The slump test: the effects of head and lower extremity position on knee extension.

Maitland's slump test is a widely used neural tissue tension test. During slump testing, terminal knee extension is assessed for signs of restricted range of motion (ROM), which may indicate impaired neural tissue mobility. A number of refinements that modify hip and ankle position has been added to the basic slump test procedure, but no research to date has measured the effects of ankle and hip position on knee extension ROM during testing. The purpose of this study was to examine the effect of neural tension-producing movements of the cervical spine and lower extremity on knee extension ROM during the slump test. Thirty-four males with no significant history of low back pain were tested in the slump position with the cervical spine flexed and extended in each of three lower extremity test positions: neutral hip rotation with the ankle in a position of subject comfort (neutral), neutral hip rotation with ankle dorsiflexion (ankle dorsiflexion), and medial hip rotation with ankle dorsiflexion. Results showed significant decreases in active knee extension ROM (F1,198 = 29.53, p < 0.0001) in the cervical flexion compared with the cervical extension conditions. Subjects also exhibited significant decreases in active knee extension ROM (F2,198 = 56.76, p < 0.0001) as they were progressed from neutral to the ankle dorsiflexion to the medial hip rotation with ankle dorsiflexion positions of the lower extremity. The results of our study indicate that limitations in terminal knee extension ROM may be considered a normal response to the inclusion of cervical flexion, ankle dorsiflexion, or medial hip rotation in the slump test in young, healthy, adult males. In addition, the presence of a cumulative effect on knee extension ROM with the simultaneous application of these motions is noted. These findings may assist clinicians when assessing knee extension ROM during slump testing.

[1]  L. M. Urban The straight-leg-raising test: a review*. , 1981, The Journal of orthopaedic and sports physical therapy.

[2]  D. Butler,et al.  The Concept of Adverse Mechanical Tension in the Nervous System Part 1: Testing for “Dural tension” , 1989 .

[3]  J. Saunders,et al.  The Clinico-Anatomical Aspects of the Lumbosacral Heqion1 , 1942 .

[4]  Thomas A. Matyas,et al.  The inter-therapist reliability of the slump test. , 1989, The Australian journal of physiotherapy.

[5]  J. Troup Straight-leg-raising (SLR) and the qualifying tests for increased root tension: their predictive value after back and sciatic pain. , 1981, Spine.

[6]  G. Maitland Negative disc exploration: positive canal signs. , 1979, The Australian journal of physiotherapy.

[7]  B. Woodhall,et al.  The Well-leg-raising Test Of Fajersztajn In The Diagnosis Of Ruptured Lumbar Intervertebral Disc , 1950 .

[8]  The effect of neural stretching technique on sympathetic outflow to the lower limbs. , 1992, The Journal of orthopaedic and sports physical therapy.

[9]  A. Breig,et al.  Biomechanics of the Cervical Spinal Cord , 1966, Acta radiologica: diagnosis.

[10]  J. Wilmink,et al.  Biomechanics of Lumbosacral Dural Sac: A Study of Flexion-Extension Myelography , 1981, Spine.

[11]  D. Butler Mobilisation of the Nervous System , 1991 .

[12]  R. Louis Vertebroradicular and vertebromedullar dynamics , 1981 .

[13]  J. Reid,et al.  Movements induced by straight leg raising in the lumbo-sacral roots, nerves and plexus, and in the intrapelvic section of the sciatic nerve , 1965, Journal of neurology, neurosurgery, and psychiatry.

[14]  J. Troup,et al.  Biomechanical Considerations in the Straight‐Leg-Raising Test Cadaveric and Clinical Studies of the Effects of Medial Hip Rotation , 1979, Spine.

[15]  C. Kornberg,et al.  The effect of stretching neural structures on grade one hamstring injuries. , 1989, The Journal of orthopaedic and sports physical therapy.

[16]  J. Reid EFFECTS OF FLEXION-EXTENSION MOVEMENTS OF THE HEAD AND SPINE UPON THE SPINAL CORD AND NERVE ROOTS , 1960, Journal of neurology, neurosurgery, and psychiatry.

[17]  G. Maitland The slump test: examination and treatment. , 1985, The Australian journal of physiotherapy.

[18]  Richard W. Bohannon,et al.  Effects of ankle dorsiflexion on active and passive unilateral straight leg raising. , 1985, Physical therapy.

[19]  J. Reid ASCENDING NERVE ROOTS , 1960, Journal of neurology, neurosurgery, and psychiatry.

[20]  D. Butler Adverse mechanical tension in the nervous system: a model for assessment and treatment. , 1989, The Australian journal of physiotherapy.

[21]  C. G. Smith Changes in length and position of the segments of the spinal cord with changes in posture in the monkey. , 1956, Radiology.

[22]  I. Macnab Negative disc exploration. An analysis of the causes of nerve-root involvement in sixty-eight patients. , 1971, The Journal of bone and joint surgery. American volume.

[23]  Manohar M. Panjabi,et al.  Clinical Biomechanics of the Spine , 1978 .

[24]  C. Morrow,et al.  The Effect of Neck and Leg Flexion and Their Sequence on the Lumbar Spinal Cord: Implications in Low Back Pain and Sciatica , 1994, Spine.

[25]  J. Troup Biomechanics of the lumbar spinal canal. , 1986, Clinical biomechanics.

[26]  Fahrni Wh Observations on straight leg-raising with special reference to nerve root adhesions. , 1966 .