Q&A Time: Slump Test Interpretations

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Just in time for my upcoming The Eclectic Approach to Clinical Neurodynamics Course on MedBridge, here is some Q&A from a reader on interpretations of the Slump Test.

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Now onto the Q&A! The Question

This is a common question when it comes to neurodynamics, and one that those of us who use these sensitizing movements in clinic have wondered at some point. The question reads:

The patient feels ¨neural tension¨type of pain in the hamstring region, non traumatic, at times non WB, but posture related.

When testing the slump, the complaint is felt only when thoracic spine is extended and then the leg is extended as opposed to the typical flexed thoracic spine, flexed cervical and extended leg. It seem in this case that the thoraco-lumbar movement is the sensitizing agent...

How do I interpret this result other then a shorter hamstring or some kind of local adherence? How would you address this or what else would you test?

Thank you for your advice.

The Answer

WAAAAY back when I took a combo The Sensitive Nervous System/Mobilization of the Nervous system in 2002, Butler had some biomechanical explanations for why maneuvers that are supposed to be sliders, end up producing perceived sensations as if they were tensioners. 

• the flexion part of the slump test actually moves a nerve root away from a spur, which could be mechanically sensitizing it
• the extension part of the slump test moves a nerve root toward a spur

This may be ok with pure peripheralists, but 12 years down the road, this explanation no longer satisfies me. Here is the way I look at the above finding

• sitting upright sensitizes the neurodynamic test, and reproduces the patient's complaint - yes the finding is the most transparent interpretation
• mechanically: possibly a loss of ability to load the thoracic and lumbar spine with a concurrent lack of spinal cord sliding caudally
• neurologically: the CNS finds sitting upright or loading the spine a bit more threatening and the resultant output is hamstring symptoms
• realistically, we cannot predict whether or not someone will perceive Sx that are their complaints they came in with, completely different Sx, or none at all with a particular neurodynamic test

What else would I test? Thoracic rotation, rib expansion, breathing patterns, lumbar extension in standing and sidegliding in standing, and hip mobility in passive and active SLR, comparing bilaterally. Any or all of these may be dysfunctional, and adding some change into the mix may be enough to reduce the threat in sitting.

A good ole fashioned lumbar roll (the support, not the technique), along with avoidance of prolonged sitting for > 20 minutes or so usually helps as well. Sitting breaks do not have to be longer than 30 seconds to do some lumbar extensions, side glides in standing, and/or walking around to get a glass of water.

Hopefully this clears it up and does not make it more convoluted. Try not to think of rules or mechanics, but be happy that you have something to pre-test, intervene/educate, then post-test. 

Keeping it Eclectic...