Special Tests: Lower Body Neurodynamic Tests

Special Tests Covered in this Lesson:

• Neurodynamic Tests
  • Straight Leg Raise Test (SLR) and Well Leg Raise Test
  • Slump Test
  • Femoral Nerve Neurodynamic Tests

Neurodynamic tests aid in ruling-out whether the sciatic nerve, femoral nerve, or dorsal nerve structures are involved in patient's complaints. Generally, these complaints are related to low back pain, and correlated with a diagnosis of a herniated disk, nerve root irritation, or lumbar radiculopathy. The straight leg raise test (SLR) (a.k.a. Lasègue’s sign) is likely the most often performed test, and is an indicator of sciatic nerve involvement. During the SLR, slump test, or femoral nerve test, hip and ankle joint actions may be used to aid in implicating specific nerves; for example, ankle dorsiflexion during the SLR may bias the test toward tibial nerve involvement. Additionally, pain on the opposite side of the low back or lower extremity during a lower extremity neurodynamic test, may be more indicative of hernatid disk. Note, the SLR also lengthens the hamstring and posterior thigh muscles, and it is common for patients to report SLR symptoms as "hamstring tightness." The most accurate neurodynamic tests have been included in this course, and lesser tests have been excluded. Clinical movement professionals (physical therapists, physical therapy assistants, chiropractors, occupational therapists, athletic trainers, etc.) should be aware of these tests, as their skillset is often the safest and most effective option for treating mild to moderate nerve irritation (e.g. manual therapy, certain modalities, and corrective exercise).

Summary:

The body of research regarding lower extremity nerve tension tests continues to grow; however, additional research is needed to answer clinically relevant questions. Studies have demonstrated the validity of these tests, but perhaps not the specificity. That is, neurodynamic testing results in the lengthening and gliding of nerves (22-25); however, more research is needed to demonstrate that each test results in the lengthening or gliding of the intended nerve.

Generally, neurodynamic tests have demonstrated higher sensitivity than specificity for related diagnoses (4 - 21, 29 - 31); however, a few studies imply specificity increases when various modifications are added to the Straight Leg Raise Test (SLR) (8-11, 17 - 21). More consideration needs to be given to what diagnoses are associated with a "positive test" (lumbar herniation, radiculopathy, neurogenic symptoms, etc.), as diagnoses vary between studies which contributes to the wide range of reported accuracies. Although a considerable number of studies have been performed on these tests, more research is needed to answer these key questions.

Brookbush Institute Recommendation:

The Brookbush Institute recommends that all clinical professionals (physical therapists, physical therapy assistants, chiropractors, occupational therapists, athletic trainers, etc.) are aware of these lower extremity neurodynamic tests. Because these tests demonstrate good sensitivity but do not provide information regarding the cause of symptoms, the Brookbush Institute recommends these tests are used as screens; that is, a negative test "rules-out" a nerve's involvement.

For an Introduction to Special Tests

• For an introduction to Special Tests including definitions of specific terminology, what special tests measure, accuracy (specificity, sensitivity, reliability, etc.), how we chose the tests in each special test course lessons, and best practice recommendations:
• Special Tests: Introduction

Courses covering Special Tests for the Lumbo Pelvic Hip Complex

• Special Tests: Sacroiliac Joint (SIJ)
• Special Tests: Hip Joint
• Special Tests: Lower Body Neurodynamic Tests

Pre-approved credits for:

• Integrated Manual Therapist (IMT) Certification

Pre-approved for Continuing Education Credits for:

• Athletic Trainers
• Chiropractors
• Physical Therapists
• Physical Therapy Assistants

This Course Includes:

• AI Tutor
• Text and Illustrations
• Audio Voice-over
• Technique Videos
• Practice Exam
• Pre-approved Final Exam

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   • Straight Leg Raise, Well Leg Raise Sign and Sensitization
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19. Baselgia, L. T., Bennett, D. L., Silbiger, R. M., & Schmid, A. B. (2017). Negative neurodynamic tests do not exclude neural dysfunction in patients with entrapment neuropathies. Archives of physical medicine and rehabilitation, 98(3), 480-486.
20. Ekedahl, H., Jönsson, B., Annertz, M., & Frobell, R. B. (2018). Accuracy of Clinical Tests in Detecting Disk Herniation and Nerve Root Compression in Subjects With Lumbar Radicular Symptoms. Archives of physical medicine and rehabilitation, 99(4), 726-735.
21. Rezkallah, S. S., & Gharib, N. M. (2017). Crossed Straight Leg Raising versus Straight Leg Raising in Patients with Lumbar Disc Herniation: Effects on Pain, Functional Disability and Balance. International Journal of Therapies and Rehabilitation Research, 6(2), 82.
22. Rade, M., Pesonen, J., Könönen, M., Marttila, J., Shacklock, M., Vanninen, R., … & Airaksinen, O. (2017). Reduced spinal cord movement with the straight leg raise test in patients with lumbar intervertebral disc herniation. Spine, 42(15), 1117-1124.
23. Rade, M., Shacklock, M., Könönen, M., Marttila, J., Vanninen, R., Kankaanpää, M., & Airaksinen, O. (2017). Normal multiplanar movement of the spinal cord during unilateral and bilateral straight leg raise: Quantification, mechanisms, and overview. Journal of Orthopaedic Research, 35(6), 1335-1342.
24. Rade, M., Könönen, M., Marttila, J., Shacklock, M., Vanninen, R., Kankaanpää, M., & Airaksinen, O. (2016). In vivo MRI measurement of spinal cord displacement in the thoracolumbar region of asymptomatic subjects with unilateral and sham straight leg raise tests. PloS one, 11(6), e0155927.
25. Rade, M., Könönen, M., Marttila, J., Vanninen, R., Shacklock, M., Kankaanpää, M., & Airaksinen, O. (2016). Correlation analysis of demographic and anthropometric factors, hip flexion angle and conus medullaris displacement with unilateral and bilateral straight leg raise. European Spine Journal, 25(3), 724-731.
26. Ridehalgh, C., Moore, A., & Hough, A. (2015). Sciatic nerve excursion during a modified passive straight leg raise test in asymptomatic participants and participants with spinally referred leg pain. Manual therapy, 20(4), 564-569.
    • Femoral Nerve Neurodynamic Test, Crossed Femoral Nerve Stretch and Sensitization (15, 20-21)
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28. Anloague, P. A., Chorny, W. S., Childs, K. E., Frankovich, M., & Graham, C. (2015). The Relationship between Femoral Nerve Tension and Hip Flexor Muscle Length. J Nov Physiother, 5(244), 2.
    • Slump Test (14, 16)
29. Stankovic, R., Johnell, O., Maly, P., & Wilmer, S. (1999). Use of lumbar extension, slump test, physical and neurological examination inthe evaluation of patients with suspected herniated nucleurs pulposus. A prospective clinical study. Manual therapy, 4(1), 25-32.
30. Ekedahl, H., Jönsson, B., Annertz, M., & Frobell, R. B. (2018). Accuracy of Clinical Tests in Detecting Disk Herniation and Nerve Root Compression in Subjects With Lumbar Radicular Symptoms. Archives of physical medicine and rehabilitation, 99(4), 726-735.
31. Baselgia, L. T., Bennett, D. L., Silbiger, R. M., & Schmid, A. B. (2017). Negative neurodynamic tests do not exclude neural dysfunction in patients with entrapment neuropathies. Archives of physical medicine and rehabilitation, 98(3), 480-486.