The Sensitive Nervous System Chapter I: Painting a Bigger Canvas

This is a summary of Chapter I of The Sensitive Nervous System.

This book is an all-encompassing manual regarding neurodynamics. This concept is defined as the physical and related physiological abilities of the nervous system.

Before delving into neurodynamic nitty-gritty, a brief history of physical therapy is laid out via a very cool brachial plexus design (you have to get the book to see it). There are three different progressions in physical therapy history: manual therapy, exercise, and neurological manual therapy.

The first time PTs learned manipulation was in 1916 at St. Thomas Hospital in London. The thought process of the time, as well as most early manual therapy, was predominantly biomechanically joint-centric. Eventually, muscle and other tissues were targeted. These approaches were championed by Geoffrey Maitland’s signs and symptoms approach and Graves’ pathological model.

Apparently clothing was also optional back then.

Concomitant with manual therapy has been exercise, which had moved from nonspecific (aerobics, tai chi) to specific movements a la Vladimir Janda and Shirley Sahrmann.

On the other side of orthopedic manual therapy were manual techniques from the likes of Bobath’s NDT and PNF. What is sad about these techniques is that they have not interacted much during manual therapy’s development. Butler makes arguably one of the most important statements in the book by saying our patients are ultimately all neurological. We will all meet at the brain.

Always the structure at fault.

Aside from various manual approaches, recent techniques have been developed including psychology, counseling, exercise physiology, and acupuncture. Butler feels these are nice adjuncts to the plan of care.

The key manual therapy points Butler wishes to make are as follows.

1)      Manual therapy is young, slightly over 2 generations.

2)      In this short time frame, rapid change has occurred.

3)      Relies heavily on tissue, usually muscle or joint.

4)      Know your roots. (Study yo history y’all).

You can have many techniques, as long as it fits in a framework.

Neurodynamics is not a new approach. Tension tests were mentioned as early as 1929. Butler argues that all the tissue techniques that manual therapy advocates have unconsciously encouraged the nervous system to move.