Neural Tension Testing and Neural Mobilization Flashcards
Who developed neural tension testing?
David Butler
List 2 rationales behind the concept of neural tension testing and neural mobilization.
- Neural tissue is mobile: There is sufficient biomechanical evidence to support the contention that when stretched, nervous tissue undergoes strain and glides within its interfacing tissue.
- Neural tissue can be injured
List 4 causes of nerve trauma that physical therapists treat in the orthopedic setting.
- Friction,
- Compression
- Stretching
- Disease process that cause nervous tissue swelling and/or bleeding
List 6 consequences of nerve trauma.
- Decreased vascularity to nervous tissue
- Connective tissue rupture
- Fibrosis
- Thickening and/or contracture
- Altered axoplasmic flow
- Changes in neural firing
The fibrotic changes, and the thickening and contractures of nervous tissue can be directly treated with ______, thus also improving vascularity, axoplasmic flow and neural firing
- Neural mobilization techniques
List 4 things that should be considered regarding the patient’s history.
- How the patient describes the symptoms
- Whether different symptoms ‘link up’, ie: whether all symptoms begin about the same time and/or increase or decrease together with certain activities
- Whether the symptoms are relevant to the patient’s problem(s)
- Whether the injury is in the acute (irritable) or chronic (stiff) stage
What 5 things are used to determine irritability?
- How much activity the patient can perform before being stopped by symptoms
- The severity (intensity of pain and level of physical restriction) of symptoms
- The distribution of symptoms
- How long it takes for the symptoms to subside to its original level
- Whether the pain is reproduced before (irritable condition) or after (stiff condition) the end feel is reached
List 4 things included in the examination for patients with nerve pain.
- Examination of extraneural sources of pain
- Standard neurological examination
- Palpation of the nerve
- Neural Tension Tests
Describe neural tension tests.
Passively position the patient in such a way as to stretch the neural tissue being tested
What 4 things should be considered/examined during a neural tension test?
- Whether the test reproduces the patient’s symptoms
- Whether there is an increase in tissue resistance or a decrease in ROM of the nerve on one side of the body as compared with the other side
- Whether the patient’s responses are different from that which occurred on the unaffected side, or that which is expected for asymptomatic subjects
- Whether the symptoms can be altered by the addition or subtraction of a sensitizing maneuver
What is a sensitizing maneuver?
A position that increases the stretch on the nerve
What concept should be used to assist with diagnosing nerve impairments?
- Structural differentiation
- This entails altering the pain provoking position or movement in such a way that one structure is incriminated as a source of symptoms while another is eliminated from contention
Symptoms can either ____ or ____with attempts at structural differentiation.
Increase or decrease
It is generally advisable to stretch the_______ area first.
Symptomatic
Wrist and finger extension produces two to four times more movement at the _____ nerve at the wrist than at the upper arm
Median
What 2 structures may also stretch when stretching a nerve.
- Fascia
2. Blood vessels
PT must determine whether the involved tissues are _____ or _____ or both.
Intraneural
Extraneural
What is the difference between intraneural and extraneural tissue?
- An intraneural tissue injury refers to an injury to conducting or connective nervous tissue,
- An extraneural injury refers to an injury to the nerve bed or interfacing structure
If the affected tissue is ______, then the symptoms should ‘fit’ with nerve anatomy, especially in relation to the level of involvement.
Intraneural
What 4 structures should be the focus of treatment if the injury is intraneural?
- Upper motor neurons
- Lower motor neurons
- Nerve roots
- Nerve
Sometimes symptoms change with neural testing because the nerve is healthy, but _______.
It is attached to sensitive or pathological structures (extraneural tissue)
List 5 common areas for nerve injury. Why are these common areas for injury?
- Soft tissue, osseous or fibro-osseus tunnels, because of the compression and increased friction associated with decreased space
- Nerve branches, because of the stretch caused by the decrease in the ability of the nerve to glide as a response to movement at these locations
- Where nerves are fixed, because of the stretch caused by the decrease in the ability of the nerve to glide as a response to movement at these locations
- Friction points
- Tension points, because of the stretch caused by the decrease in the ability of the nerve to glide as a response to movement at these locations.
True or False: The location of the symptoms pinpoints the location of the nerve injury.
FALSE
____ at non-vulnerable spots can affect vulnerable sites.
Trauma
List 3 intervention considerations employed during treatment.
- Patient positioning is the same for both examination and treatment
- Patient positioning is intended to stretch neural tissue
- Treatment is directed into the position, movement, or movement combination that produced symptoms
True or False: Treatment should provoke the patient’s symptoms and should start at the area of symptoms.
FALSE
Treatment should not provoke symptoms and should be well removed from the area of symptoms.
Treatment of _____ lesions can be performed in neural tension positions.
Extraneural
Treatment aggressiveness should be determined by the ____ of the condition
Irritability
How should irritable conditions be treated?
Irritable conditions should be treated with techniques that do not take the structure to the end range position for that patient and do not provoke pain.
How can stiff conditions be treated?
Stiff conditions can be treated with techniques that take the structure through the end range position for that patient and should also not provoke pain.
What grades of mobilization should be used to maintain neural mobility?
Maintain neural mobility by performing Grade I or Grade II oscillation range of motion into the test position for a particular nerve at any of the joints that the nerve crosses. (especially if the condition is characterized by being ‘irritable’ = pain occurs before the end feel)
What grades of mobilization should be used to increase neural mobility?
Increase neural mobility by performing Grade III or Grade IV oscillation range of motion into the test position for a particular nerve at any of the joints that the nerve crosses. (especially if the condition is characterized by being ‘stiff’ = pain occurs after the end feel)
What is flossing?
Stretch one end of the nerve while keeping slack on the other end of the nerve
List 8 precautions/ contraindications to neural mobilization techniques.
- Dizziness secondary to vertebrobasilar insufficiency
- If a circulatory disorder is present
- Malignancy
- Acute inflammatory infection of the nervous system
- Rapidly worsening symptoms
- Cauda equina lesion / alteration in bowel and bladder function
- Spinal cord instability or frank spinal cord injury
- Presence of hard neurological signs
True or False: Neural tissue management is superior to minimal intervention for the reduction of pain and disability in nerve-related chronic musculoskeletal pain.
TRUE
True or False: Neural mobilization is more effective than other forms of intervention to reduce pain and disability related to nerve related chronic musculoskeletal pain.
FALSE
No more effective than other interventions used to reduce pain
List 2 conditions for which neural mobilization proved to effective in improving symptoms.
- Chronic LBP
2. Neck-arm pain
True or False: For most of the clinical outcomes in individuals with carpal tunnel syndrome, neural mobilization was not effective but showed some positive neurophysiological effects.
TRUE
____ mobilization improves pain in nerve related neck-arm pain.
Cervical lateral glide mobilizations
____ and _____ mobilization improves pain in nerve related neck-arm pain.
Slump and SLR mobilization
