Chapter 5: Diagnosis with Neurodynamic Tests

This is a Chapter 5 summary of “Clinical Neurodynamics” by Michael Shacklock.

Neurodynamic Tests

In neurodynamic tests, there are two movement types:

1)      Sensitizing: Increase force on neural structures.

2)      Differentiating: Emphasizing nervous system by moving the neural structure as opposed to musculoskeletal tissue.

The reason why sensitizers are not considered differentiating structures is because they also move musculoskeletal structures. Examples of sensitizing movements include:

  • Cervical or lumbar spine contralateral lateral flexion.
  • Scapular depression
  • Humeroglenoid (HG) horizontal extension
  • HG external rotation
  • Hip internal rotation
  • Hip adduction
Nipples are not a sensitizer, even if they are very sensitive.
Nipples are not a sensitizer, even if they are very sensitive.

Interpreting

The ability to interpret neurodynamic findings is crucial when determining the nervous system’s involvement.  Findings such as asymmetry, symptoms, and increased sensitivity are all important. But to implicate neurodynamics, structural differentiation ought to be performed.

Just because there is a positive test does not mean that it is relevant to the patient’s complaints. There are several ways to classify findings:

  • Negative structural differentiation: Implicates musculoskeletal response.
  • Positive structural differentiation: Implicates neurodynamic response.

Neurodynamic responses can have different interpretations:

  • Normal: Fits normal responses per literature.
  • Abnormal: Differ from normal responses. Can be broken down further into…
    • Overt abnormal responses: Symptoms reproduction.
    • Covert abnormal response: No symptoms, but may have other subtle findings such as asymmetry, abnormal location, and/or different resistance.

From here, one must determine if the findings are relevant or irrelevant to the condition in question. You may also come across subclinical findings, in which the neurodynamic test is related to a minor problem that may become major at some point.

You gotta know what yo prollem is...mang.
You gotta know what yo prollem is…mang.