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The Slump Test

For many years, the concept of "neural tension" seemed perplexing to alot of Therapists. There was a definite reluctance on the part of Clinicians to attribute any signs and symptoms to this concept, as there was no proof that the nervous system itself could, in fact, be a causative factor in pain. The idea that nerves were the transporters of pain impulses, as well as being creators of pain impulses, seemed too bizarre to even contemplate.

Then came along some fresh ideas. Clinicians began looking at the spinal canal as a possible source of symptoms, which then led to the term "canal signs", which were signs of abnormal mobility of the pain sensitive structures within the vertebral canal and intervertebral foramina. These pain sensitive structures included the dura, the nerve root sleeves, the ventral nerve roots and the blood vessels of the epidural space. Pain sensitivity was not restricted to just the structures within the canal, but also consisted of the structures that made up the canal itself i.e. the posterior longitudinal ligament, the posterior portion of the annulus fibrosus and the anterior portion of the lamina.

The so-called "canal signs" could be identified utilising the variety of tests available. The traditional "basic" tests included the straight leg raise (SLR) test, the passive neck flexion (PNF) test and the prone knee bend (PKB) test. A test nicknamed the "SLR of the arm", the so-called Upper Limb Tension Test, was also devised to evaluate the neural mobility of the upper limb. What was missing was a test that tied all the "basic" tests together, to allow for differentiation. Then came along the "Slump Test".

In essence, this test comprised the following components, performed in sitting:

Thoracic and cervical flexion;

Knee extension (pseudo-SLR);

Foot dorsiflexion; and

Release of cervical flexion (to determine symptom response).

As can be seen by the photograph, the Slump Test may be quite uncomfortable and provocative, so care must be taken with the test, taking into account all of the contraindications to such a test, as well as clues from the subjective and objective examination. For most Clinicians unfamiliar with the test, this should not be undertaken unless they have been properly taught, supervised and their technique scrutinized, so as to provide them with the knowledge and handling skills necessary to perform this test/technique without adversely affecting the patient.

The ultimate aim of the Slump Test was to reproduce the subject's symptoms and then be able to alter the symptoms by releasing a component distant from the site of pain.

For example, a client presents with pain in the posterior thigh. Given that all the subjective and objective findings indicate that a Slump Test should be performed, and that there are no contraindications to neural mobility testing, a Slump Test is performed. The subject is placed in Slump Test position, the posterior thigh pain is reproduced. While maintaining all components with overpressure, the cervical flexion component is released. Should the symptoms change, the test would be deemed POSITIVE for "neural tension", as the symptoms were reproduced and then altered with movement of a distant component. On the other hand, should the pain be reproduced but the release of the cervical flexion bring about no change, the test would be deemed NEGATIVE for "neural tension", as alteration of the distant component brought about no difference in symptoms.

So, what are the implications of a POSITIVE test?

Going back to this example, I will pose the question - What structures are at fault?

Logically, one would conclude that local structures were not at fault, as it would be hard to understand how a local posterior thigh structure could be affected by release of cervical flexion. The only continuous structure from the neck to the toes is the nervous system (other than skin) which, hence, could be blamed as being the cause of symptoms.

This logic was carried through by many research projects, with particular reference to hamstring strain. For those interested in the concept of Adverse Mechanical Neuromeningeal Tension (AMNT), I have complete list of references, relevant to AMNT, linked to this page.

The key to the success of the Slump Test was the ability to differentiate between local causes of the symptoms and distant causes. With hamstrings studies, the primary objective was to determine whether the hamstrings were at fault, or whether the nervous system was at fault. The conclusions drawn from all of these research papers indicate that a great number (~64%) of our so-called "hamstring strains" were, in fact, referred pain syndromes from the nervous system. This was further supported by research into the treatment of hamstring strain, which found that, if Slump stretching was added to the treatment of Grade 1 hamstring strains, the patient would return, on average, 2 weeks earlier to their sport, when compared to patients who did not have Slump stretching.

The Moral to the Story?

With musculoskeletal disorders, the human body has a habit of making life miserable for us, as Clinicians, treating these conditions. What we need is a "tool box" filled with different tools, able to differentiate between a multitude of conditions. The Slump Test gives us an avenue by which to apply our clinical reasoning skills, to be able to differentiate between symptoms of local origin and those of symptoms arising from the nervous system. We all have to take our "blinkers" off and use a little lateral thinking to be able to see the big picture - our patients will be happier paying their money!

The concepts presented here are entirely the author's own (unless expressly stated) and do not represent the thoughts or ideas of any other person.

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Charlie Kornberg. All rights reserved. No part of this web page, or related accompanying pages, may be reproduced without the prior permission of the Author.