Neuroprovocation Testing Flashcards
Neurodynamics
-Dynamic mechanical and physiological properties of NS
-inter and intra neural communication
-neural tissue responds to moving by: gliding, lengthening, compression
Adverse Neural Tension
-abnormal physiological or mechanical response from NS
-limits range/stretch
-neuro s/s
Mechanisms of Neural Adverse Tension
-dura tethered to bony canal and adhesions increase tension
-C6, T6, L4
Site of Vulnurability: Tunnel
-tunnels increase probability of spatial compromise
-friction or trauma
ex: carpal tunnel
Site of Vulnurability: Branches
-where a nerve branches
-harder to move from forces here
ex: radial n at elbow
Site of Vulnurability: Hard Interfaces
-nerve lying on bone or passing throuhg fascia
-easier to compress
Site of Vulnurability: Proximity to Surface
-superficial nerves are more vulnerable to compression
Site of Vulnurability: Adherence to interfacing structures
-nerve more adherent in some places
ex: common fib at head of fibula
Nerve Mechanisms of Injury
-Posture: adaptive shortening
-Trauma: fracture, dislocation
-Extremes of Motion: traction
-Electrical injury
-Compression
Neurodynamic Mobility Exam
-Subjective (Pain, spasms, paresthesias)
-Observation
-Palpation
-ROM
-Resisted testing
-Nerve provocation test
Nerve Provocation Testing
-asses contribution of nerve to pain
-sequential and progressive stretch on dura
3 Signs of a Positive NTPT
- Reproduces Pt s/s
- Movement of distant body part causes responses
- Test differences from L to R
Straight Leg Raise
-test for sciatic n
- actively raise leg
- passively raise leg
- DF
- Pt lift head
Pain in 0-30: acute/severe MSK
Pain in 30-70: nerve issue
Pain >70: not positive
Crossed SLR sign: opposite s/s, disc protrusion
Sensitizers:
-Tibial: DF > Eversion > Toe Ext
-Sural: DF > Inversion
-Common fib: PF > Inversion
Slump Test
-test neuromobility
- Hands behind back
- Head and neck flexed
- Lumbar flx
- Straighten knee
- overpressure
- DF of ankle
- Pt moves head
Upper Limb Tension Testing
- Use elbow to depress scap
- Abduct
- Extend wrist and fingers
- ER
- Elbow extension
- Lat sidebending
+ Findings: differences btw sides, different elbow ROM, reproduction of s/s
Sensitizers
-maneuvers that increase neural tension
-bias toward nerves
Indication for Neurodynamic Mobilizations
-Neurological s/s
-Antalgic Postures
-Active or passive mmt Dysfunction
-Tenderness to palpation over superficial neural tissues
Contraindications for Neurodynamic Mobilizations
-Recent repair
-Malignancy
-Active Inflammatory Disorders
-Acute Inflammatory Demyelinating Disorders
Precautions for Neurodynamic Mobilizations
-irritable conditions
-SC signs
-Nerve root signs
-Severe night pain w/ no Dx
-recent paresthesia or anesthesia
-Mechanical spine pain w/ peripheralization s/s
Neurodynamic Mobilization Techniques: Gliding
-load one end of nerve while relieving stress on opposite end
- 1 “on” and 1 “off” then switch
ex: head flx and ankle PF, the head ext and ankle DF
Neurodynamic Mobilization Techniques: Tension
-load opposite ends of nerve
-both “on” or “off”
-when glides no longer help
ex: head flx and ankle DF, the head ext and ankle PF
Neurodynamic Mobilization Techniques: Stretching
-load opposite ends of nerve and hold
-7-30s
-both “on” or “off”
-most agressive
ex: head flx and ankle DF (hold), the head ext and ankle PF (hold)
