Bowstring Test

Published July 2, 2026 Read time 2 min read Readers 1

What is the "Bowstring Test" used for?

The examiner performs a Straight Leg Raise (SLR) on the affected side until the patient reports pain or radicular symptoms radiating down the leg (Fig. 9.51).
Without changing the position of the thigh, the examiner slightly flexes the knee—about 20 degrees—which usually reduces the symptoms.
The examiner then applies firm pressure with the thumb or fingers over the popliteal fossa (where the sciatic nerve runs).
Reproduction of the patient’s pain or paresthesia constitutes a positive Bowstring Test.

The patient sits on the edge of the examination table with knees flexed. The examiner passively extends the patient's knee, producing pain through sciatic nerve tension.
The examiner slightly flexes the knee until the pain and radicular symptoms disappear. The examiner maintains this position by clasping the patient's leg between their own knees, stabilizing the limb.
With the leg stabilized, the examiner presses the fingers of both hands deeply into the popliteal space. Pain resulting from this maneuver indicates a positive test.

Reproduction of the patient’s pain or paresthesia constitutes a positive Bowstring Test.

This finding suggests:

Nerve root compression (commonly from disc herniation at L4-L5 or L5-S1 levels) .
Sciatic nerve irritation or inflammation .
True radiculopathy rather than muscular or non-neurogenic pain.