This is Brent of the Brookbush Institute and in this video we're going to go over this
slump test. I'm going to have my friend Yvette come out, she's going to help me
demonstrate this test. Now this is one of our neurodynamic tests, chances are I'm
going to use this test if I think the sciatic nerve is involved, or perhaps I
have a lumbar pathology patient and they're starting to complain of things
like pain into their buttock, or pain down the back of their leg. Now the slump
test is what it says it is, it is a test in a slumped position. You just
have to remember how you're going to step this out, what the progression of
the test is, and I think you guys will get that as we go. The first thing I'm
going to ask Yvette to do is put her hands behind her back. Now if I'm a good
clinician here or a clever clinician I should say, I'm going have Yvette
monitor her sacrum, her tailbone and go okay make sure you keep that
straight up and down, can you do that for me.
You can also use your hand to monitor their sacrum,
but as they slump which is the next step of this, I want them to flex their
thoracic and lumbar spine and not let their sacrum either tilt forward or
tilt back, because that's an anterior or posterior pelvic tilt that will change
neurodynamic tension by adding hip flexion or hip extension. So we
keep a nice flat sacrum and then we get all of our flexion in through here. Now
once we get to this point I can of course ask, does this bring on any of
your symptoms? (No). If that did bring in on any of her symptoms it could be positive,
this isn't a real comfortable position for somebody with lumbar spine pain
but if they did have some of those neurogenic symptoms like: numbness,
tingling, shooting pain, paresthesia pins and needles right, we might consider this
a positive test. Now the next step I would probably do is add overpressure
to make sure she's really into that slumped position, but I want
her to start without her neck in flexion, So this is something we're going to
use as a sensitizing thing. As we progress this test from here I'm going to
go ahead and ask her to extend her leg, and ask her hey did that bring on
any symptoms? (No). Okay let me see the other leg.
All right and Butler actually recommends doing
both legs at the same time, both the affected and unaffected sides so that
you can easily see if there's asymmetry. Now of course so far we're fine, this is
a very negative test, Yvette is very normal so far, she's not getting any
neurogenic symptoms and we're symmetrical even with the slump. The next
thing I could do is go okay let's try this with neck flexion. All right so I'm
just going to brace her because her tendency is going to be to, as her legs
come up, to let her head back up which isn't going to help our test. Now
let's go ahead and try to straighten your affected side, all right
rather than both legs at once let me see just to this side. Okay so lets just
double check, back down. Okay let's see both sides, alright and she's still very
normal no symptoms. Okay make sure you keep communicating on this test
right because you can't see their face. The next thing we could start doing is
we could start doing all of those little sensitizations at the ankle. If you
watched the straight leg raise test I go over in detail that
if we go into dorsiflexion that further sensitizes the tibial
nerve. If we go onto dorsiflexion and eversion i get even more sensitization.
If I go into dorsiflexion and inversion I can add a little sural nerve. If I go
into plantarflexion and inversion I can test some peroneal nerve stuff.
Now as we can see, go ahead and sit up for me, I know that's not very
comfortable. As you can see here so far that is super super negative on this
test, we were getting no symptoms at all. Now we should bring up that this isn't a
comfortable test, all right how comfortable is that? Not real comfortable,
you have somebody leaning on you in this really horrible flexed position and you're
trying to extend your legs. It's very normal for people to have
discomfort at T8-T9 and feel some tension there on this test, it's very
common to have discomfort in the back of the knees as they're extending their leg.
It's very common to have bilateral restriction, all right some people are
just not as flexible as others. Always keep in mind with this test we're
looking for concordant signs, we're looking for signs that replicate the
patient's symptoms. We're looking for bringing on low back pain so she's
extending her legs and it's making her low back hurt, or we're looking for some
of those neurogenic symptoms, so the the rush of pain down the leg,
the sharp burning pain that comes with sciatica or the tingling
or numbness, all those things are like oh that's definitely a positive
sign. We could probably even think towards the, we talked about the 'well
straight leg raise test', if she had pain when she did the opposite side in the
other side of her back, so if she had right-sided low back pain, lifted her
left left leg and that caused right side low back pain we're probably talking
about like HMP stuff. You can even think about how that would work
out, like it would take a pretty significant herniated disc to make it so
that moving nerves on this side would make her right side hurt, so take all of
that stuff into consideration. So let me go through this test one more time, and
I'm going to take it back to the the simple part here, you want to make
sure that the sacrum is straight up and down and the reason for that is so that we
don't get any pelvic tilting which would then add hip flexion or hip extension
and change our neural tension. We want to be nice and reliable and do this the
same way every time. Now one little trick you can use is you're going to have the
patient put their hands behind their back, they can monitor straight up and
down and of course you can use your hand initially, let me just slide my hand
right underneath your hands, right on their sacrum to make sure it stays up
and down. The next thing you're going to have them do is, I
want you to like slouch almost I have you doing a crunch. Okay so you know
for those of you who have patients who work out a lot, most people get that
crunch cue pretty good. They'll do a better thoracic and lumbar flexion than
if you just tell them to slouch, where people want to like lean back and sit on
their tailbone. Remember we want to keep the sacrum straight. So she's got a nice
crunch for me. Now the initial test I'm just going to ask
does she have symptoms just doing this. We mentioned at this point we're not
just talking about pain we're talking about did it bring on some neurogenic
stuff, she said no and then we could have her lift her affected side, how does that
feel? (Fine), Okay good let's make this a little
rougher. Over pressure, but remember we're not going to add the neck yet. So we got
lumbar and thoracic flexion, then over pressure, then cervical flexion and we're
going to keep testing knee extension over and over as we do this to see if we can
keep sensitizing the test and bring on some of these neurogenic symptoms. Of
course throughout we can be comparing legs, or if as Butler suggested we could
have them just do both legs at once so that we can see any asymmetry.
The last thing I would do, and you can go ahead and sit up, is of course all the
movements of the ankle we talked about. The the tibial nerve is going to be
dorsiflexion and eversion, the sural nerve is dorsiflexion and inversion and
then the peroneal nerve is plantar flexion and inversion, you got all
that. I know that's a lot to remember, the basic slump test just like I suggested
on the straight leg raise test, start with the basics keep those in mind. It's
pretty rare that you're going to have somebody who you even need to
differentiate those lower extremity nerves right, which is the only reason we
would do that is to help us understand what what level of nerve root issue we
have; or if we wanted to get really fancy with our intervention and do specific
release or neurodynamic techniques based on the nerve track that we're
we're working on, great then you can bring those in, but just being reliable
on the basics and does this patient have neurogenic symptoms involved in their
pathology is what this test was originally designed for and we want to
make sure we're reliable there, and can differentiate a positive and negative
first. Much like the straight leg raise test I feel bad for some of my
students out there, I know this is one of those ones where until you get a patient
who's a positive it's very hard to understand what you're looking for. If
you get a chance to do your clinical affiliations, this is one of
those cases that you want to bring up with your clinical instructor, like hey I
would really love to see somebody who had sciatic nerve involvement who had
neural symptom, neural inflammation involvement in their lumbar
pathology because although I've practised it on my friends and
colleagues at school I'd really like to see and feel what a positive actually
feels like, and once you feel one you will be good to go. If you have any
questions leave them in the comments box below, I'll be happy to answer that for
you.