A physical therapist performs a slump test on a patient with complaints of intermittent posterior leg pain and numbness. The patient reports increased symptoms when the neck is flexed during the test, but symptoms decrease when the neck is extended while maintaining knee extension and ankle dorsiflexion. What is the MOST accurate interpretation of this finding?

1. The symptoms are likely due to hamstring tightness
2. The test result is negative because pain improved with neck extension
3. The response suggests adverse neural tension involving the spinal cord or nerve roots
4. The findings are consistent with mechanical low back pain from a lumbar paraspinal strain

Transcript

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A physical therapist performs a slump test on a patient with complaints of intermittent posterior leg pain and numbness. The patient reports increased symptoms when the neck is flexed during the test, but symptoms decrease when the neck is extended while maintaining knee extension and ankle dorsiflexion. What is the MOST accurate interpretation of this finding?

1. The symptoms are likely due to hamstring tightness
2. The test result is negative because pain improved with neck extension
3. The response suggests adverse neural tension involving the spinal cord or nerve roots
4. The findings are consistent with mechanical low back pain from a lumbar paraspinal strain

Slump Test

The slump test is a neurodynamic test used to assess for adverse neural tension along the length of the spinal cord and peripheral nerves of the lower extremity. It is performed with the patient seated at the edge of a table and involves a sequential loading of the nervous system from top to bottom.

Here's how it works - the patient first slumps into thoracic and lumbar flexion, then brings their chin to their chest to add cervical flexion. The therapist then positions the ankle in dorsiflexion and asks the patient to actively extend the knee. Each step progressively increases tension on the neural structures. If symptoms are provoked, the therapist asks the patient to extend their neck.

The key concept here is that the nervous system is one continuous structure. From the brain all the way down to the tips of your toes, it's all connected. So when you change the position of the cervical spine, you can actually influence tension on neural structures all the way down in the lower extremity. That's the beauty and the diagnostic power of the slump test.

Let's explore each of the options:

Option 1 - The symptoms are likely due to hamstring tightness

Hamstring tightness is probably the most common alternative explanation students reach for when they see posterior leg symptoms during a slump test. The slump test does place the hamstrings on stretch, so it seems reasonable. But here's the critical question - can moving your neck affect your hamstring tightness? Absolutely not- muscles don't work that way. If symptoms change based on cervical spine position, the structure being affected has to be continuous from the neck down to the leg. That's neural tissue, not muscle. Hamstring tightness is off the table.

Option 2 - The test result is negative because pain improved with neck extension

This is a really sneaky distractor, and I can see why some students might fall for it. The logic seems reasonable on the surface - if pain goes away, the test must be negative. Wrong. In fact, it's the exact opposite. The symptom change with neck position is precisely what makes this test POSITIVE. Think about it - if symptoms increase with neck flexion and decrease with neck extension, that tells us the nervous system is directly involved. The cervical spine is influencing symptoms all the way down in the leg. That's not a negative test - that's a textbook positive slump test!

Option 3 - The response suggests adverse neural tension involving the spinal cord or nerve roots

When the patient flexes their neck, they're adding tension to the neural structures from above. Combined with the knee extension and ankle dorsiflexion already loading the system from below, there is tension on nervous system from both ends simultaneously - like stretching a rubber band from both sides at once. This increases symptoms. When the neck is extended, that tension from above is released. Even though the distal tension (knee extension and ankle dorsiflexion) is maintained, the overall neural tension decreases enough to reduce symptoms. This bidirectional response - symptoms up with neck flexion, symptoms down with neck extension - is the hallmark of adverse neural tension. The nervous system is the structure being provoked, and the spinal cord or lumbosacral nerve roots are the most likely culprits.

Option 4 - The findings are consistent with mechanical low back pain from a lumbar para-spinal strain

A Lumbar para-spinal strain causes localized pain in the low back region due to muscle injury or overuse. It might cause some stiffness or discomfort with movement, but it would not produce posterior leg symptoms, and it certainly would not be influenced by cervical flexion and extension. Remember - muscles in the lumbar spine have no anatomical connection to the cervical spine that would explain symptom changes with neck movement. This option simply doesn't fit the clinical picture.
When we eliminate the options that cannot explain a symptom change driven by cervical spine position, only one answer remains - the nervous system is the culprit, and adverse neural tension is the most accurate interpretation of these findings.

The correct answer is Option 3.

Let's explore the all student data:
2% of students selected Option 1 - The symptoms are likely due to hamstring tightness
 3% of students selected Option 2 - The test result is negative because pain improved with neck extension
 93% of students selected Option 3 - The response suggests adverse neural tension involving the spinal cord or nerve roots - the correct response
 2% of students selected Option 4 - The findings are consistent with mechanical low back pain from lumbar paraspinal strain

System Classification
This question is a Neuromuscular and Nervous Systems question which represents approximately 24% of all exam items.

Content Outline Classification
This question is a Physical Therapy Examination question which represents approximately 24% of all exam items.

Level Classification
This question is a Level 2 question since the question requires students to integrate numerous pieces of information or to apply knowledge in a given clinical scenario. Remediation of Level 2 questions occurs by increasing flexibility with academic content and by carefully analyzing decision making processes when answering applied examination questions.    

Academic Focus Area
Looking to review related academic content? Check out page 116 in PTEXAM: The Complete Study Guide.

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