Chapter 6: Planning the Physical Examination

This is a Chapter 6 summary of “Clinical Neurodynamics” by Michael Shacklock. Observe When assessing the patient, you must look at the following information: Symptom location, extent, quality, and behavior. Movement resistance. Range of motion. Compensatory patterns. Breathing quality. Tone of voice. Facial expression Protective muscle tone. Avoidance. When planning the exam, you can tier to what extent you ought to assess someone. Level 0: neurodynamics are contraindicated for physical or psychosocial reasons. Level 1: Limited exam where symptoms are minimally provoked. Full neurodynamic tests are not performed, and are tested separately from musculoskeletal structures. The neurodynamic tests are performed with relieving-based structural differentiation. Level 1 is indicated when… Symptoms are easily provoked and take a long time to settle after movement. Severe or latent pain is present. Potential pathology. Neurological deficit. Progressive worsening prior to exam. Level 2: Standard examination in which neurodynamics, interfaces, and innervated tissue are tested separately. Standard neurodynamic sequences are used and symptoms can more readily be brought on. Level 2 is indicated when… Less severe, latent, or easily provoked symptoms. Absent/minor neurological symptoms. Stable problem that is not rapidly deteriorating. Level 3: It’s gettin’ real. Here we see greater force localization and sequences that start at the problem. Sensitizers are often used as well. Level 3 is indicated when… Level 2 exam is normal or provides insufficient information. Symptoms are not severe or easily provoked. Problem is stable. No evidence of pathology. There are four examination types here: 3a) sensitizers are added. 3b) Begin

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