Chapter 8: Method of Treatment: Systematic Progression

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

Read More

Course 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 More

Chapter 2: Specific Neurodynamics

This is a Chapter 2 summary of “Clinical Neurodynamics” by Michael Shacklock. Intro Specific neurodynamics include local effects of body movements on the nervous system. So today we will go through each body region discussing these. The Spine Here are some interesting tidbits regarding the spine and neurodynamics. When we flex the spine, the spinal canal elongates by about 9 cm. Neck flexion creates significant tension to the lumbosacral nerve roots. Neural structures slide relative to the bony interface differently depending on the location and the movement used. Flexion increases tension, but reduces compression. Extension adds compression, but reduces tension. Lateral flexion increases tension on the convex/contralateral side of the spine. This situation occurs by interface and neural tissue elongation and increased distance between the spine and periphery. Rotation closes on the ipsilateral side and opens on the contralateral side. The spinal cord tends to move towards various specific segments. These areas are termed zones of convergence, and these areas include C5-6 and L4-5.  For example, tissues above C5-6 will slide toward this zone, as will tissues below this segment. The midpoint at which tissues diverge is at T6. At this point, tissues below T6 will converge towards L4-5, and tissues above T-6 will converge to C5-6. Gravity can also play a role in neurodynamics. For example, if you perform a SLR in sidelying, the downward side usually has less mobility.  This difference occurs because the neural contents are convex on the downward side and convex on the upper side,

Read More

The Sensitive Nervous System Chapter XV: Clinical Aspects of Neurodynamics

This is a summary of chapter XV of “The Sensitive Nervous System” by David Butler. Intro In this chapter we discuss many specific neurodynamic pathologies and implementing the nervous system into treatment approach. Conservative Nervous System Decompression Here is a general step-by-step approach to decreasing threat throughout the nervous system. 1)      Decrease tissue sensitivity by removing relevant stimuli and decreasing CNS threshold. 2)      Improve container tissue health. 3)      Improve the nerve tract’s ability to absorb traction forces. 4)      Assess and improve the nerve to container relationship. 5)      Assess/modify any adverse ergonomic or environmental factors. Carpal Tunnel Syndrome Tests to perform. ULNT1 & reverse. ULNT2 (median) & reverse. Compression (can add ULNT). Phalens and reverse Phalens. Phalens + ULNT. Treatment There are several options to treat carpal tunnel syndrome. Mobilizing not only the median nerve, but radial and ulnar is beneficial because the nerves are closely connected. Movement is critical because nerve inflammation and swelling does not leave the carpal tunnel easily. This problem is because there are minimal lymphatic channels in the tunnel. Nerve Root Complex Nerve root issues often have corresponding postural adaptations. Cervical – forward head posture. Lumbar – Flat lumbar spine with knees flexed, positioned toward the injured sign. In acute instance, it may be okay to let the patient rest in these antalgic postures until AIGS settle. Other presentations indicative of nerve root complex pathology include numbness/tingling down the extremities. Other possibilities include coldness, shooting, tiredness. Pain rarely goes into the extremities. Double Crush Double crush

Read More

The Sensitive Nervous System Chapter XIV: Management Strategies: Integration of Neurodynamics

This is a summary of chapter XIV of “The Sensitive Nervous System” by David Butler. The Big Picture Evidence Based Approach Here is the step by step patient care process that Butler advocates. 1)      Identify red flags and manage accordingly. 2)      Educate on the whole problem to include tissue health status, the nervous system’s role, and test results. 3)      Provide prognosis and make realistic goals. 4)      Promote self-care, control, and motivation. 5)      Decrease unnecessary fear and manage catastrophization. 6)      Get patients moving as early as possible. 7)      Help patients identify success and sense of mastery of a problem. 8)      Perform a skilled exam. 9)      Acknowledge that biopsychosocial inputs combine with the nervous system to produce pain and disability. 10)   Use any measures possible to reduce pain. 11)   Minimize number of treatments and contacts with all medical personnel. 12)   Chronic pain may need a multidisciplinary approach. 13)   Manage physical function and dysfunction. 14)   Assess and assist in improving general fitness. 15)   Assess how injury affects creative outlets and assist the patient with regaining creativity and discovering new creative outlets. Incorporating Neurodynamics There are several ways to incorporate neurodynamics into the patient’s plan of care which will be outlined below. Reassessment. Explanation. Passive mobilization. Active mobilization. Posture and ergonomics. Reassessment There are many evaluation protocols that warrant constant reassessment after applying an intervention. Be it a comparable sign or audit, neurodynamic tests can be utilized well within these systems. A word of caution with instant reassessment, as quick changes could merely be

Read More