Evidence for the effective use of slump sit

The intrepid Dr. Josh Cleland has completed a small trial demonstrating the effectiveness of the slump sit position as a  treatment mode.Download slumparticle_man_ther2.pdf  A cohort of 30 patients with buttock or lower pain, negative for SLR, but positive for slump-sit tests were randomized to receive either slump sit stretching or mobilization/exercise. All subjects were seen for 6 treatments. The slump sit treatment group had a significantly greater reduction in Oswestry (9.7 pts) & pain score (NSPRS 0.98)...that's difference between the groups folks! I smell a low back pain treatment subgroup emerging. Thanks, Josh,

Britt

Comments

[Bart Bishop]

Good article, but my question is why wouldn't they have given hamstring stretching to the control group? I believe that this study shows that the slump sit stretch is effective, but is it more effective than doing those same things with a hamstring stretch? Maybe, it is a future study that Dr. Cleland can do.

[David Poulter]

Josh,

Kudos to you and your group.

I read the study whilst working out at lunch time and couldn't wait to pass on some comments.

In a former life I worked for the Mckenzie Institute, so I have a vested interest in some of the terms you used in your article.

I would suggest that your patients may not have "peripheralized" but only produced pain distally and were no worse afterwards.

This was an ongoing discusion/debate when I wrok for the Institute.

I would suggest that peripheralisation has definite meaning. Pain is produced and or radiates distally and remains there after the mechanical loading strategy, indicating an active lession.

I can not state whther tis is what happened to you patients because it isn't clear in the study.

The other common pattern is that patients can produce pain in a distal location with mechanical loading, but it does not remain there afterwards.

It would indicate an inactive lession.

I would also suggest that centralisation wasn't defined. As you know there has been recent discussion in JOSPT between Julie Fritz and two of my former students (not that they would like me referring to them as that) Mark Werneke and Steven May, on what the definition of centralisation should be.

I would propose a more accurate term should be "Focalisation" (I know this is going to stimulate some discussion, hopefully)

See below:
Focalisation:

Sequential abolition of referred symptoms back to their origin, under the effect of a mechanical loading strategy.
On cessation of the loading strategy the response remains.

Note: Focalisation of symptoms occurs as a result of mechanical loading, it is important to note that a similar symptom response may occur over time i.e. as the patients condition resolves.

If the process is slowly achieved over a period of time then this does not indicate a mechanical problem per se. Any space-occupying lesion, which diminishes in size, may appear to have focalising symptoms.

In a recent study Mark Werneke suggest that symptom responses over time are a better indicator of recovery, than at one position in time, such as the initial evaluation.

Whilst this may be true, I would suggest that the focalising symptom response under mechanical loading is an indicator of a mechanical condition responding, whereas focalising slowly over time may not be.

Proposal: Replace centralisation with focalisation. It is less confusing clinically.

Central is often mistaken for middle and therapists think they have to produce symptoms in the middle of the spine in order to have centralisation, even if the patient’s symptoms originated in their buttock.

I will be intrested in all comments.

"Nothing endures like change."

Regards,

David P.