Neural Tissue Management

• Lumbar Spine – Neural Tissue Management:

  • It is important that we consider the impact of neural tissue on the patient’s presentation
  • Remember the nervous system is continuous from the head to the toe!
  • From our assessment we would have identified if neural tissue was the source or a contributing factor
  • We would have identified this through key subjective information
  • Pain description
  • Change in nerve function: Altered sensations: burning, paraesthesia, anaesthesia, sharp shooting pain
  • Objective Assessment:
  • Neural tissue provocation testing
  • Neural integrity examination
• Sliders:

  • Neural tissue techniques called sliders focus on desensitising and normalising neural tissue’s ability to tolerate movement
  • Compression, tension and friction occurs in every day movements and can in some activities place more load onto the neural system and quite often this will be linked to the patient’s aggravating factors
• Sliders:

  • Gentle movement of the neural tissue in the form of sliders will match the symptomatic specific neural tissue we identified in our objective assessment
  • Two main hypothesised reasons behind mobilising neural tissue is for
  • Reducing the neural tissue sensitivity by improving it’s tolerance to load
  • Reduces the fear of movement into aggravating positions
• Sliders:

  • Active movements involving the target neural tissue by encouraging movement between neural structures and non-neural tissues
  • These are to be done in a non-provocative positions and ranges of movement
  • The aim is to increase length at one end of the nervous system and decrease length at the other end
  • The Cervical spine helps with all movements as it increased movement and tension in the upper quadrant through flexion and reduction in tension is performed by moving the cervical spine into extension
• cervical spine in extension = decrease in load

  cervical spine in flexion = increase in load
• Sliders:

  • Monitor throughout and be careful to not over do it! Common for patients to have latent pain well after doing the exercise
  • Begin with small ranges of movement first then increase
  • Must always be pain free
  • Starting point: 2 – 3 sets of 10 repetitions a day. No more!
  • Remember to have a clear outcome measure to monitor progress
  • Can progress to Tensioners however this is not always needed- can only be done once the patient is neurologically normal, so no positive reproduction on neural integrity or provocation testing, minimal symptoms