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The Slump Test is a neural tension test used to detect altered neurodynamics or neural tissue sensitivity.
The slump test is described differently among sources. The common factor among sources is the reproduction of pain as tension is applied to the dura during the test. The technique depicted below is adapted from Mark Dutton.
To begin the test, have the patient seated with hands behind back to achieve a neutral spine. The first step is to have the patient slump forward at the thoracic and lumbar spine. If this position does not cause pain, have the patient flex the neck by placing the chin on the chest and then extending one knee as much as possible.
If extending the knee causes pain, have the patient extend the neck into neutral. If the patient is still unable to extend the knee due to pain, the test is considered positive.
If extending the knee does not cause pain, ask the patient to actively dorsiflex the ankle. If dorsiflexion causes pain, have the patient slightly flex the knee while still dorsiflexing. If the pain is reproduced, the test is considered positive.
Repeat test on opposite side.
Overpressure can be applied during any of the test positions.
Some caution is needed here as the diagnostic accuracy of the slump test is under debate! During the slump test, (Maitland 1985) the neural structures within the vertebral canal and foramen are slowly and progressively put on maximum stretch. A recent Cochrane review (on physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain), also looked at the available data on the Slump test (van der Windt 2010). They listed two studies (Majlesi 2008; Stankovic 1999) that reported results on the slump test. Stankovic (1999) present the results of the slump test at different cut-off values (angles at which pain occurred), showing that sensitivity of the slump test was poor (0.44, 95% CI:0.34 to 0.55), and specificity only slightly better (0.58, 95% CI:0.28 to 0.85) when using a strict cut-off (pain radiating below the knee). Sensitivity increased (but specificity decreased) when using a milder cut-off (pain anywhere). Majlesi (2008) reported similar sensitivity (0.84), but higher specificity (0.83), using an unknown cut-off for a positive test result. So it was not clear when a test was scored as “positive”. Also, the higher specificity might partly be the result of the case control design of this study: patients with back pain were selected as controls if MRI findings were completely normal. In conclusion: the Straight Leg Raise (SLR) most likely is a test with high sensitivity (able to help rule OUT the condition) but low specificity (a positive SLR is not only indicative of a herniated disc). The Crossed SLR (X-SLR) most likely is a test with high specificity (able to help rule IN the condition) but low specificity (a negative X-SLR does not rule out the possibility of a herniated disc). Other tests for a lumbar radiculopathy have an unknown or questionable diagnostic accuracy
Maitland GD. The slump test:examination and treatment. Austr J Physiother 1985;31:215.
Majlesi J, Togay H, Unalan H, Toprak S. The sensitivity and specificity of the Slump and the Straight Leg Raising tests in patients with lumbar disc herniation. J Clin Rheumatol 2008;14:87–91.
Stankovic R, Johnell O, Maly P, Willner S. Use of lumbar extension, slump test, physical and neurological examination in the evaluation of patients with suspected herniated nucleus pulposus. A prospective clinical study. Man Ther 1999;4:25–32.
van der Windt DA, Simons E, Riphagen II, Ammendolia C, Verhagen AP, Laslett M, Devillé W, Deyo RA, Bouter LM, de Vet HC, Aertgeerts B. Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain. Cochrane Database Syst Rev. 2010 Feb 17;(2):CD007431.
Recent Related Research (from Pubmed)
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- ↑ Flynn TW, Cleland JA, Whitman JM. Users' Guide to the Musculoskeletal Examination: Fundamentals for the Evidence-Based Clinician. Buckner: Evidence in Motion; 2008.
- ↑ Dutton M. Orthopaedic Examination, Evaluation and Intervention. 2nd ed. New York: McGraw-Hill Companies, Inc.; 2008.
- ↑ Kim Bevillard. Slump Test as described by Dutton . Available from: http://www.youtube.com/watch?v=8Qknf8yyMFQ [last accessed 14/12/13]
- ↑ Physical Therapy Nation. Thoracic Sympathetic Slump Test. Available from: http://www.youtube.com/watch?v=KlpSbcSS3es [last accessed 14/12/13]
Learn about the knee in this month's members learn topic with book chapters including D. Magee 2014: Orthopedic Physical Assessment