Differentially Diagnosing a Lumbar Nerve Root Adhesion

joseph,

david poulter came up with a great little technique for treating nuerological “tightness” symptoms called retlouping. it works wonders with people with low back pain and “hamstring tightness.”

here is a youtube video of it being done:
http://www.youtube.com/watch?v=u3BwXOkbWCo

Nice article. This is the process I generally use for back pain differential diagnosis.

I like to use a step stool and place the affected extremity’s foot on the stool. Then I have them perform forward flexion and note if there is a difference.

Modification of the slump test is a great treatment technique along with retlouping. Great article and more people should be able to recognize this in patient’s with back pain.

Great post! Look forward to hearing more from you in the future. I really enjoy with neurodynamic techniques and have been dabbling in some research. We currently have 1 article published on the role of neural tension in hamstring flexibility and we also have 2 follow up papers which should be coming out in the next few months.

I am not so sure how this procedure will actually demonstrate that the pain source is an adherant nerve root. It certainly confirms that the pain source is responsive to the slump manouvre, but how sure can you be that there is not a local muscular source within the buttock, for example the sciatic nerve interface within or adjacent to piriformis, that may also respond to local treatment such as dry needling / acupunture? It is also worth noting the extensive fascial connections throughout the spinal extensor group and through the pelvis (see research by Briggs and Barker published in Spine in 2002/3/ or 4 which theoretically can connect cranial/cervcial movements throught to movement of the lower limb. Essentially this very useful technique assesses or treats a movement impairment of a group (or tract perhaps) of tissues rather than a specific structure, but is probably not so valuable as a ‘diagnostic’ test.

Thanks for the comments Roy and you do have a good arguement. While yes, the specificity of this test may not be 100% I do believe it is a good tool for looking at a neurogenic root of pain vs. a disc herniation.

In terms of piriformis syndrome, a patient would have a + SLR by definition. In the diagnostic criteria I provided for a nerve root adhesion, a SLR would be -. This stated, there are always false negatives and we shouldn’t rely soley on one test to rule out a condition so I also included “walking and weightbearing is better” and in a true piriformis syndrome, walking would be worse.

In terms of fascial restrictions being the source of pain, the descriptors of a “sharp, burning” pain would make me consider the pain to be neurogenic in nature vs. fascial. Also the + Slump test is one of our best special tests at identifying neural adhesions (it actually also increases disc pressure so we can differentiate between both with the repeated flexion testwith knees extended and flexed).

Its the cluster of + signs and symptoms I provided which would cause me to think that the patient has an nerve root adhesion vs. something else. That stated, if the patient didn’t respond favorably to the neural flossing techniques I would perform, then yes I would reassess and maybe consider other conditions which can present similarly.

Great site. A lot of useful information here. I’m sending it to some friends!

What about nerve gliding techniques as one treatment suggestion?

Kayla,
Actually in the last paragraph of this article I state I would use neurodynamic techniques and a modified Slump…These are “neural flossing” interventions…May have missed this