Chapter 11 - Neurodynamic Mobility/Mobilizations Flashcards
Neurodynamics
Study of the mehcanics and physiology of the nervous system
Three mechanisms of nerve adaptability
1) elongation of the nerve against elastic forces up to 2 cm
2) longitudinal movement of the nerve trunk in the longitudinal direction
3) increase/decrease of tissue relaxation at level of nerve trunk
Tension Sites
Areas where dura is tethered to the bony canal providing stability to the spinal cord, at C6, T6, and L4
What can cause injury to the spine and spinal nerves?
Posture, direct trauma, extremes of motion, electrical injury and compression
What are double crush injuries?
A compromise of axonal transport along the same nerve fiber causing a lesion at the distal site to become symptomatic (must be anatomic continuity of nerve fibers between two sites)
Neurodynamic Mobility Examinations include…
Upper Limb Tension Test
Straight Leg Raise
Prone Knee Flexion Test
Slump Test
Positive symptoms for the presence of neuropathic dysfunction include…
Pain
Paresthesia
Spasm
(must reproduce patient’s symptoms AND decrease those symptoms with movement of distal body part)
What can the slump test indicate?
Spinal stenosis, extraforaminal lateral disk herniation, disk sequestration, nerve root adhesions, vertebral impingement
How does the slump test work?
Elongates the vertebral canal, stretching the spinal dura. Tension is transmitted to spinal cord, lumbosacral nerve roots. When cervical flexion is added, dura slackens as the vertebral canal shortens
Sequence for Slump Test
- Pt in sitting with hands behind back
- C spine flexed
- slump of thoracic, lumbar and posterior tilt of pelvis
- knee extension
- ankle dorsiflexion
- gentle cervicothoracic overpressure
What indicates a positive slump test?
If the patient’s symptoms are reproduced and once put into cervical extension, the symptoms subside
What are the LE tension tests?
SLR, crossed SLR, bilateral SLR, bowstring test, sciatic nerve test, prone knee bending test
How do you perform a SLR?
- pt is supine (no pillow)
- trunk/hips should be neutral
- passively raise leg with slight IR and ADD of hip, knee extended
- hold at heel, and stabilize ASIS with other hand
- raise until complains of pain
- note ROM and lower leg slightly until symptoms resolve
Pain in 0-30 degrees of SLR may indicate…
Acute spondylolisthesis tumor of the buttock gluteal abscess large HNP or extrusion acute inflammation of dura malingering patient the sign of the buttock
Pain in 30-70 degrees of SLR may indicate…
Spinal nerves, dura sleeves and their roots are stretched 2-6 mm
Pain after 70 degrees of SLR may indicate…
Hamstrings, gluteus maximus, hip, lumbar, SIJs
What indicates a positive SLR test?
If ROM is limited to less than 70 degrees of ROM with spasm (suggesting compression or irritation of nerve).
If patient’s pain is reproduced and is neurologic in nature.
NOTE: back pain alone is NOT a positive SLR
What are ways to sensitize the SLR test?
- Passive ankle dorsiflexion (Braggard’s Test)
- Passive cervical flexion (Soto-Hall Test)
- Increased IR or ADD of hip
How to determine if Tibial Branch is irritable
SLR + ankle dorsiflexion, foot eversion and toe extension
How to determine if Sural Nerve is irritable
SLR + ankle dorsiflexion and inversion stress
How to determine if Common Fibular Nerve is irritable
SLR + plantarflexion and inversion stress
What are some possible conclusions if SLR is negative but slump test is positive?
- soft disk protrusion
- acute spondylolisthesis
- posterior instability
- malingering patient
- nonorganic symptoms
3 Types of Crossed SLR Sign
1) SLR that produces contralateral leg pain, but not when contralateral leg is raised
2) SLR that produces pain in both legs
3) SLR of either leg that produces contralateral pain
What findings are strongly predictive of a disc herniation?
- severely limited SLR
- positive crossed SLR
- severely restricted/painful trunk movements
Crossed SLR is highly specific, more significant than SLR in terms of diagnosing…
Large disk protrusion
What does bilateral SLR detect?
Central disc protusion
can add cervical flexion and/or dorsiflexion to sensitize
How to Perform Bicycle Test of Van Gelderen
- Pt on bike pedaling against resistance
- Intermittent claudication of LE and intermittent cauda equina compression pts will experience increase in symptoms
- Lateral spine stenosis will not
- Central disc protrusion fairs well if lumbar spine extended (if flexed, will increase symptoms)
Bowstring test is a strong indicator of ______ and only needs to be performed if ______.
HNP, SLR is positive with addition of ankle dorsiflexion
How to Perform Bowstring Test
- perform SLR to point of reproduction of symptoms
- rest patient’s LE on shoulder and lower leg to where symptoms resolve
- apply pressure to popliteal fossa
- positive test = symptoms reproduced
- negative test = no true symptoms
What does the Prone Knee Bending Test indicate?
Indicates presence of upper lumbar disk HNP, stretches the femoral nerve
How to Perform Prone Knee Bending Test
- patient prone
- stabilize ischium to prevent anterior rotation of pelvis
- LE is move gently into knee flexion until reproduction of pain
- positive = reproduce symptoms
- negative = no reproduction
Parameters for all ULTTs
- question patient prior to test and as each segment is added
- should only be performed until patient’s symptoms reproduced
- at this point, test stops, and cervical sidebending to same side added to see if symptoms subside
- compare to contralateral side
ULTT 1
Median Nerve
- pt supine
- clinician depresses shoulder
- abducts UE to 110 degrees
- supinate forearm
- extend elbow
- extend wrist
- extend fingers
ULTT 2
Radial Nerve
- pt supine
- clinician depresses shoulder
- abducts shoulder 30 degrees
- IR shoulder
- pronate forearm
- extend elbow
- flex wrist and thumb
ULTT 3
Ulnar Nerve
- pt supine
- clinician depresses shoulder
- extend the wrist and fingers
- supinates forearm
- flex elbow
- abducts shoulder to 90 degrees
Benefits from neural tension mobilization
- facilitates nerve gliding
- reduction of nerve adherence
- dispersion of noxious fluids
- increased neural vascularity
- improve axoplasmic flow
