation. This response acts as a second confirmation of the initial finding from the SLR test.

The other options do not accurately replicate the necessary steps to elicit the Bragard Sign. Lowering the leg without movement does not assess nerve tension, flexing the knee and relaxing the leg does not stress the nerve roots appropriately, and dorsiflexing the toes while the patient is standing does not align with the methodology of the test. The correct performance of the Bragard Sign is crucial for accurately diagnosing conditions of the lumbar spine and nerve root involvement.