Neural Provication

• neural provocation tests confirm whether the problem is caused by nerves or another structure
• • dont do neural provocation tests if you already know they have a nerve problem or if they had problems with neural integrity tests
  • do the neural provocation test slowly so they dont get hurt
• • Neural provocation tests puts a nerve (and therefore the NS) on a stretch (by flexing a joint at least 2 joints away from the pain) to identify if its the cause of the pain
  • e.g.
  • if theres hamstring pain, do a straight leg raise to the point of the pain and then dorsiflex the ankle
  • and then get pt to flex their neck, to stretch the NS
  • if there is more pain when the neck is flexed and less pain when the neck is extended back up, its indicative of a nerve issue
  • if theres no additional pain when the neck is flexed, there is no nerve issue
• flexion movements (such as neck, lumbar, hip and dorsiflexion) puts the nervous system on a stretch
• If youve found a nerve issue in the foot you can differentiate which nerve it is by adding further movement:

  • Sural nerve = dorsiflexion and inversion
  • Peroneal nerve = plantarflexion and inversion
  • Tibial nerve = dorsiflexion and eversion
• Slump tests (slumped body position with neck flexion and lumbar flexion) also stretches the NS so can be used in conjunction with body part in pain to see if theres a nerve issue
• Passive knee bend can assess if theres femoral nerve issues:

  • tuck the knee of the leg with no pain into chest
  • the leg in pain goes into hip extension
  • then flex the neck to add another stretch
  • if theres pain when the neck is flexed and the pain then goes away after the neck has been extended, there are femoral nerve problems