SLUMP Test

The Slump Test is a neurodynamic assessment used to evaluate altered neural mobility or increased sensitivity of neural tissue¹. It is particularly relevant in patients with suspected lumbar radiculopathy, nerve tension syndromes, or sciatica-like symptoms.

The test was first described in detail by Maitland (1985) and has since become a standard part of neurodynamic assessment in musculoskeletal and neurological physiotherapy.

Test Procedure

Note: Multiple variations of the slump test exist in the literature. The following description is based on Mark Dutton’s method².

Step-by-step execution:

1. Patient Position

   • The patient sits upright on an examination bench, with hands behind their back to maintain neutral spinal alignment.

2. Thoracic and Lumbar Flexion

   • The patient is instructed to “slump” forward, flexing both the thoracic and lumbar spine.

   • If no pain occurs, proceed to the next step.

3. Cervical Flexion

   • The patient flexes the neck, bringing the chin toward the chest.

4. Knee Extension

   • The patient extends one knee as far as possible.

   • If this reproduces pain, the patient is instructed to extend the neck back to neutral.

   • If pain decreases, the test is considered positive.

5. Ankle Dorsiflexion

   • If knee extension alone does not provoke symptoms, the patient dorsiflexes the ankle.

   • If no pain is provoked, the test can be reinforced by simultaneous knee extension with dorsiflexion.

   • A reproduction of familiar pain indicates a positive test.

6. Bilateral Testing

   • The procedure is repeated on the opposite leg.

7. Overpressure

   • Overpressure can be applied at any stage to further stress the neural structures.

   
   

Diagnostic Evidence

The diagnostic accuracy of the Slump Test is debated, with studies reporting variable sensitivity and specificity.

• The test progressively increases tensile load on neural structures within the spinal canal and intervertebral foramina.

• A Cochrane review on physical tests for lumbar radiculopathy (secondary to disc herniation) concluded that evidence for the Slump Test’s reliability remains limited³⁻⁴.

Sensitivity and Specificity Findings:

• Stankovic et al. (1999)⁶

  • Strict definition (pain below the knee):

    • Sensitivity: 44%

    • Specificity: 58%

  • Broader definition (pain anywhere in the leg):

    • Higher sensitivity, lower specificity.

• Majlesi et al. (2008)⁵

  • Sensitivity: 84%

  • Specificity: 83%

  • Note: Thresholds for a positive result were not consistently defined.

Clinical Relevance

• A positive Slump Test suggests increased neural mechanosensitivity, commonly seen in lumbar disc herniation with radiculopathy.

• Should not be used in isolation for diagnosis—interpretation must be combined with:

  • Patient history

  • Neurological examination

  • Other neurodynamic tests such as Straight Leg Raise (SLR) or Femoral Nerve Stretch Test (FNST).

• The test can help distinguish between neurogenic pain and musculoskeletal pain sources.

Conclusion

The Slump Test is a widely used neurodynamic test for detecting lumbar nerve root involvement and altered neural mobility. While it may demonstrate good sensitivity and specificity in certain studies, results remain inconsistent. It is best applied in combination with other neurodynamic and orthopedic tests to support diagnostic accuracy.

References

1. Flynn TW, Cleland JA, Whitman JM. Users' Guide to the Musculoskeletal Examination: Fundamentals for the Evidence-Based Clinician. Buckner: Evidence in Motion; 2008.

2. Dutton M. Orthopaedic Examination, Evaluation and Intervention. 2nd ed. New York: McGraw-Hill Companies, Inc.; 2008.

3. Maitland GD. The slump test: Examination and treatment. Austr J Physiother, 1985; 31: 215-219.

4. van der Windt DA, Simons E, Riphagen II, Ammendolia C, Verhagen AP, Laslett M, Devillé W, Deyo RA, Bouter LM, de Vet HC, Aertgeerts B. Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain. Cochrane Database Syst Rev, 2010; 17(2): CD007431.

5. Majlesi J, Togay H, Unalan H, Toprak S. The sensitivity and specificity of the Slump and the Straight Leg Raising tests in patients with lumbar disc herniation. J Clin Rheumatol, 2008; 14: 87–91.

6. Stankovic R, Johnell O, Maly P, Willner S. Use of lumbar extension, slump test, physical and neurological examination in the evaluation of patients with suspected herniated nucleus pulposus. A prospective clinical study. Man Ther, 1999; 4: 25–32.