INTEGRATION OF NEURODYNAMICS IN ORTHOPAEDICS Tanja Rauter Pungartnik, MD, specialist of physical and rehabilitation medicine Dajana Vučić, physiotherapist Terme Ptuj

NEURODYNAMICS a special technique one of the way of patient treatment deals with the differential diagnosis of musculoskeletal pain assessment treatment of the peripheral nervous system.

NEURODYNAMICS The concept is based on very precise search of the causes of a particular clinical problem. Incorrect position of the joint, inflexibility of the nervous system cause poor muscle activation.

NEURODYNAMIC TESTING looking for obstruction passing the peripheral nerves (passive movement of upper, lower extremities and the body) to determine if the inferior function of the musculoskeletal system is a result of obstructed passing the peripheral nerves.

THE GOAL OF THE THERAPY to establish an optimal sliding of the peripheral nervous system and consequently easier to obtain the full flexibility of the joint and increase muscle activation. (Mobilisation of musculoskeletal system, decompression and break adhesions)

MUSCLE REEDUCATION For the ultimate success it is necessary to include the muscle reeducation (proper education of individual muscle groups witout »trick« movements and such associated reactions).

OUR CASE… a 39-year old patient after implantation of the endoprosthesis in left hip date of surgery: 27.8.2015 Admission date: 30.9.2015 Anamnesis: - pain in the area of the postoperative scar (VAS 6-7), - weakness of the muscles - no active movement of left leg in left hip -lying position on back

OUR CASE… Status: walking with the crutches, without crutches very bizarre she could not elevate the left leg from the bed when she wanted to elevate the left leg - the appearance of pain in left groin and in gluteal region on the left side

Range of motion in left hip at the beginning of the rehabilitation program 1.10.2015 Flexion 50°, 55° Retroflexion 0°, 0° Adduction 0°, 5° abduction 0°, 10° Int.rot. 15°, 20° Ext.rot. 0°, 0°

Rehabilitation program Hydrotherapy – active exercises in thermal water Kinesiotherapy – passive movements of the left hip (to improve the range of motion), assisted active exercises (to help m.), exercises with equipments (balls, elastic tape…) improve the right pattern of walking) Magnetotherapy Electrotherapy Massage of the lumbar spine

After 10 days… the intensity of the pain was the same as in the beginning (VAS 6-7) minimal improvement in the range of motion still walking with crutches walking without crutches was not functional and efficient

Range of motion in left hip after 10 days of the rehabilitation program 1.10.2015 12.10.2015 Flexion 50°, 55° 65°, 70° Retroflexion 0°, 0° 0°, 0° Adduction 0° , 5° 0°, 15° abduction 0°, 10° 0°, 15° Int.rot. 15°, 20° 25°, 35° Ext.rot. 0°, 0° 0°, 5°

1. del (walking with crutches) 2. del (walking without crutches) 3. del (putting on socks) 4. del (testing) 5. del (testing the rotation) 6. del (testing the rotation while the patient is lying on her stomach)

No significant improvement in After 10 days… No significant improvement in her clinical status…

8.del (testing the n. femoralis and mobilisation) 9. del (mobilisation) 10. del (testing after the mobilisation)

Range of motion left hip after mobilisation of the femoral nerve 1.10.2015 12.10.2015 13.10.2015 Flexion 50°, 55° 65°, 70° 95°, 100° Retroflexion 0°, 0° 0°, 0° 10°, 20° Adduction 0°, 5° 0°, 15° 20°, 25° abduction 0°, 10° 0°, 15° 15°, 20° Int.rot. 15° , 20° 25°, 35° 35°, 35° Ext.rot. 0° , 0° 0°, 5° 5°, 20°

11. del (education)

Thank you for your attention…