Slump Test for Sciatica

Tingling in feet and legs

Keywords; slump test for sciatica, micro discectomy, chiropractic help.


This orthopaedic examination for a pinched nerve in the lower back is a complex manoeuvre that comes in a simpler form called Flip which you can do at home to discover if your paresthesias in the lower limb could be coming from your spine.

The lower back supplies two main nerves to the legs that can cause tingling in the feet and legs. It's the onset of leg pain that gets the surgeon excited, and that you don't want.

At our femoral nerve page you will appreciate that the pain and tingling from the lower back may radiate to the groin and top of the thigh, and the slump test will be negative. Instead we use a femoral nerve stretch test, which is far more difficult to administer, and has no place in a self-help site such as this. It's best left to your chiropractor.

There's plenty of combined medical and chiropractic research for pinched nerves. 

In interesting research, three neurosurgeons and a chiropractor evaluated the effectiveness of micro diskectomy versus manipulation in a pilot study for patients with pain and tingling in the feet and legs from a pinched nerve in the lower back. 

All forty patients had first undergone three months of conservative medical and physiotherapy without relief of the leg pain.

Actually, even that is an over simplification because the Flip and Slump tests are only for a pinched SCIATIC NERVE.

Results

After three months there was clear benefit in

  1. 85% of the the micro diskectomy group.
  2. 60% of the chiropractic research group.
  3. Seven of the eight patients who did not respond to chiropractic treatment responded well to a subsequent micro-diskectomy, at the same rate and degree of benefit as the primary group. Nothing was lost by the delay of surgery.
  4. After twelve months there was little difference between the two groups.
  5. The recommendation of the researchers was that all patients with a pinched nerve in the back should first, because of the cost and risks, consider manipulative treatment before going on to surgery.

The cost of the chiropractic care was less than 10 percent of the surgery, with zero risks and side effects.

The Flip is a simplified version of the slump test for sciatica.

In the Flip test, you can assess an impingement of the sciatic nerve at home. Sit in an ordinary upright chair, and somebody else raises first your good leg parallel to the ground, then lower it, remembering the pull in the good leg.


Now ask your examiner to raise the naughty leg. Is it significantly tighter or more painful than the other? If it hurts only in the back, not the lower limb, then you have no frank sciatica, only the first stage.


In the full slump test for sciatica, progressively more stretch is placed on the sciatic nerve but that is best left to an experienced chiropractor.

Micro diskectomy is a far less invasive procedure than normal back surgery, the surgeon is able, using an operating microscope, to remove a part of the facet joint that may be pinching the nerve root and any disc material from under the nerve root.

Under risks mention is made of recurrent herniations (immediately or later), cerebrospinal fluid leaks due to damage to the dura, nerve root damage, bladder and bowel incontinence, bleeding and infection. The authors assure that these risks are relatively low. "Quite rare".


How soon should you rush off to the doctor or chiropractor? 

It depends. Pain on the left side of the chest? I'd phone the emergency rooms right now. An old niggle in the back that you've had for years? No rush.

Having said that, last week my wife bent over, and twisted to lift a corner of the carpet for sweeping. She felt what she described as "a bottle exploding at the bottom of her back". Not good. She was stuck forwards in what we call an antalgic posture. The sign of Pisa. Because the swelling and inflammation hadn't yet started, the Slump Test for sciatica was negative. But wait three days... and I would have had drama on my hands, in the bosom of the family.

The long and the short of it is that I reduced that bulging disc within three hours of the injury, she spent the rest of the day in bed with an ice pack and doing half-hourly lower back exercises ...

A second treatment two days later, and within five days she is almost painfree during the day, except for prolonged sitting and early morning discomfort. Of course, I'm exhorting her to follow the 50 percent less pain rule. Today we'll start the rehab exercise program.

If there is any suggestion of leg pain muscle weakness then careful testing should be done. The progression from grade 3 to 4 or 5 can be insidious.


Lower back exercise at Slump test for sciatica

For more details, Chiropractic Research ...

In normal circumstances, if you wait a few weeks with leg pain before seeking the advice of your chiropractor, you will probably be in for extended treatment.

What's my point? When you know you've done a mischief to some part of your body then it's better not to wait. Dealing with a disc herniation when it's become swollen and inflammation has set in, is immeasurably more difficult.

Ringing in the changes before it starts referring down the leg, and the Slump test for sciatica is strongly positive, makes good sense. Likewise if you have a bad dose of bronchitis don't wait for the pleurisy before contacting your doctor.

I see little point in writing a story about Mr John who hurt his back, went to the chiropractor, who performed a miracle and he's again playing championship golf or tennis.

Such things do happen; actually quite regularly. But I prefer to write about the bizarre, funny and tragic things that happen at the chiropractic coalface. For such, I make no apology, take my books for what they are; controversial and fun.


My first three novels have been described by one fan as gems, both funny and healthful, from the life and work of a chiropractor.  Such was not actually my intent but he has indeed hit the nail on the head. A patient with a brachial neuralgia turns out to be a blood diamond trader. A woman with acute low back pain is helped to the clinic by her lover, the parish priest.

A head on confrontation with a gynaecologist who refused to accept a referral from a chiropractor because he thought it would be unethical is typical. The reason for the referral is pertinent? An xray of her pelvis revealed an ancient IUD that a previous doctor had inserted some twenty years previously, and couldn't find to remove; titivating stories, you'll love them.

And now a new genre that I and many other people, Christian and those without religion, find difficult; homosexuality. A Family Affair is my take after a ten year search on the subject. Unless you're very straight, you'll love it; promise. It turned out to be so long that it's split into a trilogy; only 99c on Kindle, Nook, tablet or your smartphone. If you find it boring you can demand your money back and you'll get it; all 99c.


Dr Barrie Lewis DC = Dr Bernard Preston DC

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Interesting challenges of the day

1. Mrs D, a 78 year old woman has very severe sacroiliac joint pain, and even more severe cramps in her right leg. There are two problems; she is on two diuretics but no slow K. Taking her temporarily off one diuretic and adjusting the SIJ brought 50 percent relief within four days. 

2. Mr S, a 48 year old man, has right low back pain, groin pain and a numb feeling in his lower leg when he sports. For six months he's been off football. He too has two problems; a very treatable lumbar facet syndrome and a very serious blocked artery in the groin; it's called intermittent claudication. Smokers beware.  

3. Mr S looks like the leaning tower of Pisa; he has a slipped disc at L5 making him lean towards the opposite side. It's called the postero lateral disc hernia; we'll fix it, but he has to stop for a week or two. Antalgias are serious so take them seriously. 

4. Mrs V too has  two conditions; a chronic low grade sciatica giving her an ache in the right leg, and a threatening Morton's neuroma. She's glad I'm back in Holland; chiropractic fixed it before, and we'll fix it again. 

5. Mrs W is one of the lucky ones, says her doctor. I agree. He says only 40% of patients with lumbar stenosis have a successful operation. We fixed a nasty slipped disc three years ago, but it came back two years later; the surgeon did a fine job but she has a weak ankle now giving her subtalar joint pain; it's routine stuff. 

6. I myself had an acute exacerbation of a femoral nerve lesion last year. One immediate treatment of the new strain by my colleague has fixed the pain in the lower back, but there's some residual numbness in the lower leg; no soaring tomorrow alas.

7. This lady is a 86 year old woman with a 63 scoliosis. Chronic lower back has been her lot in life but she's well pleased with chiropractic and comes for chiropractic help once a month; some conditions you can never cure.

8. She is an 78 year old woman, is doing remarkably well with a bad sciatica. But over 200 pounds she is not losing weight; in fact, gaining despite my suggestions. She's high risk for a stroke. I have referred her to a dietician to crack the whip.

9. A 61 year old man with upper cervical pain yesterday; it's not severe but also not getting better of its own accord. He's afraid it may turn very acute as when I treated him three years ago. Since then it's been fine. 

10. A 64 year old woman has had scheuermanns disease; it's left her with a spinal kyphosis and chronic middorsal pain. She responds well to chiropractic treatment provides she come every six weeks or so for maintenance treatment.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mrs D, a middle aged woman with hip pain of one year duration, despite other treatment. Xrays reveal an impingement syndrome and early hip arthritis. There's much to be done.

13. Mrs B has had one of the nastiest of conditions; vertigo caused by a disturbance in the inner ear. Falling repeatedly and vomiting she consulted her doctor but medication didn't help. After two sessions of the Epley manoeuvres she was 50 percent better. After two weeks 75 percent improved. No longer vomiting all falling. She's not enjoying the Brandt Daroff home exercises.

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.



Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?


Interesting questions from visitors

CLS writes:

Greetings, Dr B.
You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.

Your own unresolved problem. Pose a question

Knowing that up to 70% of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there's a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong! Give plenty of detail if you want a sensible reply.


You visited this chiropractic help site no doubt because you have a problem that is not resolving and want to know more about what chiropractors do.

The quickest and most interesting way is to read one of my ebooks of anecdotes. Described by a reader as gems, both funny and healthful, from the life and work of a chiropractor, you'll love them. Priced right at $2.99, though Kindle fiddles the price without telling me.