The Slump Test evaluates neural tissue mechanosensitivity in individuals with lower extremity symptoms. However, there has been little research assessing the role of altering lumbar spine positioning on sensory response. Therefore, this study compared differences in subjective and objective findings observed in different lumbar spine positions during neurodynamic testing.
Methods
Healthy participants were assessed using the 90/90 knee extension (KEA) to determine available ROM, followed by lumbar spine flexed slump (FS), and lumbar spine extended slump (ES). Outcomes included knee extension angle, hamstring EMG activity (%MVIC), distal extent of sensory response, and qualitative mechanosensory response.
Results
Forty participants (23.95 ± 2.64 years; 14 male/26 female) completed the study. Significantly less knee extension ROM was found for ES vs. FS (p < .001) and ES vs. KEA (p = .037). A greater proportion of distal symptoms were observed during ES vs. FS (p < .05). FS and ES showed higher EMG values than KEA (p < .001), with no difference between the two slump conditions.
Conclusion
In this healthy population, ES produced the greatest distal sensory responses, highest EMG activity, and lowest knee extension ROM. Incorporating lumbar extension during slump testing may be useful to determine mechanosensitive behavior, but further research is needed in clinical populations.
The trial was prospectively registered at clinical trials.gov. NCT05313217
SmartKMBlakeCStainesA, et al.The discriminative validity of “nociceptive,” “peripheral neuropathic,” and “central sensitization” as mechanisms-based classifications of musculoskeletal pain. Clin J Pain2011; 27: 655–663.
2.
SelimAJRenXSFinckeG, et al.The importance of radiating leg pain in assessing health outcomes among patients with low back pain: results from the Veterans Health Study. Spine1998; 23: 470–474.
3.
McHughMPJohnsonCDMorrisonRH. The role of neural tension in hamstring flexibility. Scand J Med Sci Sports2012; 22: 164–169.
4.
PhilipKLewPMatyasTA. The inter-therapist reliability of the slump test. J Physiother1989; 35: 89–94.
5.
JohnsonEKChiarelloCM. The slump test: the effects of head and lower extremity position on knee extension. J Orthop Sports Phys Ther1997; 26: 310–317.
6.
MaitlandGD. Movement of pain sensitive structures. S Afr J Physiother1980; 36: 4.
7.
McDevittAWO’HalloranBCookCE. Cracking the code: unveiling the specific and shared mechanisms behind musculoskeletal interventions. Arch Physiother2023; 13: 14.
8.
CookCERhonDIBialoskyJ, et al.Developing manual therapy frameworks for dedicated pain mechanisms. JOSPT Open2023; 1: 1–31.
9.
MajlesiJTogayHÜnalanH, et al.The sensitivity and specificity of the slump and the straight leg raising tests in patients with lumbar disc herniation. J Clin Rheumatol2008; 14: 87–91.
10.
WalshJFlatleyMJohnstonN, et al.Slump test: sensory responses in asymptomatic subjects. J Man Manip Ther2007; 15: 231–238.
11.
SmartKMBlakeCStainesA, et al.Mechanisms-based classifications of musculoskeletal pain: part 2 of 3: symptoms and signs of peripheral neuropathic pain in patients with low back (+/- leg) pain. Man Ther2012; 17: 345–351.
12.
HarrisonDECaillietRHarrisonDD, et al.A review of biomechanics of the central nervous system—Part II: spinal cord strains from postural loads. J Manipulative Physiol Ther1999; 22: 322–332.
13.
ButlerDGiffordL. The concept of adverse mechanical tension in the nervous system part 1: testing for “dural tension”. Physiotherapy1989; 75: 622–629.
14.
InufusaAAnHSLimT-H, et al.Anatomic changes of the spinal canal and intervertebral foramen associated with flexion-extension movement. Spine1996; 21: 2412–2420.
15.
SchmidMRStuckiGDuewellS, et al.Changes in cross-sectional measurements of the spinal canal and intervertebral foramina as a function of body position: in vivo studies on an open-configuration MR system. AJR Am J Roentgenol1999; 172: 1095–1102.
16.
HallTZusmanMElveyR. Adverse mechanical tension in the nervous system? Analysis of straight leg raise. Man Ther1998; 3: 140–146.
17.
FidelCMartinEDankaertsW, et al.Cervical spine sensitizing maneuvers during the slump test. J Man Manip Ther1996; 4: 16–21.
18.
BoydBSWanekLGrayAT, et al.Mechanosensitivity of the lower extremity nervous system during straight-leg raise neurodynamic testing in healthy individuals. J Orthop Sports Phys Ther2009; 39: 780–790.
19.
DavisDSQuinnROWhitemanCT, et al.Concurrent validity of four clinical tests used to measure hamstring flexibility. J Strength Cond Res2008; 22: 583–588.
20.
WalshJHallT. Agreement and correlation between the straight leg raise and slump tests in subjects with leg pain. J Manipulative Physiol Ther2009; 32: 184–192.
21.
NeeRJYangC-HLiangC-C, et al.Impact of order of movement on nerve strain and longitudinal excursion: a biomechanical study with implications for neurodynamic test sequencing. Man Ther2010; 15: 376–381.
22.
StegemanDHermensH. Standards for surface electromyography: the European project surface EMG for non-invasive assessment of muscles (SENIAM). Enschede: Roessingh Research and Development, 2007, pp.108–112.
23.
TuckerNReidDMcNairP. Reliability and measurement error of active knee extension range of motion in a modified slump test position: a pilot study. J Man Manip Ther2007; 15: E85–E91.
24.
MourcouQFleuryADiotB, et al.Mobile phone-based joint angle measurement for functional assessment and rehabilitation of proprioception. BioMed Res Int2015; 2015: 328142.
25.
MehtaSPBremerHCyrusH, et al.Smartphone goniometer has excellent reliability between novice and experienced physical therapists in assessing knee range of motion. J Bodyw Mov Ther2021; 25: 67–74.
26.
MilaneseSGordonSBuettnerP, et al.Reliability and concurrent validity of knee angle measurement: smart phone app versus universal goniometer used by experienced and novice clinicians. Man Ther2014; 19: 569–574.
27.
YaoMXuB-pLiZ-j, et al.A comparison between the low back pain scales for patients with lumbar disc herniation: validity, reliability, and responsiveness. Health Qual Life Outcomes2020; 18: 175.
28.
YoudasJWKrauseDAHollmanJH, et al.The influence of gender and age on hamstring muscle length in healthy adults. J Orthop Sports Phys Ther2005; 35: 246–252.
29.
ReurinkGGoudswaardGJOomenHG, et al.Reliability of the active and passive knee extension test in acute hamstring injuries. Am J Sports Med2013; 41: 1757–1761.
30.
CohenJ. Statistical power analysis for the behavioral sciences. New York: Routledge, 2013.
31.
LakensD. Calculating and reporting effect sizes to facilitate cumulative science: a practical primer for t-tests and ANOVAs. Front Psychol2013; 4: 863.
32.
MehtaSPBarkerKBowmanB, et al.Reliability, concurrent validity, and minimal detectable change for iPhone goniometer app in assessing knee range of motion. J Knee Surg2017; 30: 577–584.
33.
EllisRFHingWAMcNairPJ. Comparison of longitudinal sciatic nerve movement with different mobilization exercises: an in vivo study utilizing ultrasound imaging. J Orthop Sports Phys Ther2012; 42: 667–675.
34.
RileySPSwansonBTClelandJA. The why, where, and how clinical reasoning model for the evaluation and treatment of patients with low back pain. Braz J Phys Ther2021; 25: 407–414.
35.
HallTCachoAMcNeeC, et al.Effects of the mulligan traction straight leg raise technique on range of movement. J Man Manip Ther2001; 9: 128–133.
36.
HallTHardtSSchäferA, et al.Mulligan bent leg raise technique—a preliminary randomized trial of immediate effects after a single intervention. Man Ther2006; 11: 130–135.
