Home Blog Things I Learned from Smart People: Installment 1

Things I Learned from Smart People: Installment 1

Written on July 29, 2009 at 12:25 pm, by Eric Cressey

This post marks the first of a new series where I’ll give credit to a lot of the people who in one way or another have made me better at what I do.  In most cases, they’ll be quick tips that I’ve taken away and applied immediately into my existing methodology.  Very few of them will require more than a few sentences to explain – and I’ll usually give you some recommended reading at the end of the entry.

Today’s tip was one I picked up from Bill Hartman on a recent trip to Indianapolis.  Keep in mind that this is more along the lines of “knowledge for the sake of being smart,” not because many of these provocative tests are ones that should be used by those who aren’t trained as physical therapists.

Anyway, We were talking about the high frequency of lumbar spine disc herniations and bulges on MRI that are not accompanied with any symptoms.

Taking it a step further, though, you’ll also see people who have back pain plus these issues on diagnostic imaging, yet that doesn’t necessarily mean that the imaging finding is clinical significant (the pain might be coming from something else).  One classic test that’s been used to test for neural tension in this regard is the slump test.

As is the case with most physical assessments, though, a good test should simulate the injury mechanism, and while the slump test gets things rolling in the right direction, Bill actually mentioned that he favors a McKenzie-influenced repeated flexion test  (slump test only involves a single “bout” of flexion) – which essentially simulates how you’d herniate a disc in a laboratory setting.  If someone has a one of these findings on the MRI, plus back pain, but this repeated flexion test doesn’t provoke their symptoms, chances are that the pain is coming from somewhere else (muscular, etc.).  If symptoms are exacerbated, it’s probably related to the disc issue.  Of course, repeated extension would apply to more posterior issue.

Of course, check with a qualified physical therapist for issues along these lines; you don’t want to be self-diagnosing or provoking something on your own.  However, the trainers and strength and conditioning coaches in the crowd can use this information attained by physical therapists to classify folks as extension-based or flexion-based back pain and program exercise accordingly alongside rehabilitation initiatives.   I covered this in some detail in Lower Back Savers: Part I.

Recommended Reading: Ultimate Back Fitness and Performance, by Stuart McGill

  • Jack

    Eric,

    Have you seen cases where significant soft tissue issues in the para-spinal muscles caused the spine to lock up like a board and made both flexion and extension quite difficult and possibly even uncomfortable?

  • This is an excellent tip. I’ve experienced this in assessing patients in more instances than I can count. True disc herniation pain is pretty obvious when someone is acute. Rarely will they need to perform more than 10 flexions to induce symptoms. I do find, however, that on average athletes will need to perform more flexions to get symptoms than the average gym-goer.

    I think the Slump test can have such varied outcomes, I don’t tend to use it, but the straight leg raise test is excellent, which can determine disc and/or SI joint involvement.

    Sam Visnic NMT
    http://www.endyourbackpainnow.com/blog

  • This is what Fitness tips from experience and not textbook facts is all about. And now i have learn’t something new again. Thanks for the post.

    Shaun
    stayfitbug


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