Hlebs S1, Salmic V1
1Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
Background: Neurodynamic tests are used to assess the mechanosensitivity of the neural tissue. Clinical observation and experience teaching neural tension testing led the present investigators to observe that many asymptomatic subjects without cervical, lumbar, or peripheral symptoms present with neural-mediated symptoms when full range testing of the seated slump test (SST) and upper limb neural tension test (ULNTT) is performed. Thus, this observation indicated that there might be an unusually high false positive rate among these tests when performing full-range testing of the knee (SST) and the elbow (ULNTT).
Purpose: The purpose of this study was to determine the outcome the SST and ULNTT among healthy young adults without cervical, lumbar, or peripheral symptoms and to identify possible cut-off scores based on knee (SST) and elbow (ULNTT) range of motion for tests to be positive.
Methods: Eighty-four subjects (23 men and 61 women) with a mean age of 21.13 ± 2.13 years participated in the investigation. All participants completed a screening questionnaire designed to exclude subjects with a history of cervical or lumbar spine pain or injury, or upper or lower extremity neurological symptoms. The ULNTT and the SST were performed on the left lower and upper extremity of each participant. To find the false positive rate of each test, a simple percentage of positive tests divided by the total sample size was calculated. Descriptive statistics included the mean, range, standard deviation, 95% confidence interval (CI); and the 75th percentile were calculated for each test.
Results: Of the 84 participants tested, 79 (94 %) were found to have false positive SST at same point in the available range of knee extension and 84 (100 %) had a positive ULNTT at some point of elbow extension. For all positive SSTs the mean knee extension angle was 20.25° ± 12.5° (95 % CI: 17.45°-23.05°). The mean elbow extension angle for all positive ULTTs was 39.17° ± 9.75° (95 % CI: 37.05°- 41.28°). The 75th percentile for SSTs and ULTTs was 30° and 45°, respectively.
Conclusion(s): The number of positive tests for both the SST and the ULNTT found to be high in this sample of asymptomatic healthy young adults, which raises question about the diagnostic validity of these tests. Based on the results of this investigation, it appears that there is a significant degree of inherent neural sensitivity among healthy adults without a history of spinal or peripheral symptoms when full-range testing is performed. Based on the 75 th percentile, we suggest that a positive test only be identified when peripheral symptoms are reproduced before 30° of knee extension in the SST and 45° of elbow extension in the ULNTT.
Implications: To increase the diagnostic accuracy of these tests, we have proposed possible cut-off scores for these tests. Further investigation is warranted to determine the diagnostic validity of the SST and ULNTT in both symptomatic and asymptomatic subjects based on the proposed cut-off scores.
Keywords: Neural Tension Testing, Neurodynamic, Test validity
Funding acknowledgements: The study was not funded.
Purpose: The purpose of this study was to determine the outcome the SST and ULNTT among healthy young adults without cervical, lumbar, or peripheral symptoms and to identify possible cut-off scores based on knee (SST) and elbow (ULNTT) range of motion for tests to be positive.
Methods: Eighty-four subjects (23 men and 61 women) with a mean age of 21.13 ± 2.13 years participated in the investigation. All participants completed a screening questionnaire designed to exclude subjects with a history of cervical or lumbar spine pain or injury, or upper or lower extremity neurological symptoms. The ULNTT and the SST were performed on the left lower and upper extremity of each participant. To find the false positive rate of each test, a simple percentage of positive tests divided by the total sample size was calculated. Descriptive statistics included the mean, range, standard deviation, 95% confidence interval (CI); and the 75th percentile were calculated for each test.
Results: Of the 84 participants tested, 79 (94 %) were found to have false positive SST at same point in the available range of knee extension and 84 (100 %) had a positive ULNTT at some point of elbow extension. For all positive SSTs the mean knee extension angle was 20.25° ± 12.5° (95 % CI: 17.45°-23.05°). The mean elbow extension angle for all positive ULTTs was 39.17° ± 9.75° (95 % CI: 37.05°- 41.28°). The 75th percentile for SSTs and ULTTs was 30° and 45°, respectively.
Conclusion(s): The number of positive tests for both the SST and the ULNTT found to be high in this sample of asymptomatic healthy young adults, which raises question about the diagnostic validity of these tests. Based on the results of this investigation, it appears that there is a significant degree of inherent neural sensitivity among healthy adults without a history of spinal or peripheral symptoms when full-range testing is performed. Based on the 75 th percentile, we suggest that a positive test only be identified when peripheral symptoms are reproduced before 30° of knee extension in the SST and 45° of elbow extension in the ULNTT.
Implications: To increase the diagnostic accuracy of these tests, we have proposed possible cut-off scores for these tests. Further investigation is warranted to determine the diagnostic validity of the SST and ULNTT in both symptomatic and asymptomatic subjects based on the proposed cut-off scores.
Keywords: Neural Tension Testing, Neurodynamic, Test validity
Funding acknowledgements: The study was not funded.
Topic: Musculoskeletal
Ethics approval required: Yes
Institution: Faculty of Health Sciences
Ethics committee: University’s Institutional Review Board for the Protection of Human Subjects
Ethics number: 43001
All authors, affiliations and abstracts have been published as submitted.
