neurodynamic testing Flashcards
what is neurodynamic testing?
neurodynamic testing tests how well your nerves move and stretch.
a physio will move arms, legs or spine in certain ways to gently stretch the nerve
- it is a positive test if the patients pain, tingling or “reported symptoms” are reproduced
- test is not positive if person describes tightness from stretch etc
what are examples of neurodynamic tests?
- straight leg raise - stretches sciatic nerve
- slump test
-prone knee bend test - femoral nerve
what does a positive neurodynamic test indicate about a nerve?
that it is sensitised nerve ie it has become overly reactive to movement or mechanical stress which stretch or compress the nerves
what are some general guidelines with neurodynamic tests?
-explain what the test involves and ask them to report any responses to test anywhere in the body
-perform on non painful side first to establish baseline
-note symptoms at baseline ad then actual responses eg pain, feelings of tightness
-watch for antalgic posters and other motor responses during test
-test for symmetry
-repeat several times before recording (unless very irritable)
when would you do a straight leg raise neurodynamic test?
- if the patient is reporting LBP and also pain into the poster/lateral thigh
how do you do the SLR test?
-pt is in supine
-check non symptomatic leg first - record hip flexion range & symptoms to compare to symptomatic leg
-stand facing pt, lift at heel and use other hand to keep knee extended
-constantly check for pain & other symptoms as you go up
-go very slowly and gently
what is a normal response to SLR test?
-ROM - 50-120 degrees hip flexion
-posterior thigh, knee and calf pulling / stretch - sometimes into foot
- symptoms relived by neck extension
what does a positive SLR test involve?
-reproduces leg pain and or p+n’s and possibly LBP
-assymetrical ROM (one leg more than other)
-different to expected normal response
in addition to SLR, what other sensitising manoeuvres can put further stretch to the sciatic nerve?
- ankle DF
-hip adduction
-passive neck flexion
what is another alternative test other than the SLR test for the sciatic nerve?
-passive neck flexion
-done in combination with SLR or slump test
-as the NS is a continuous structure, neck flexion can increase tension along the nerve pathway
-can be a good additional test to check after SLR
what nerve does the slump test assess?
-primarily the sciatic nerve
-but also puts tension on other nerves eg the tibial or perineal etc
what are indications for the slump test?
-spinal symptoms
-lumbar or thoracic radiculopathy
-provacative activities that indicate that slump may be aggravating eg kicking, leg kick during dancing
what is the method for the slump test?
-pt is seated on plinth with thighs supported and arms behind back
-physio sits beside pt
-pt is asked to have a slumped posture
-then pt is asked to perform cervical flexion and physio maintains it by putting hand on head - ask for pain
-then get pt to extend out leg and dorsiflex ankle - ask for symptoms
-do asymptomatic side first
-then release knee and ankle, reset trunk and perform on symptomatic side
-if symptomatic - neck is extended to assess response
what is a normal response to the slump test?
-trunk flex- nil symptoms
-cervical flex - 50% report pain in T8/T9 region
-knee ext - stretching in posterior knee/thigh/ham
-ankle DF - intensifies stretch
-when neck is released - decreases all symptoms and increases knee extension
what indicates a positive slump test?
-reproduce patients symptoms
-asymmetry
-symptoms moved by other movement of distant body parts
what nerve does the prone knee bend test?
-femoral nerve - L2,L3,L4
-must add sensitising manoeuvres eg hip extension to distinguish neuropathodynamics from quads or psoas muscle tightness
how is the prone knee bend test performed?
-patient is prone, head is turned toward the physio side, arms by side
-passively flex the knee while palpating the limbo pelvic region for movement
-can also lift the hip into extension - ensure good physio posture (keep the flexed knee on the inside of body)
-assess symptom response and ROM
what is a normal response to the prone knee bend test?
-the heel can reach the buttock and the pt feels a stretching sensation in the anterior thigh
what would a positive prone knee
