Execution
- 1Position the patient supine and record the baseline standard SLR response.
- 2Perform a proximal initiation sequence by flexing the hip with the knee extended before adding distal sensitizers such as ankle dorsiflexion.
- 3Perform a distal initiation sequence by first positioning the ankle and foot into the chosen sensitizing position, then adding hip flexion.
- 4Compare the angle, symptom location, and sequence at which symptoms begin.
- 5Release one component at a time to confirm whether symptoms are mechanically sensitized.
Positive outcome
The test is positive when the patient’s familiar symptoms are reproduced and the symptom response changes according to whether loading is initiated proximally or distally. Earlier symptoms with distal initiation may suggest greater distal neural mechanosensitivity or peripheral nerve contribution. Earlier symptoms with proximal initiation may suggest a more proximal nerve-root or disc-related driver.
CommentMagee describes neurodynamic testing as sequence-dependent and note that neural tissue moves toward the joint where movement is initiated. The distal / proximal initiation framing is a clinical reasoning modification rather than a validated diagnostic test. Record the exact sequence because changing the order changes the meaning of the result.
Low Clinical Value