This is a Chapter 8 summary of “Clinical Neurodynamics” by Michael Shacklock. Let’s Treat the Interfaces The two main ways to treat interfaces involve opening and closing techniques. These treatments involve either sustained or dynamic components. We will discuss which techniques work best in terms of dysfunction classification. – Reduced Closing Dysfunction – Given static openers early in this progression, continuing to increase frequency and duration. Eventually you move to more aggressive opening techniques, while finishing with closing maneuvers. – Reduced Opening Dysfunction – Start with gentle opening techniques working to further increasing the range. – Excessive Closing and Opening Dysfunctions – Work on improving motor control and stability. How About Neural Dysfunctions The main treatments are sliders and tensioners; each can be performed as one or two-ended. Sliders ought to be applied when pain is the key symptom. Sliding may milk the nerves of inflammation and increase blood flow. These techniques could also be used to treat a specific sliding dysfunction. Sliders can be performed for 5 to 30 reps with 10 seconds to several minute breaks between sets. Increased symptoms such as heaviness, stretching, and tightness is okay, but pain should not occur afterwards. Typically sliders are performed in early stages, and in acute situations should occur away from the offending site. Tensioners are reserved for higher level tension dysfunctions. The goal is to improve nerve viscoelasticity. Some symptoms are likely to be evoked, but this occurrence is okay as long as symptoms do not last. Tensioners are
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Chapter 7: Standard Neurodynamic Testing
This is a Chapter 7 summary of “Clinical Neurodynamics” by Michael Shacklock. Passive Neck Flexion With this test, the upper cervical tissues slide caudad, and the lower cephalid. The thoracic spine moves in a cephalid direction as well. Normal responses ought to be upper thoracic pulling at end-range. Abnormal symptoms would include low back pain, headache, or lower limb symptoms. Median Neurodynamic Test 1 (MNT1) This test, also known as the base test, moves almost all nerves between the neck and hand. Normal responses include symptoms distributed along the median nerve; to include anterior elbow pulling that extends to the first three digits. These symptoms change with contralateral lateral flexion and less often ipsilateral lateral flexion. Anterior shoulder stretching can also occur. Ulnar Neurodynamic Test (UNT) This test biases the ulnar nerve, brachial plexus, and potentially the lower cervical nerve roots. Normal responses include stretching sensations along the entire limb, but most often in the ulnar nerve’s field. Median Neurodynamic Test 2 (MNT2) This version biases the lower cervical nerve roots, spinal nerves, brachial plexus, and median nerve. Normal responses would be similar to MNT1. Radial Neurodynamic Test (RNT) This test looks predominately at radial nerve, as well as the nerve roots. It is uncertain if this test biases any particular nerve root. Normal responses include lateral elbow/forearm pulling, stretch in the dorsal wrist. Axillary Neurodynamic Test (ANT) This test tenses the axillary nerve, though may not be specific. Normal responses include posterolateral shoulder pulling with about 45-90 degrees of
Read MoreChapter 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 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.
Read MoreCourse Notes: Mobilisation of the Nervous System
I Have an Addiction It seems the more and more that I read the more and more and read the more and more addicted I become to appreciating the nervous system and all its glory. To satisfy this addiction, I took Mobilisation of the Nervous System with my good friend Bob Johnson of the NOI Group. This was the second time I have taken this course in a year’s span and got so much more value this time around. I think the reason for this enrichment has been the fact that I have taken many of their courses prior and that I prepared by reading all the NOI Group’s books. A course is meant to clarify and expand on what you have already read. So if you are not reading the coursework prior, you are not maximizing your learning experience. What made this course so much more meaningful was being surrounded by a group of like-minded and intelligent individuals. As many of you know, I learned much of my training through Bill Hartman. Myself, Bill, the brilliant Eric Oetter and Matt Nickerson, my good friend Scott, and my current intern Stephanie, all attended. When you surround yourself with folks smarter than you, the course understanding becomes much greater. This course was so much more with the above individuals, so thank you. Try to attend courses with like-minded folks. Here are the highlights of what I learned. If you would like a more in-depth explanation of these concepts, check out my
Read MoreThe Sensitive Nervous System Chapter XII: Upper Limb Neurodynamic Tests
This is a summary of Chapter XII of “The Sensitive Nervous System” by David Butler. Intro Today we will take a look at assessing upper limb neurodynamic tests (ULNT). These assessments used to be called tension tests, but that terminology is now a defunct mechanical description. We now describe these as neurodynamic tests to better appreciate the neurophysiologic aspects of mechanosensitivity and upper limb homunculi stability. These tests are numbered based on the movement sensitizer, which are as follows: 1 – Shoulder abduction. 2 – Shoulder depression. 3 – Elbow flexion. ULNT1: Median Nerve Here is the quick test first. Here is how to do the manual test. A quick heads up regarding head motions. Sidebending away increases symptoms in 90% of people. Sidebending toward decreases symptoms in 70% of people. ULNT2: Median Nerve Here is the manual test ULNT2: Radial Nerve Here is the active test. And the manual test. ULNT3: Ulnar Nerve Here is the active test And the manual test. Musculocutaneous Nerve Here is the active test And the passive test. Axillary Nerve Here is the passive test. Suprascapular Nerve Here is the test. Final Words Have some fun with these tests, and be mindful that you are not too aggressive. Thanks to Scott and Sarah for your videotaping help. You guys rock.
Read MoreThe Sensitive Nervous System Chapter X: Neurodynamic Tests in the Clinic
This is a summary of Chapter X of “The Sensitive Nervous System” by David Butler. The Tests 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). Slump. 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. Positive Test 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
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