Neurodynamics

• • neurointegrity: refers to the function of the nervous system, is it intact, or are there any lesions within the central or peripheral nervous system - NOT WHAT THIS LECTURE IS ABOUT
  • neural provocation/neurodynamics - sequence of movement designed to assess the physiology of the nervous system by elongating it and seeing if this provokes any symptoms the patient reports. This will help us with out diagnosis and working out the source of the patients symptoms as to whether the nerves are involved
• 3 neural provocation tests for the upper limb:

  • median nerve
  • radial nerve
  • ulnar nerve
• Neural provocation tests:

  • Potential Sources of symptoms:
  • Axons in the nerve
  • Connective tissues in the nerve (nervi nervorum)
  • Blood vessels in or around the nerve
  • Muscles
  • Joints
  • Fascia
  • so putting someone into these provocative positions on its own it doesnt tell us what is causing those symptoms and what is the source of their symptoms - thats why we need to be able to structurally differentiate the different sorts of symptoms
• Structural Differentiation:

  • Structural differentiation is used to make a distinction between neural and non-neural structures as the cause of pain
  • Nerves in the problem area are moved without moving the musculoskeletal tissues - If the symptoms change with the differentiating manoeuvre, the symptoms are inferred to be neurogenic.
  • In the non-neural response (musculoskeletal) the symptoms do not change with the differentiating movement.
• Criteria for a positive test:

  • Change in resistance (protective muscle contraction)
  • Reproduction of patients symptoms
  • Neurodynamic test are pain provocative in normal subjects
  • Need to reproduce some or all of patients pain
  • Differential diagnosis of symptoms
  • demonstrate source of symptoms is neural not another musculoskeletal structure
• Neurodynamic Treatments: Neural Mobilisations:

  • Neural mobilization facilitates movement between neural structures and their surroundings (interface) through exercise
  • Use knowledge of neural provocation tests as to how to mobilise the nerves
  • Can lead to latent symptoms so perform with care and always monitor symptoms
  • Not appropriate where there are changes in nerve conduction

  
• Neurodynamic Treatments: Neural Mobilisations:

  • need to be cautious as sometimes pts may not have bad symptoms when theyre performing the movements, but may report pain later on
  • tend to be done in small repetitions, normally about a set of 10 at a time whilst monitoring symptoms
  • if someone has a positive neurointegrity, neural mobilisations wouldnt be appropriate as we may cause further injury

  
• Radial Nerve:

  • flex cervical spine (neck) towards arm thats being used, extend arm and extend wrist
  • progress onto keeping head still then moving head away from arm
  • watch video!

  
• Median Nerve:

  • extend the elbow and add in lateral flexion of cervical spine (neck) towards the arm thats being used, whilst adding tension at the wrist
  • wrist extension and neck lateral flexion to the opposite side are progressions
  • watch video!

  
• Ulnar Nerve:

  • lateral flexion of cervical spine (neck) towards arm, then progress onto keeping head straight then laterally flex neck away to progressively add tension
  • bend elbow and extend wrist, bring them towards your face

  
• Effects of Neural Mobilisations:

  • Neurodynamics (NM) is an ‘intervention aimed at restoring the homeostasis in and around the nervous system, by mobilization of the nervous system itself or the structures that surround the nervous system’
  • Neural mobilization facilitates movement between neural structures and their surroundings (interface) through manual techniques or exercise
• Effects of Neural Mobilisations:

  • Human and animal studies revealed that NM:
  • Reduces intraneural oedema
  • Improves intraneural fluid dispersion
  • Reduces thermal and mechanical hyperalgesia
  • Reverses the increased immune responses following a nerve injury
• CNS = upper motor neurone

  PNS = lower motor neurone