Neurodynamic Treatment: Difference between revisions
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'''Position:''' Patient in long sitting with feet against the wall (to ensure ankle remains at 0° dorsiflexion). | '''Position:''' Patient in long sitting with feet against the wall (to ensure ankle remains at 0° dorsiflexion). | ||
Revision as of 20:27, 10 June 2022
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Original Editor - Lauren Heydenrych
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Description[edit | edit source]
Neural mobilization is a treatment modality of neurodynamics. Neurodynamic treatment falls within manipulative therapy - a group of techniques that aid in pain relief and restoration of function[1]Neural mobilization, as a treatment technique, was introduced nearly 30 years ago and comprised of 16 techniques, closely resembling neurodynamic tests.
Neural mobilisation generally consists of techniques termed neural glides or neural flossing. Neural stretching is also performed as a mobilisation technique. Although glides or flossing is also seen by some as a stretch, they are generally more dynamic in nature.[2]
Objectives of neural mobilisation[edit | edit source]
The main objectives of neural mobilisation are to:
- Achieve overall balance in the nervous system.
- Restore balance to the dynamic neural structures and the surrounding mechanical interfaces, by restoring the slide and glide of the nerves. This is performed through pressure relief on affected structures.[3] [4]
- Normalizing the intraneural environment (through 1. & 2.)
Median nerve glide[edit | edit source]
Indication[edit | edit source]
Various upper limb conditions including various upper limb nerve entrapment syndromes. For example, carpal tunnel syndrome, cubital tunnel syndrome and nonacute cervical radiculopathy.[2]
Procedure[5][edit | edit source]
Position: Patient supine on plinth. Shoulder 90° abduction and externally rotated. Forearm in supination. Wrist in neutral with fingers in supination.
Therapist: Restraint is placed across acromioclavicular joint to prevent shoulder girdle elevation during shoulder abduction. Extra support is placed under distal arm.
Procedure: For gliding techniques elbow and cervical movement are done towards the same direction – when right elbow is flexed, cervical lateral flexion to the left is performed.
For tensioning (stretching) techniques movement is done in the opposite direction – when the right elbow is extended, cervical lateral flexion to the left is performed. To complete the motion cervical flexion to the right is performed while right elbow is flexed.
Amplitude of range is done where no discomfort is felt.
Cervical lateral glide[edit | edit source]
Indication[5][edit | edit source]
Pain in the upper quarter. This includes the neck, shoulder, arm, upper back and/or chest. This pain may or may not be associated with headache.
In addition, positive signs including:
- Active movement dysfunction
- Passive movement dysfunction
- Adverse responses to neural provocation tests
- Hyperalgesic responses to palpation of related cutaneous tissues
- Evidence of related local area of pathology
Procedure[5][edit | edit source]
Position: Patient supine. The shoulder slightly abducted, with a few degrees of medial rotation. Elbow flexed to 90° so that patient's hand rests on their chest/ abdomen.
Therapist: Supporting the shoulder over the acromial region with one hand. With the other hand supports the head and neck.
Movement: Gentle, controlled lateral glide to the contralateral side of pain in a slow oscillating manner up until the point of range where resistance is felt by therapist. This is before pain.
Shoulder girdle oscillation[edit | edit source]
Indication[5][edit | edit source]
As with Cervical lateral glide.
Procedure[5][edit | edit source]
Patient position: Prone. The involved arm is comfortably supported by the physiotherapist towards a position of hand behind the back.
Therapist: Holding patient's one hand behind the back, the other hand over the acromial area.
Movement: Gentle oscillation of the shoulder girdle in a caudad - cephalad direction. The range is done to the onset of initial resistance palpated by therapist in caudad direction.
Progression: Gradually increasing amount of hand behind the back position
Slump stretching[edit | edit source]
Indication[edit | edit source]
Most often this technique is used for individuals who suffer from lower back pain (LBP), non radicular in nature and display mild to moderate mechano sensitivity (often more distal in nature).
This sensitivity can be tested through the slump test and the straight leg raise (SLR) test.
Procedure[edit | edit source]
Position: Patient in long sitting with feet against the wall (to ensure ankle remains at 0° dorsiflexion).
Therapist: Applies over-pressure into cervical spine flexion to the point where symptoms are reproduced.
Duration: The position is held for 30 seconds.
Repetition: 5x.
As a home exercise program[edit | edit source]
Done as a self stretch.
Position: Patient in long sitting with feet against the wall.
Patient provides own over-pressure with upper extremities until symptoms are reproduced.
Duration: The position is held for 30 seconds.
Repetition: 2x.
Straight leg raise[edit | edit source]
Indication[edit | edit source]
The same as for the slump stretch/ glide.
Procedure 1[11][edit | edit source]
Position: Patient lies supine on the plinth.
Therapist: The therapist passively raises the patient's leg into a SLR until the initial onset of pain. Hip is then flexed and extended in a small range of motion (Gr IV).
Duration: 2 min (with 1 minute rest in-between sets)
Repetition: 3 sets
Procedure 2[12][edit | edit source]
Position: Patient in side lying. Leg to be worked, on top.
Therapist: supports leg and oscillates joints: knee extension, hip flexion and ankle dorsiflexion.
Duration: 10 X
Repitition:3 X
Resources[edit | edit source]
An article demonstrating different neural glide techniques: Different Nerve-Gliding Exercises Induce Different Magnitudes of Median Nerve Longitudinal Excursion: An In Vivo Study Using Dynamic Ultrasound Imaging
References[edit | edit source]
- ↑ Vicenzino B, Collins D, Wright A. The initial effects of a cervical spine manipulative physiotherapy treatment on the pain and dysfunction of lateral epicondylalgia. Pain. 1996 Nov 1;68(1):69-74.
- ↑ 2.0 2.1 COPPIETERS M. Hough A. Dilley A. Different Nerve-Gliding Exercises Induce Different Magnitudes of Median Nerve Longitudinal Excursion: An In Vivo Study Using Dynamic Ultrasound Imaging. Journal of Orthopaedic and Sports Physical Therapy. 2009 [cited at 31 May 2022]. Available from: https://www.jospt.org/doi/pdf/10.2519/jospt.2009.2913
- ↑ Ellis RF, Hing WA. Neural mobilization: a systematic review of randomized controlled trials with an analysis of therapeutic efficacy. Journal of manual & manipulative therapy. 2008 Jan 1;16(1):8-22
- ↑ Russel J. Neural Manipulation: Hands-on work to promote nerve tissue health. iahe.com. Available from: https://www.iahe.com/docs/articles/261-neural-manipulation.pdf. (Accessed 31 May 2022)
- ↑ 5.0 5.1 5.2 5.3 5.4 Allison GT, Nagy BM, Hall T. A randomized clinical trial of manual therapy for cervico-brachial pain syndrome–a pilot study. Manual therapy. 2002 May 1;7(2):95-102.
- ↑ Southlake Hand Therapy. Tendon Gliding. Available from: https://www.youtube.com/watch?v=dUhjUBAQv30[09/06/2022]
- ↑ Physio Plus Fitness. C-spx lateral glide for nerve root pathology. Available from: https://www.youtube.com/watch?v=nwELtKGnjrI [last accessed 09/06/2022]
- ↑ AthleteFIX. Cervical Spine Lateral Glide. Available from: https://www.youtube.com/watch?v=vFn1lukU3hQ [last accessed 09/06/2022]
- ↑ Physiotutors. Lower Limb Neurodynamic Techniques Sliders & Tensioners. Available from: https://www.youtube.com/watch?v=WXzf8gxYQ2o [last accessed 09/06/2022]
- ↑ NASSspine. Lumbar Nerve Flossing. Available from: https://www.youtube.com/watch?v=GPPtVFmI4kA [last accessed 09/06/2022]
- ↑ Hanney RN, Ridehalgh C, Dawson A, Lewis D, Kenny D. The effects of neurodynamic straight leg raise treatment duration on range of hip flexion and protective muscle activity at P1. Journal of Manual & Manipulative Therapy. 2016 Jan 1;24(1):14-20.
- ↑ Čolaković H, Avdić D. Effects of neural mobilization on pain, straight leg raise test and disability in patients with radicular low back pain. Journal of Health Sciences. 2013 Sep 15;3(2):109-12.
- ↑ Paul Marquis. Sciatic Nerve Flossing-How and When to Perform. Available from:https://www.youtube.com/watch?v=tr88uGR5w80 [last accessed 10/06/2022]
