Slump / SLR

[joshmeyer]

I have a patient who is a competitive surf ski paddler. He has had gluteal pain for two weeks. His main problem is neural tension and therefore a positive slump and half SLR. He thus cannot sit properly on the ski as this requires a slump like position. I have tried some various techniques and have gained small improvements but I am basically brainstorming for ways to improve slump / SLR. Anyone got some good ideas

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[SamBowden]

Sorry this'll be a bit late now but i think what you really need to do to answer your own question is define neural tension and why your guy's got/ had it. Base tests check how the CNS can handle input. A hyperalgaesic response involves not just peripheral factors but central processing as well.( CNS up/downregulation). Therefore does the response indicate a recent peripheral incident like a disc herniation ( as the SLR has been shown to have good validity in it's ability to diagnose disc herniation) or do other factors make you think the response may be a result of maladaptive CNS processing, and that any input would be percieved as painful.
I hope this may direct you to more current thinking on AND or whatever the term is now!( Sensitive nervous System, Butler, 2000)

[perfphysio]

Do you mean his main symptom (something you feel) is gluteal pain, brought on by slump testing. I would investgate the bilateral inernal rotation of the hip joints, especially in a slumped position with the trunk in rotation towards the leg that should be internally rotating. Lack of hip internal rotation her ecould be the result of asymmetry in his obliques/lats/multifidus at EOR/transversus etc. This may have later manifested as a tight or overactive piriformis which is causing a sacral and therefore lumbar imbalance. I have found that this is common in rowers who display symptoms of discal lesions that are created from inadequacies farther afield. It is the farther afield issues that you must treat if you wish to have a longterm result. You can always sell the idea to the patient that if they fix it they won't simply reduce their pain, they will increase their performance. :-) richard