Neurodynamic Treatment

Original Editor - Lauren Heydenrych Top Contributors - Lauren Heydenrych and Kim Jackson  

Description[edit | edit source]

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 assessment. Neurodynamic assessment is used to evaluate the length and mobility of the components of the nervous system.

Neural mobilization 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:

  1. Achieve overall balance in the nervous system.
  2. 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]
  3. Normalizing the intraneural environment (through 1. & 2.)

Median nerve glide[edit | edit source]

Indication[edit | edit source]

The median nerve glide is indicated for 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[edit | edit source]

Position: Patient supine on plinth. Shoulder in 90° abduction and externally rotated. Forearm in supination. Wrist in neutral with fingers in supination.[5]

Therapist: Restraint is placed across acromioclavicular joint to prevent shoulder girdle elevation during shoulder abduction. Extra support is placed under distal arm.[5]

Procedure: See picture opposite.[5]

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. Diagram A.

Median Nerve glides and stretches

For tensioning (stretching) techniques movement is done in the opposite direction – For example, 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. Diagram B.

Diagram C. and D. depict extension of the elbow with head held in a laterally flexed position away from the arm being extended (C.) and towards the arm being extended (D.)

Diagram E. and F. depict lateral flexion of the neck while the arm is kept in a more extended position (E.) or a more flexed position (F.).

Amplitude of range is done in the range where no discomfort is felt.


Radial nerve glide[edit | edit source]

Indication[edit | edit source]

Tingling down the thumb side of the forearm, caused by pressure on the nerve.[6]

Procedure[edit | edit source]

Position: Patient stands in a relaxed position.

Therapist: Guides patient through the movement; uses verbal or tactile cues.

Procedure:[6] Depress shoulder, flex wrist, internally rotate wrist, add lateral and cervical flexion, finally add wrist flexion as shoulder is extended.

Movement should be done until gentle tension, with no pain involvement.


Ulnar nerve glide[edit | edit source]

Guyon syndrome pain distribution.jpg

Indication[edit | edit source]

Pain or dysfunction in the ulnar nerve distribution. This includes ulnar nerve entrapment.

Procedure[edit | edit source]

Position: Patient stands relaxed.

Therapist: Provides verbal and tactile cueing.


1. Shoulder forward flexed, elbow extended, wrist and fingers flexed. Slowly move fingers and wrist into extension while keeping the elbow straight. As a second movement, flex the elbow while keeping wrist and fingers extended.

2. Now move arm into an abducted position (out to the side of the body), gently flex the wrist, externally rotate the arm, and gently laterally flex the neck in the contralateral direction.

Another procedure for mobilizing the ulnar nerve can be found in the video below:


Cervical lateral glide[edit | edit source]

Indication[10][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:

Procedure[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.[10]

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 the therapist. This is before pain.

Shoulder girdle oscillation[edit | edit source]

Indication[edit | edit source]

As with Cervical lateral glide.[10]

Procedure[edit | edit source]

The procedure for shoulder girdle oscillation is as follows:[10]

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 stretch[edit | edit source]

Indication[edit | edit source]

The same as for the slump stretch/ glide.

Procedure[edit | edit source]

Two procedures can be described for the lower limb and are as follows:

Procedure 1[15]

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[15]

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]

  1. 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. 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:
  3. 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
  4. Russel J. Neural Manipulation: Hands-on work to promote nerve tissue health. Available from: (Accessed 31 May 2022)
  5. 5.0 5.1 5.2 5.3 Southlake Hand Therapy. Tendon Gliding. Available from:[09/06/2022]
  6. 6.0 6.1 New England Hand Associates. Radial Nerve Gliding 2017.
  7. Paul Marquis under Ortho EVAL PAL. Radial Nerve Gliding/Sliding Exercises. Available from: [last accessed 29/06/2022]
  8. New England Hand Associates. Ulnar Nerve Gliding 2017.
  9. Paul Marquis under Ortho EVAL PAL. Ulnar Nerve Gliding/Sliding Exercise Video. Available from: [last accessed 29/06/2022]
  10. 10.0 10.1 10.2 10.3 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.
  11. Physio Plus Fitness. C-spx lateral glide for nerve root pathology. Available from: [last accessed 09/06/2022]
  12. AthleteFIX. Cervical Spine Lateral Glide. Available from: [last accessed 09/06/2022]
  13. Dr. Matthew Rome and Equilibrium Physical Therapy through Physical Therapy Nation How to Perform Lower Extremity Nerve Glides. Available from: [last accessed 09/07/2022]
  14. NASSspine. Lumbar Nerve Flossing. Available from: [last accessed 09/06/2022]
  15. 15.0 15.1 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.