Neurodynamic Mobility and Mobilizations Flashcards
What is neurodynamics?
the study of the mechanics and physiology of the nervous system
What are the 3 mechanisms that play a role in peripheral nerve adaptation?
- Elongation of the nerve against elastic forces
- Longitudinal movement of the nerve trunk in the longitudinal direction
- An increase and decrease of tissue relaxation at the level of the nerve trunk
Nerves can elongate _ cm
2
What are the 3 areas called tension sites in which the dura is tethered to the bony canal, providing stability to the spinal cord?
C6, T6 and L4
*The elbow, shoulder, and knee have similar sites
Under what circumstances are the areas of adhesion problematic?
When the dura becomes adherent, causing excessive stress to be produced in these areas
What are the 5 things that are suspected to contribute to injury processes?
- Posture
- Direct trauma
- Extremes of motion
- Electrical injury
- Compression
What term refers to the coexistence of dual neuropathies along the course of the same peripheral nerve? Assuming one lesion is proximal and one is distal
Double Crush Injuries
In order for double crush injuries to occur what must there be?
anatomic continuity of nerve fibers between the two lesion sites
What are the 4 Neurodynamic Mobility Examinations?
- Upper Limb Tension Tests (ULTT)
- Straight Leg Raise
- Prone Knee Flexion test
- Slump Test
What are 3 symptoms for the presence of neuropathic dysfunction?
- Pain
- Paresthesia
- Spasm
A positive test for neuropathic dysfunction is represented how?
Reproduction of the patient’s symptoms and a decrease in those symptoms with the movement of a distal body part
What 3 positions are combined in the slump test?
It is a combination of seated SLR, neck flexion, and lumbar slumping
What does the slump test test for?
Adverse nerve root tension caused by
- Spinal stenosis
- Extraforaminal lateral disk herniation
- Disk sequestration
- Nerve root adhesions
- Vertebral impingement
What causes the dura and nerve roots to slacken during the slump test?
extension of the cervical spine
What are the 5 progressions to perform when administering the slump test?
1) Cervical spine is flexed
2) Slump of thoracic spine, lumbar spine and posterior tilt of pelvis
3) Knee extension
4) Ankle dorsiflexion
5) Gentle cervicothoracic overpressure
If at any point during the slump test the patient’s symptoms are reproduced, what happens next?
Ask them to extend the neck
- If cervical extension relieves symptoms, then the test is positive - If no change occurs, then the test is negative
What are the 6 types of LE Tension Tests?
- Straight Leg Raise
- Crossed Straight Leg Raise Sign
- Bilateral Straight Leg Raise
- Bowstring Test
- Sciatic Tension Test
- Prone Knee Bending Test
The first __ degrees of the SLR serve to take up the slack in the sciatic nerve
30
If there is pain during the first 30 degrees of the SLR what may it indicate?
- Acute spondylolisthesis
- Tumor of the buttock
- Gluteal abscess
- Large HNP or extrusion
- Acute inflammation of the dura
- Malingering patient
What occurs between 30-70 degrees of the SLR range?
The spinal nerves, their dural, and the roots of L4-S2 are stretched with an excursion of 2-6mm
What occurs after 70 degrees of the SLR range?
Other structures such as the hamstrings, glute max, hip, lumbar, and SIJs become involved
What is indicative of a positive SLR test?
The patient’s ROM is limited to <70 degrees with spasm (pain).
- Patient’s pain is reproduced and is neurologic in nature
What are 3 variations of the SLR test?
- Passive ankle dorsiflexion (Braggard’s test)
- Passive cervical flexion (Soto-Hall test)
- Increased IR or Add of the hip
If the patient’s symptoms are more irritable when performing the SLR test with ankle dorsiflexion, foot eversion and toe extension what nerve is under stress?
The tibial nerve
If the patient’s symptoms are more irritable when performing the SLR test with ankle dorsiflexion and eversion what nerve is under stress?
sural nerve
If the patient’s symptoms are more irritable when performing the SLR test with ankle plantarflexion and inversion what nerve is under stress?
Common Fibular nerve
What are the 3 crossed SLR signs?
- SLR that produces pain in the contralateral leg but not when the contralateral leg is raised
- SLR that produces pain in both legs
- SLR of either leg that produces pain in the contralateral leg
Which SLR test is the most significant in terms of its diagnostic powers to indicate the presence of a large disk protrusion?
The crossed SLR
What 3 test results are strongly predictive of disc herniation?
- Severely limited SLR
- Positive Crossed SLR
- Severely restricted and painful trunk movements
What type of SLR detects a central disc protrusion?
A bilateral SLR
What can be done to differentiate between central disc protrusions and various other causes of pain resultant of a positive bilateral SLR?
the Bicycle Test of van Gelderen
What types of patients can tolerate the bicycle test?
Lateral spinal stenosis patient will tolerate this activity.
Central disk protrusion patient usually fairs well IF the lumbar spine remains extended (not if it is flexed)
What is a positive bowstring test a strong indicator for?
HNP and possible need for surgical intervention
When is the bowstring test performed?
Only if the SLR is positive with the addition of ankle dorsiflexion
What nerve does the prone knee bending test stretch?
the femoral nerve
What is the prone knee bending test used to indicate?
the presence of upper lumbar disk HNP
What are the 3Upper Limb Tension Tests (ULTT) in order?
- ULTT 1: Median Nerve
- ULTT 2: Radial Nerve
- ULTT 3: Ulnar Nerve
Describe the progression of ULTT 1
1) Clinician depresses the shoulder girdle
2) Abducts the UE to approx. 110 degrees
3) Supinates the forearm
4) Extends the elbow
5) Extends the wrist
6) Extends the fingers
Describe the progression of ULTT 2
1) Clinician depresses the shoulder girdle
2) Abducts the shoulder to 30 degrees
3) IR shoulder
4) Pronates forearm
5) Extends the elbow
6) Flexes the wrist and thumb
Describe the progression of ULTT 3
1) Clinician depresses the shoulder girdle
2) Extends the wrist and fingers
3) Pronate the forearm
4) Flexes the elbow
5) Abducts the shoulder to approximately 90 degrees
What are the 5 benefits from neural tension mobilization?
- Facilitation of nerve gliding
- Reduction of nerve adherence
- Dispersion of noxious fluids
- Increased neural vascularity
- Improvement of axoplasmic flow
Describe the treatment parameters for adverse neural nerve mobilization/stretching
5-10 gentle repetitions held for 5-10 seconds
