Neurodynamic Management

Question 1

Neurodynamic Tests

Answer 1

Neurodynamic tests try to determine whether a patient’s symptoms are related to increased nerve mechanosensitivity by using specific combinations of spine and limb movements that apply mechanical forces to a part of the nervous system.

A neurodynamic test response is thought to be related to neural tissue sensitivity when it changes with movement of a distant body part that further loads or unloads the nervous system. Analysing a neurodynamic test response by moving a distant body part is termed structural differentiation.

A positive neurodynamic test should be at least partly reproduce the patient’s symptoms and the symptoms should change with structural differentiation.

Question 2

Neurodynamic management

Answer 2

Neurodynamic techniques aim to either mobilise the nervous system itself or mobilise the structures that surround it. Sliding and tensioning technique mobilise the nervous system, whereas a cervical contralateral lateral glide technique would mobilise the structures surrounding the nervous system.

Question 3

Indications and contraindications

Answer 3

Specific signs that should be present to support the hypothesis of a neurogenic disorder for which physiotherapy management could be considered:

1. active movement dysfunction that is related to noncompliance of a specific nerve
2. passive movement dysfunction that correlates with the active dysfunction
3. positive neurodynamic test
4. abnormal response to nerve palpation
5. signs of a musculoskeletal dysfunction that would indicate that the cause of the neurogenic disorder would be responsive to physiotherapy
6. protective posture that shortens the anatomical course of the affected nerve.

Question 4

Influences on pathobiological processes

Answer 4

1. Normalisation of impaired nerve movement
2. Evacuation of intraneural oedema
   Following nerve compression, impaired intraneural blood flow can lead to localised hypoxia, oedema, inflammation and fibrosis. Considering the absence of a lymphatic drainage system within the bundles of axons in a peripheral nerve, evacuation of this oedema is more difficult, potentially resulting in an increase in intraneural pressure. Intraneural oedema was shown to be reduced following neurodynamic exercises which also improved symptoms and function.
3. Reduction of extraneural oedema and pressure
4. Dispersal of inflammatory mediators
   An inflamed nerve becomes extremely sensitive to mild compression or elongation, whereas the conduction velocity through the inflamed region may remain largely unaffected. Mobilisation may result in faster elimination of the inflammation
5. Facilitation of descending modulation
   The initial analgesic effects following various forms of manual therapy have frequently been linked to the activation of the descending pain inhibitory system projecting from the periaqueductal grey region in the mid brain to the spinal cord.