Sometimes the slump test will elicit more pain upon cervical extension versus flexion. This concerns how the affected lumbar nerve root exits the foramen. This video with Dr. Stuart McGill explains how this occurs.
Slump Test description from Chat GPT
The slump test in orthopedics is a diagnostic maneuver used to assess nerve root irritation or compression in the lumbar spine. It is primarily employed to evaluate conditions such as sciatica, disc herniation, or other nerve-related issues in the lower back and legs. The test involves the passive movement of the spine, combined with various neural tension maneuvers, to provoke or reproduce the patient’s symptoms.
Here’s a step-by-step description of the slump test in orthopedics:
- Patient positioning: The patient is initially seated on the edge of a table or chair with their legs hanging freely. The back and neck should be in a relaxed position.
- Starting position: The patient is instructed to slouch forward, rounding their lower back and allowing the shoulders and head to relax forward.
- Passive movement: The clinician or examiner provides support to the patient’s shoulders and instructs them to maintain the slouched position. The examiner then applies a controlled and gradual downward pressure on the patient’s shoulders.
- Leg extension: While maintaining the slouched position, the patient is asked to extend one leg at a time. The examiner can assist by gently lifting the patient’s extended leg at the ankle.
- Neural tension maneuvers: As the leg is extended, the examiner may apply additional maneuvers to increase the tension on the neural structures. These maneuvers commonly involve dorsiflexion of the foot (bending the foot upward) or neck flexion (bringing the chin towards the chest).
- Observation and assessment: During leg extension and neural tension maneuvers, the examiner carefully observes the patient for any symptoms, such as pain, tingling, or electric shock-like sensations. The test is considered positive if the patient experiences a reproduction or exacerbation of their typical symptoms.
The slump test aims to stretch and tension the sciatic nerve and its nerve roots as they pass through the lumbar spine. A positive test result, with the reproduction of symptoms, suggests nerve root irritation or compression, potentially caused by conditions like disc herniation, spinal stenosis, or foraminal encroachment.
It’s important to note that the slump test is just one component of a comprehensive orthopedic examination. It should be performed and interpreted by a trained healthcare professional, such as a physician or physical therapist, in conjunction with other clinical findings and diagnostic tests to establish an accurate diagnosis and develop an appropriate treatment plan for the patient.