Neural Tension Testing and Neural Mobilization

Question 1

Who developed neural tension testing?

Answer 1

David Butler

Question 2

List 2 rationales behind the concept of neural tension testing and neural mobilization.

Answer 2

1. 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.
2. Neural tissue can be injured

Question 3

List 4 causes of nerve trauma that physical therapists treat in the orthopedic setting.

Answer 3

1. Friction,
2. Compression
3. Stretching
4. Disease process that cause nervous tissue swelling and/or bleeding

Question 4

List 6 consequences of nerve trauma.

Answer 4

1. Decreased vascularity to nervous tissue
2. Connective tissue rupture
3. Fibrosis
4. Thickening and/or contracture
5. Altered axoplasmic flow
6. Changes in neural firing

Question 5

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

Answer 5

1. Neural mobilization techniques

Question 6

List 4 things that should be considered regarding the patient’s history.

Answer 6

1. How the patient describes the symptoms
2. Whether different symptoms ‘link up’, ie: whether all symptoms begin about the same time and/or increase or decrease together with certain activities
3. Whether the symptoms are relevant to the patient’s problem(s)
4. Whether the injury is in the acute (irritable) or chronic (stiff) stage

Question 7

What 5 things are used to determine irritability?

Answer 7

1. How much activity the patient can perform before being stopped by symptoms
2. The severity (intensity of pain and level of physical restriction) of symptoms
3. The distribution of symptoms
4. How long it takes for the symptoms to subside to its original level
5. Whether the pain is reproduced before (irritable condition) or after (stiff condition) the end feel is reached

Question 8

List 4 things included in the examination for patients with nerve pain.

Answer 8

1. Examination of extraneural sources of pain
2. Standard neurological examination
3. Palpation of the nerve
4. Neural Tension Tests

Question 9

Describe neural tension tests.

Answer 9

Passively position the patient in such a way as to stretch the neural tissue being tested

Question 10

What 4 things should be considered/examined during a neural tension test?

Answer 10

1. Whether the test reproduces the patient’s symptoms
2. 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
3. Whether the patient’s responses are different from that which occurred on the unaffected side, or that which is expected for asymptomatic subjects
4. Whether the symptoms can be altered by the addition or subtraction of a sensitizing maneuver

Question 11

What is a sensitizing maneuver?

Answer 11

A position that increases the stretch on the nerve

Question 12

What concept should be used to assist with diagnosing nerve impairments?

Answer 12

1. Structural differentiation
2. 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

Question 13

Symptoms can either ____ or ____with attempts at structural differentiation.

Answer 13

Increase or decrease

Question 14

It is generally advisable to stretch the_______ area first.

Answer 14

Symptomatic

Question 15

Wrist and finger extension produces two to four times more movement at the _____ nerve at the wrist than at the upper arm

Answer 15

Median

Question 16

What 2 structures may also stretch when stretching a nerve.

Answer 16

1. Fascia

2. Blood vessels

Question 17

PT must determine whether the involved tissues are _____ or _____ or both.

Answer 17

Intraneural

Extraneural

Question 18

What is the difference between intraneural and extraneural tissue?

Answer 18

1. An intraneural tissue injury refers to an injury to conducting or connective nervous tissue,
2. An extraneural injury refers to an injury to the nerve bed or interfacing structure

Question 19

If the affected tissue is ______, then the symptoms should ‘fit’ with nerve anatomy, especially in relation to the level of involvement.

Answer 19

Intraneural

Question 20

What 4 structures should be the focus of treatment if the injury is intraneural?

Answer 20

1. Upper motor neurons
2. Lower motor neurons
3. Nerve roots
4. Nerve

Question 21

Sometimes symptoms change with neural testing because the nerve is healthy, but _______.

Answer 21

It is attached to sensitive or pathological structures (extraneural tissue)

Question 22

List 5 common areas for nerve injury. Why are these common areas for injury?

Answer 22

1. Soft tissue, osseous or fibro-osseus tunnels, because of the compression and increased friction associated with decreased space
2. 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
3. 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
4. Friction points
5. 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.

Question 23

True or False: The location of the symptoms pinpoints the location of the nerve injury.

Answer 23

FALSE

Question 24

____ at non-vulnerable spots can affect vulnerable sites.

Answer 24

Trauma

Question 25

List 3 intervention considerations employed during treatment.

Answer 25

1. Patient positioning is the same for both examination and treatment 2. Patient positioning is intended to stretch neural tissue 3. Treatment is directed into the position, movement, or movement combination that produced symptoms

Question 26

True or False: Treatment should provoke the patient's symptoms and should start at the area of symptoms.

Answer 26

FALSE Treatment should not provoke symptoms and should be well removed from the area of symptoms.

Question 27

Treatment of _____ lesions can be performed in neural tension positions.

Answer 27

Extraneural

Question 28

Treatment aggressiveness should be determined by the ____ of the condition

Answer 28

Irritability

Question 29

How should irritable conditions be treated?

Answer 29

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.

Question 30

How can stiff conditions be treated?

Answer 30

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.

Question 31

What grades of mobilization should be used to maintain neural mobility?

Answer 31

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)

Question 32

What grades of mobilization should be used to increase neural mobility?

Answer 32

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)

Question 33

What is flossing?

Answer 33

Stretch one end of the nerve while keeping slack on the other end of the nerve

Question 34

List 8 precautions/ contraindications to neural mobilization techniques.

Answer 34

1. Dizziness secondary to vertebrobasilar insufficiency 2. If a circulatory disorder is present 3. Malignancy 4. Acute inflammatory infection of the nervous system 5. Rapidly worsening symptoms 6. Cauda equina lesion / alteration in bowel and bladder function 7. Spinal cord instability or frank spinal cord injury 8. Presence of hard neurological signs

Question 35

True or False: Neural tissue management is superior to minimal intervention for the reduction of pain and disability in nerve-related chronic musculoskeletal pain.

Answer 35

TRUE

Question 36

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.

Answer 36

FALSE No more effective than other interventions used to reduce pain

Question 37

List 2 conditions for which neural mobilization proved to effective in improving symptoms.

Answer 37

1. Chronic LBP | 2. Neck-arm pain

Question 38

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.

Answer 38

TRUE

Question 39

____ mobilization improves pain in nerve related neck-arm pain.

Answer 39

Cervical lateral glide mobilizations

Question 40

____ and _____ mobilization improves pain in nerve related neck-arm pain.

Answer 40

Slump and SLR mobilization