The Sensitive Nervous System Chapter XI: Neurodynamic Testing for the Spine and Lower Limb

This is a summary of Chapter XI of “The Sensitive Nervous System” by David Butler.


For today’s chapter, I have decided that the best way to learn these tests is to show you. I will write in any pertinent details you need for a good test performance.

The Straight Leg Raise (SLR)

SLR hacks.

  • Add sensitizers (dorsiflexion, plantarflexion, etc) to determine nervous system involvement.
  • Add cervical flexion or visual input to enhance responses.
  • Be mindful of symptoms before and after pain responses.
  • If this test is positive post-operation, it will likely be inflammatory in nature.
  • You can preload the system further with cervical flexion or sidebending the trunk away from the test side.

Here are some other ways to perform the SLR with sensitizers first. (I apologize for the way the camera shot in advance).

For tibial nerve-bias.

For fibular nerve bias.

For sural nerve bias.

Passive Neck Flexion (PNF)

Here is how to perform the test.

PNF Hacks.

  • Add SLR to further bias the test.
  • Be mindful of Lhermitte’s sign, which is an electric shock down the arms or spine. This is a must-refer sign as there is potential spinal cord damage.

Slump Test

Here is how to perform the slump.

Slump Knee Bend

In the book itself, Butler uses the prone knee bend as his base test. However, NOI does not teach this motion as much and now favors the slump knee bend. This movement allows for much more differentiation to be had.

And the saphenous nerve (just so you get a break from seeing me).

Final Words

Have some fun with these tests, and be mindful that you are not too aggressive.

  1. Hey Zac,
    Are there any norms for the Slump knee bend in the book? (other than left-right asymmetries or symptoms)

    1. Hey Iordan,

      Usually what constitutes a “normal” is if you can bring on some sort of sensation/ROM limitation with the hip extension/knee flexion sensitizer, but changing head position has no influence. If this is so, then the restriction or sensation likely comes from something local (muscular stiffness/shortness or joint capsular restrictions). I hope that answers your questions.



  2. Thanks a ton Zac. I’m lucky that they taught us these individual special tests for different nerve biases. I use them all the time in clinic.