Care Plan          

Sitting

Strength of ankle & great toe dorsiflexion	Decrease in ankle and great toe dorsiflexion strength may document the presence of neurological deficits (L5).
Knee reflexes	The patellar reflex, or knee jerk, is a deep tendon reflex, mediated through nerves emanating from the L2, 3 and 4 neurologic levels, but predominantly from L4. Insert Figure 56 here
Ankle reflexes	The ankle reflex is an S1 reflex mediated through the gastrocnemius-soleus muscles. Insert Figure 86 here
Brief sensory examination	Testing light touch or pressure in the medial (L4), dorsal (L5) and lateral (S1) aspects of the foot is usually sufficient for sensory screening, if neurologic deficit is suspected. NOTE: In order to see the full size phothograph click on thumbnails below.
Straight leg raise (SLR)	A variation of SLR, sitting knee extension, can be done with the patient sitting on the side of the exam table. The patient with significant nerve root irritation will tend to complain or lean backward to reduce tension on the nerve.
Comment: If the physician prefers, ankle strength and great toe dorsiflexion and knee and ankle reflexes may also be done with the patient in the supine position.