Open Access
Subscription Access
Open Access
Subscription Access
A Study to Validate Diagnostic Strength of Modified Slump Test in Lumbar Radiculopathy
Subscribe/Renew Journal
Introduction: Neural tissue provocation tests (NTPT) have been increasingly incorporated into clinical practice. Unfortunately, the early terminology used in describing these tests-'neural tension test' and 'adverse mechanical tension'- did little to further the acceptance, understanding or credibility of the physical treatment of neurogenic pain. A more appropriate term is 'neural tissue provocation tests' as they are passive test applied in a manner to selectively stress different neural tissues in order to assess their sensitivity to mechanical provocation. Many experts in the field of neurodynamics have clearly stated the importance of the reproduction of a patient's symptoms, which implies the presence of pathology. The other feature which is vital to the interpretation of any neuromusculoskeletal clinical measure is the comparison between sides. It is essential to compare sides for there is tremendous variation in flexibility of the peripheral nervous system in both the lower and upper quarter.
Objectives: While there has been considerable research on neurodynamics, there has been little research investigating the diagnostic validity of such tests. The purpose of this study was to find out the rate of true positive (sensitivity) Slump Test (modified) in patients with lumbar spine mediated neural symptoms. This research also attempted to find bilateral variability, that is, difference in the angles of knee extension within the range at which the responses were provoked, between the asymptomatic and symptomatic side of the patient.
Methods: Experimental same subject study design with 30 randomly selected patients in the age group of 20-60 years. Sample population was drawn from physiotherapy out-patient department of Gian Sagar Medical College and Hospital and New Hope Physiotherapy Centre, based on inclusion and exclusion criteria. Subjects with lumbar pain and associated neural signs and symptoms (unilateral) went through modified Slump Test (ST1). The test was performed bilaterally, first on asymptomatic and then on the symptomatic side of the patient.
Results: Out of 30 patients, 28 were tested positive with ST1. True positive rate (sensitivity) was calculated using simple percentage. To find difference in the angles of knee extension between asymptomatic and symptomatic side, paired t-test was used.
Conclusion: It was concluded that Neural tissue provocation test (ST1) is highly sensitive in diagnosing the patients with lumbar spine mediated neural signs and symptoms. Significant difference in the angles of knee extension existed between the asymptomatic and symptomatic sides.
Keywords
- Beith, I, Robins, E & Richards, P 1995, ‘An assessment of the adaptive mechanisms within and surrounding the peripheral nervous system, during changes in nerve bed length resulting from underlying joint movement’, in Moving in on pain, ed M Shacklock, Butterworth Heinemann, Sydney, Australia, pp. 194-203.
- Maitland, GD 1979, ‘Negative disc exploration: Positive canal signs’, Australian Journal of Physiotherapy, vol. 25, no. 3, pp. 129-134.
- Magarey, M 1984, ‘Canal signs: their significance in examination and treatment of spine’, in Lecture presented at the school of physiotherapy, Lincoln Institute.
- Kornberg, C & Lew, P 1987, ‘The effect of using slump as a stretching technique on grade one hamstring injuries’, in Proceedings of the fifth biennial conference of the manipulative therapists association of Australia, Melbourne, pp. 183-191.
- Maitland, GD 1985, ‘The slump test: Examination and treatment’, Australian Journal of Physiotherapy, vol. 31, no. 6, pp. 215-219.
- Butler, DS 1991, Mobilisation of the nervous system, Churchill Livingstone, Melbourne.
- Philip, K, Lew, P & Matyas, TA 1989, ‘The intertherapist reliability of the slump test’, Australian Journal of Physiotherapy, vol. 35, no. 2, pp. 89-94.
- Stankovic, R, Johnell, O, Maly, P & Wilmer, S 1999, ‘Use of lumbar extension, slump test, physical and neurological examination in the evaluation of patients with suspected herniated nucleus pulposus: A prospective clinical study’, Manual Therapy, vol. 4, no. 1, pp.25-32.
- Majlesi, J, Togay, H, Ünalan, H & Toprak, S 2008, ‘The sensitivity and specificity of the slump and the straight leg raising tests in patients with lumbar disc herniation’, Journal of Clinical Rheumatology , vol. 14, no. 2, pp. 87-91.
- Johnson, EK & Chiarello, CM 1997, ‘The slump test: The effects of head and lower extremity position on knee extension’, Journal of Orthopaedic & Sports Physical Therapy, vol. 26, no. 6, pp. 310-317.
- Woolf, CJ 1991, ‘Generation of acute pain: central mechanisms’, British Medical Bulletein, vol. 47, no. 3, pp. 523-533.
- Butler, D & Gifford, L 1989b, ‘The concept of adverse mechanical tension in the nervous system. Part 2: Examination and treatment’, Physiotherapy, vol. 75, no.11, pp 629–636.
- Davis, DS, Anderson, BI, Carson, MG, Caroline, LE & Lindsey, BS 2008, ‘Upper limb neural tension and seated slump tests: The false positive rate among healthy young adults without cervical or lumbar symptoms’, Journal of Manual & Manipulative Therapy, vol. 16, no. 3, pp. 136–141.
- Tucker, N, Duncan, R & McNair, P 2007, ‘Reliability and measurement error of active knee extension range of motion in a modified slump test position: A pilot study’, The Journal of Manual & Manipulative Therapy, vol. 15, no. 4, pp. E85-E91.
- Herrington, L, Bendix, K, Cornwell, C, Fielden, N & Hankey, K 2008, ‘What is the normal response to structural differentiation within the slump and straight leg raise tests?’, Manual Therapy, vol. 13, no. 4, pp. 289-294.
Abstract Views: 680
PDF Views: 0