This is a summary of Chapter X of “The Sensitive Nervous System” by David Butler.
When assessing neurodynamics, there is a general system that is used including the following tests:
- Passive neck flexion (PNF).
- Straight leg raise (SLR).
- Prone knee bend (PKB).
- 4 different upper limb neurodynamic tests (ULNT).
I will demonstrate these tests for you in later chapters.
Many clinicians when discussing the lower extremity-biased tests deem that maybe only one or two of the tests need to be performed, however this assertion is erroneous. Slump, SLR, and PNF all need to be tested as a cluster. The reason being is that the clinical responses may often differ.
This difference is especially noticeable when comparing the SLR and the slump. These two are not equal tests for the following reasons:
- Components are performed in a different order.
- Spine position is different.
- Patients may be more familiar with the SLR, therefore give more familiar responses.
- The patient is in control during the slump, not in the SLR.
- The slump is more provocative.
Rules of Thumb
When testing neurodynamics, here are the following guidelines:
1) Active before passive.
2) Differentiate structures – add/subtract other movements to see if symptoms can change.
3) Document the test order.
The positive testing here is a little dated based on what Butler’s group and the research says as of right now. Based on what I have learned from Adriaan Louw, having any of the following is what constitutes a positive test.
- Symptom reproduction.
- Gross range of motion asymmetry between sides.
- Gross sensitivity asymmetry between sides.
There are several pieces to look at when determining potential sources of neural findings.
- Area: Cutaneous zones generally nerve trunk; dermatome generally nerve root.
- Motor loss: Reflex loss is usually the nerve root; specific motor loss can be the root or trunk.
- Patient history.
- Palpation: Generally how to find AIGS.
- The movement exam: Good at showing neural container dysfunction.
There are several unexpected responses that often have very rational explanations.
- Release worsens, addition is better: Likely a neural container problem.
- Ulnar symptoms with ULNT1 (a median nerve test): Tests are crude, and could have an anatomical variance.
- Bizzare pain responses.
- Multiple positive tests: Generally treat the least sensitive.