The Post Wonderful Time of the Year: Top Posts of 2013

The Best…Around Time is fun when you are having flies. It seems like just yesterday that I started up this blog, and I am excited and humbled by the response I have gotten. Hearing praise from my audience keeps me hungry to learn and educate more. I am always curious to see which pages you enjoyed, and which were not so enjoyable; as it helps me tailor my writing a little bit more. And I’d have to say, I have a bunch of readers who like the nervous system 🙂 I am not sure what the next year will bring in terms of content, as I think the first year anyone starts a blog it is more about the writing process and finding your voice. Regardless of what is written, I hope to spread information that I think will benefit those of you who read my stuff. The more I can help you, the better off all our patients and clients will be. So without further ado, let’s review which posts were the top dogs for this year (and some of my favorite pics of course). 10.  Lessons from a Student: The Interaction This was probably one of my favorite posts to write this year, as I think this area is sooooooo underdiscussed. Expect to be hearing more on patient interaction from me in the future. 9) Clinical Neurodynamics Chapter 1: General Neurodynamics Shacklock was an excellent technical read. In this post we lay out some nervous system basics, and

Read More

Chapter 12: Lower Limb

This is a Chapter 12 summary of “Clinical Neurodynamics” by Michael Shacklock. Piriformis Syndrome Piriformis syndrome often involves the fibular tract of the sciatic nerve. It has the capacity to create symptoms from the buttock down to the anterolateral leg. Testing the neurodynamics with a fibular nerve bias is essential. To attempt to isolate this problem, we must best differentiate interface from neurodynamic components. Using Cyriax principles –palpation, contraction, and lengthening –can be beneficial in this regard. Keep in mind that below 70 degrees hip flexion the piriformis produces external rotation, and above 70 degrees it is an internal rotator. When treating this problem, the goal is to change pressure between the piriformis muscle and the sciatic nerve. Level 1a – Static opener VID – KF, ER Level 1b – Dynamic opener VID – Passive ER Level 2a – Closer mobilization using passive IR. VID – Passive IR Level 2b – We finish with a passive piriformis stretch VID – Tailor stretch If there is a neurodynamic component to things, slightly modify things by using sliders. We start things off with the same opener as the interface above.  As the patient progresses, you can add proximal or distal components eventually finishing with a fibular nerve-based slump. VID – Building the slump To combine interface and neural treatments, contract-relax can be utilized. Sciatic Nerve in the Thigh Oftentimes with hamstring strains, sciatic nerve sensitivity can increase. The slump and straight leg raise tests can be utilized to help differentiate a pure

Read More

Chapter 11: Lumbar Spine

This is a Chapter 11 summary of “Clinical Neurodynamics” by Michael Shacklock. Physical Exam The slump is the big dog for assessing lumbar spine complaints. Deciphering which movements evoke the patient’s symptoms can tell you a lot about the nervous system’s dysfunction: Neck flexion increases symptoms – Cephalid sliding dysfunction. Knee extension/dorsiflexion increases symptoms – Cauded sliding dysfunction. Both neck flexion and knee extension increase symptoms – Tension dysfunction. The straight leg raise is another important test that can help determine the nervous system’s state. Treatment The treatment parallels similar tactics as previous body areas. For reduced closing dysfunctions We start level 1 with static openers, progress to dynamic openers, then work to close. For opening dysfunctions, we progress toward further opening/contralateral lateral flexion. Neural Dysfunctions We treat these mechanisms based on which dysfunction is present. For cephalid sliding dysfunctions, we approach with distal to proximal progressions; and for caudad sliding dysfunction, we work proximal to distal Tension dysfunctions are started with off-loading mvoements towards tensioners Complex Dysfunctions Sometimes you can have interface dysfunctions that simultaneously have contradictory neurodynamic dysfunction. There are several instances of the case. Reduced closing with distal sliding dysfunction – Treat by combining closing maneuvers while perform active knee extension. Reduced closing with proximal sliding dysfunction – Address by closing maneuver with neck flexion. Reduced closing with tension dysfunction – This is treated with adding closing components to tensioners Reduced opening with distal sliding dysfunction – Here we add a dynamic opener along with leg movements. Reduced

Read More

Chapter 10: Upper Limb

This is a Chapter 10 summary of “Clinical Neurodynamics” by Michael Shacklock. Thoracic Outlet Syndrome (TOS) When discussing TOS pathoneurodynamics, you must talk about breathing. The brachial plexus passes inferolaterally between the first rib and clavicle. When inhalation occurs, the plexus bowstrings over the first rib cephalidly. So breathing dysfunctions can contribute to one’s symptoms. Excessive scapular depression can also contribute because the clavicle approximates the plexus from above. Clinically, TOS often presents as anteroinferior shoulder pain, with some cases passing distally along the course of the ulnar nerve.  A resultant upper trapezius/levator scapula hyper or hypoactivity can occur that may affect the neural elements. Treating the Interface Level 1 – Static Opener with breathing Level 2 – Static opener with rib mob during exhalation; progressing with scapular depression. Level 3 – Rib depression with sliders and tensioners. Pronator Tunnel Syndrome This syndrome consists of pain in the anteromedial forearm region with or without pins and needles. Symptoms are usually provoked by repetitive activities such as squeezing, pulling through the elbow, and pronation movements. From an interface perspective, pronator syndrome deals with excessive closing. So we will use openers to treat. Level 1 – Static opener combining 60-90 degrees of elbow flexion with forearm pronation Level 2 – Dynamic opener Treating neural components depends on the present dysfunction. There are the following possible dysfunctions: Distal sliding dysfunction – symptoms decrease with contralateral cervical flexion. Proximal sliding dysfunction – Symptoms increase with contralateral cervical sidebend and finger flexion. Tension dysfunction –

Read More

Chapter 9: Cervical Spine

This is a Chapter 9 summary of “Clinical Neurodynamics” by Michael Shacklock. Physical Exam The key tests you will want to perform include: Slump test. MNT 1. You can tier your testing based on one’s dysfunctions, such as opening or closing, as well as using sensitizers for less severe problems. Reduced Closing Dysfunction Level 1a – Static opener to increase space and decrease pressure in the intervertebral foramen. In the picture below, we would open the right side by combining flexion, contralateral sidebend, and contralateral rotation. Level 1b to 2b Reduced Opening Dysfunctions For these impairments, they are treated just the same as closing dysfunctions. The major difference is rationale. In closing dysfunction, the goal is to reduce stress on the nervous system. With opening dysfunctions, however, we are trying to improve the opening pattern. Static openers will generally not be used because these treatments could potentially provoke symptoms. Neural Dysfunction The gentlest technique is the two-ended slider, in which an ipsilateral lateral glide and elbow extension are performed. For tension dysfunctions, we go through the following progression:

Read More