Neurodynamic Testing Flashcards
State the mechanical functions of the nervous system
- Lengthening
- Sliding (longitudinal & transverse)
- Compression (external & internal)
- Angulation
What happens if any of the mechanical functions are impaired
- When normal physiology is compromised &/or mechanical systems fail (Loss of these 4 mechanics) or are exceeded, symptoms/pathology occur
- If pathology arises nerve becomes adhered down/tethered and cannot undergo mechanical functions
What is a mechanical interface (nerve bed/neural container)
Adjacent tissues where nerves move through/ around/over/under
What are the types of neural containers and how can they effect nerve function
Types:
- Bone
- Muscle
- Ligament
- Tendon
- Joint
- Fascia
- Fibro-osseous tunnels
Mechanical interface can have an effect on nerve function:
- Fractures
- Inflammation
- Tears
- Adhesions /tethering
Explain the pathodynamics of nerve tissue
Pathological conditions (irritation) can produce symptoms in neural tissues by compromising the neural tissues ability to:
- Conduct an impulse - Pins & needles / numbness symptoms
- Motor weakness - painless weakness in myotomal fashion symptom
- Generate length - Pain / tugging / pulling symptoms
- Slide through mechanical interface - Pain / tugging / pulling symptoms
What are the aims of Neurodynamic Testing assessment
- Determine if the nerve is compromised/involved in symptoms
-
Determine severity of compromise
- Level(s) of compromise
- Is conductivity affected (red flag) or just neural pain/sensory disturbance
- Ascertain site of mechanical interface issue
- Use for red flags, monitoring - progressive neurological loss surgery is warranted, referral for scanning needed
What are the aims of neurodynamic treatment
Reduce symptoms
- Primarily by improving neural blood supply
Targeted by mobilising the container
- Direct soft tissue or bony treatments
Floss the nerve to restore nerves ability to glide/slide or tolerate compression
Tensioning techniques
- Highly provocative
- Only used for chronic, persistent, low irritability nerve conditions where container mobilisation or nerve flossing were ineffective
What is included in nerve conduction testing and why is it done
-
Dermatomes
- Light touch, pinprick test
- Myotomes
- Reflex - tendon jerks
-
Other neuro tests
- Co-ordination testing - FTN/HTS
-
UMNL testing
- Babinski reflex
- Clonus
- Hoffman’s sign
Critical to examine these first – if positive no need to do AND/ANT tests
State LL myotomes
L2-3
- Femoral nerve
- Illio-psoas
- Hip flexion
L3-4
- Femoral nerve
- Quadriceps
- knee extension
L4-5
- Deep Peroneal nerve
- Tibialis Anterior
- DF
L4-5 S-1
- Deep Peroneal nerve
- EHL
- Big toe extension
L5-S1
- Common Peroneal nerve
- Peroneus Longus &Brevis
- Eversion
L5-S1
- Sciatic nerve
- Hamstrings
- Knee extension
S1-2
- Tibial nerve
- Gastrocnemius, Soleus
- PF
State LL reflex tests and findings
Reflex tests:
- Patella tendon jerk
- Achille’s tendon jerk
Findings:
Hyper-reflexic
- UMN lesion
- Further investigation required - Clonus, babinski reflex, hoffman’s sign
Hypo-reflexic (reduced)
- LMN lesion or low tone
Normal
Absent
- LMN lesion
State LL neurodynamic tests
- SLR
- PKB
- Slump
What structures does SLR test for and how to sensitise differing structures
Tests for: Sciatic nerve and branches
- Supine Lying
- MR hip slightly
- Passively ext knee & flex the hip
- R1 or P1
+ve = Look for a response in tissue may include tingling and pain in thigh
SLR can be combined with other movements to sensitise structures:
SLR/DF/Ev = Tibial N; TED
SLR/DF/Inv = Sural N; SID
SLR/PF/Inv = CPN; PIP
SLR/HipAdd +/- hip MR, Neck flex = Sciatic N
What structures does PKB test for and how to sensitise for structures
Tests for: Femoral nerve
- Sidelying, lower knee pulled up to chest with neck flex
- Full knee flexion (passive)
- Passive hip ext
- Until R1/P1 then ask patient to extend neck, upper Tx
- Should be able to take leg further!
- Compare with other side
Must ensure no lumbar ext occurs as this would alter SIJ, HIP and soft tissue structures
What structures does slump test for and how to sensitise structures
Tests for: sciatic nerve and above
- Sitting relaxed assess symptoms
- Asymptomatic side first then on symptomatic then both
- Sit fully supported with thighs on bed
- Hands held behind back
- “Slump” shoulders down
- Hold or OP
- Neck flexion active, monitor/OP
- DF ankle + Kn ext
Normal test results will be variable and involve different findings, but should always be symmetrical!!
Sensitizing movement will depend on area of symptoms and will normally involve removing a component to reduce pain and increase knee ext or ankle DF
