Physical Therapy Examination Tests

GENERAL TESTS

Techniques and structural differentiation for the main neurodynamic

tests.

Passive neck flexion

Physical Therapy


Indications

Headaches.

Pain in the upper limbs.

Pain in the neck and shoulder area.

Technique

Start with the patient lying supine. Stand behind the patient and place one hand under the neck and the other hand on the forehead. Alternatively, have both hands under the head. Move the head in flexion.

Structural differentiation

For structural differentiation a second therapist is needed for assistance. Once you have positioned the head in maximum neck flexion, the second therapist carries out a SLR as described later.

Slump test

Indications

Pain and altered sensation related to nerve roots

L4S3.

Muscle dysfunction (weakness or overactivity) in myotomes supplied by these nerve roots (foot dorsiflexion, extension hallux, eversion of

the foot, contraction buttock, knee flexion, toe standing).

Pain in the area of the sensory supply of the sciatic, tibial or peroneal nerve.

Muscle dysfunction (weakness/overactivity) of the muscles supplied by the sciatic nerve (semitendinosus, semimembranosus, biceps femoris, hamstring part of adductor magnus), tibial nerve (gastrocnemius, soleus, plantaris, popliteus, tibialis posterior, flexor digitorum longus, flexor halluces longus) or peroneal nerve (peroneus longus and brevis, extensor digitorum longus, tibialis anterior, extensor hallucis longus, peoneus tertius, extensor digitorum brevis).

Symptoms related to sitting, driving, sprinting, hurdling, kicking and bending.

Pathologies such as lumbar spine pathologies, sacroiliac joint pathologies, hamstring and calf muscle strains, Achilles, peroneal and tibial tendon injuries, ankle ligament sprains and plantar fasciitis.

Technique

Start the test with the patient sitting on the edge of a plinth with their spine in a neutral position, their sacrum vertical and their hands behind their back. Then, get the patient to slump forward so that their thoracic and lumbar spine is flexed but still with their head looking up and the sacrum vertical (neutral). Next, ask the patient to flex their neck so that they bring their chin to their chest. Place your hand over the top of their head and your elbow on the thoracic spine to maintain this position

 Now, ask the patient to actively extend their knee until the end of range, and then dorsiflex their ankle also to end-of-range or to when they indicate a reproduction of pain/symptoms. Finally, remove your hand from the patient’s head and ask them to look up. This is your structural differentiation manoeuvre. If neural tissue is involved the symptoms are changing (either reducing or increasing).

Sensitising manoeuvre

You can sensitise the test by getting the patient to put their foot into plantar flexion and inversion instead of dorsiflexion (sensitises for the common peroneal nerve).

LOWER LIMB NEURODYNAMIC TESTS

(LLNTs)

Straight leg raise test (SLR)

Indications

Pain and altered sensation related to nerve roots L4S3.

Muscle dysfunction (weakness or overactivity) in myotomes supplied by these nerve roots (foot dorsiflexion, extension hallux, eversion of the foot,

contraction buttock, knee flexion, toe standing).

Pain in the area of the sensory supply of the sciatic, tibial or peroneal nerve.

Muscle dysfunction (weakness/overactivity) of the muscles supplied by the sciatic nerve (semitendinosus, semi-membranosus, biceps femoris,

hamstring part of adductor magnus), tibial nerve (gastrocnemius, soleus, plantaris, popliteus, tibialis posterior, flexor digitorum longus, flexor hallucis

longus) or peroneal nerve (peroneus longus and brevis, extensor digitorum longus, tibialis anterior, extensor hallucis longus, peoneus tertius, extensor

digitorum brevis).

Symptoms related to sitting, driving, sprinting, hurdling, kicking and bending.

Pathologies such as lumbar spine pathologies, sacroiliac joint pathologies, hamstring and calf muscle strains, Achilles, peroneal and tibial tendon

injuries, ankle ligament sprains and plantar fasciitis. Generally, the slump test is used because it puts greater mechanical load on neural tissues and so allows for greater sensitivity. SLR might be chosen over the slump test

if tissue is perceived to be highly irritable and sensitive to load.

Technique

Start the test with the patient lying supine. Stand to the side of the patient you are about to perform the test on, facing towards their head. Place one hand just above their knee and the other under their Achilles tendon with your palm over their foot. Perform the test by lifting their leg, bringing their hip into flexion while maintaining the extended knee until the end-of-range or until the patient indicates a reproduction of pain/symptoms.

Structural differentiation

Add structural differentiation by getting the patient to side flex their trunk to the contralateral side.

Sensitising manoeuvre

You can sensitise the test by adding plantar flexion and inversion of the foot (sensitises for the common peroneal nerve) or adding ankle dorsiflexion (sensitises for the tibial nerve).

Modifications of SLR: peroneal, sural and tibial nerve test

Indications

Pain and altered sensation related to nerve roots L4S3.

Muscle dysfunction (weakness or overactivity) in myotomes supplied by these nerve roots (foot dorsiflexion, extension hallux, eversion of the foot,

contraction buttock, knee flexion, toe standing).

Pain in the area of the sensory supply of the tibial, sural or peroneal nerve.

Muscle dysfunction (weakness/overactivity) of the muscles supplied by the tibial nerve (gastrocnemius, soleus, plantaris, popliteus, tibialis posterior, flexor digitorum longus, flexor hallucis longus) or peroneal nerve (peroneus longus and brevis, extensor digitorum longus, tibialis anterior, extensor halluces longus, peoneus tertius, extensor digitorum brevis).

Symptoms related to sitting, driving, sprinting, hurdling, kicking and bending.

Pathologies such as lumbar spine pathologies, sacroiliac joint pathologies, hamstring and calf muscle strains, Achilles, peroneal and tibial tendon

injuries, lateral ankle ligament sprains and plantar fasciitis.

Technique

Peroneal

Start the test with the patient lying supine. Stand to the side of the patient you are about to perform the test on,facing towards their feet and place one hand just above their knee. Reach with the other hand under their foot, placing your fingers on their toes to bring the foot into plantar flexion and inversion . Perform the test by lifting their leg, bringing their hip into flexion while maintaining the extended knee and plantar flexed/inverted foot until the end-of-range or the patient indicates a reproduction of pain/symptoms.

Sural

Start the test with the patient lying supine. Stand to the side of the patient you are about to perform the test on, facing towards their feet and place one hand just above their knee. Place the other hand around their foot and bring the foot into dorsiflexion, inversion position. Perform the test by lifting their leg, bringing their hip into flexion while maintaining the extended knee and dorsiflexed/inverted foot until the end-of-range or the patient indicates a reproduction of pain/symptoms.

Tibial

Start the test with the patient lying supine. Stand to theside of the patient you are about to perform the test on, facing towards their feet and place one hand just above their knee. Place the other hand around their foot and bring the foot into dorsiflexion, eversion position. Perform the test by lifting their leg, bringing their hip into flexion while maintaining the extended knee and dorsiflexed/ everted foot until the end-of-range or the patient indicates a reproduction of pain/symptoms.

 

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