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 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.
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My 50th Post: Motivation to Learn
A Little Personal It is hard to believe that I have already written my 50th post after starting this blog in February as a way to enhance both my learning and the learning of others. This blog has allowed me to interact with a variety of different individuals that I otherwise would not have. And when people who I deeply respect say they admire what I have to say (or at least my version of what other people say), I am deeply humbled. But I have had several cases in which people wondered if I do anything other than physical therapy and personal training (I do). One of my former mentors came up to me saying that she was worried about me because of how much I am into this. These interactions have made me reflect on why I am reading, working, writing, and learning as much as I can. Thus, I have come to some conclusions as to what drives me to help others. And this drive, while not the norm that some of my peers are accustomed to, is far from wrong. Others are Depending on You When you work as a health professional, some people neglect the fact that your patients and clients trust their bodies with you. They put their confidence in your knowledge and skills to show them the path to bettering themselves. When someone puts this amount of trust into me, the last thing I want to do is let them down. So I
Read MoreWhy Everything Works (and Doesn’t Work)
A Great Place to Be I was recently at my home away from home, IFAST. Every time I go here the following occurs: I have an amazing time with amazing people. I learn a ton and realize how little I really know. Prolific discussions are had. I end up purchasing WAY too many books as soon as I get home. As many of you know, Bill Hartman and I appreciate a PRI philosophy. When I go to IFAST, we inevitably experiment with many different things. This weekend, Bill and I were playing with how many different ways we could achieve full right shoulder internal rotation on my good friend Lance and the lovely IFAST intern Liz. Here was everything that gave these people full motion. Soft tissue mobilization to the infraspinatus. Manually assisted breathing. Tickling the right side of the face. Tapping the left hamstring. Smacking the right glute max (yes, I spanked someone). Having someone think about contracting their right glute max as hard as possible. Having someone watch me breathe with a left sidebend. Reflex locomotion. Now of course, that does not mean you should be spanking your patients and clients with shoulder issues (but if you do make sure it is the right glute), but we have to ask why did all of these different techniques–even the weird ones– achieve the same outcome we wanted? Why Things Work Joseph Brence, a gentleman whose material I enjoy, recently posted a blog showing several different techniques and polling his
Read MoreLessons from a Student: The Brain
Oh It’s On Believe it or not, I currently have someone interning with me for the next 12 weeks which is has led me to thinking about many things: 1) People trust me with the youth of America? 2) I have to justify what I am doing now? 3) I hope I can teach her something. It has been a great and even nostalgic experience thus far. I remember just a couple years ago being in this young lady’s shoes having the same successes, failures, and questions she has now. I think working with me may have been quite a difference from the scholastic framework that she was accustomed to. This difference is because our common theme for the week was wait for it…………………………………….The Brain. Most schools, especially in the orthopedic realm, teach about developing physical therapy diagnoses and treating various pathologies. However, we had a couple different cases in which we didn’t necessarily nail down a pathology yet got fantastic results. Case 1 The first patient we saw was a lovely middle-aged woman who was classic for the biopsychoscial treatment model I espouse. She comes into seeing us with chronic low back pain over the past 3 years, has had several TIAs, been diagnosed with an eating disorder, and generally lives a stressful life. Our comparable sign for the day was flexion which was at 50% range and painful (or DP for you functional movement folks out there). We discuss what we think is going on and the first
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