Neurodynamic Mobility Chapter 12 Neurodynamic Mobility

Overview Neurodynamic mobility testing is designed to examine the neurological structures for adaptive shortening and inflammation of the neural structures

Neurodynamic Dysfunction Proposed mechanisms: Theoretically, increased dural tension may be felt throughout the neuromeningeal system, and can potentially affect the range of motion available to the trunk and to an extremity Neural tissue responds in the same way to trauma that a ligament or tendon does by evoking the cascade of the inflammatory process, resulting in pain when stressed

Mechanisms of injury Adverse posture Direct trauma Extremes of motion Electrical injury Compression/ischemia

Double Crush Injuries Theoretically, if the axoplasmic flow is partially reduced at a proximal site of injury, further reduction can occur at a distal compression site Evidence is inconclusive

Neurodynamic Mobility Examination Consist of a series of tension tests The tension tests are designed to apply controlled mechanical and compressive stresses to the dura and other neurological tissues, both centrally and peripherally Employ a sequential and progressive stretch to the dura until the patient’s symptoms are reproduced

Neurodynamic Mobility Examination Positive symptoms for the presence of neuropathic dysfunction include pain, paresthesia, and spasm

Straight Leg Raise test The SLR test places a tensile stress on the sciatic nerve, and exerts a caudal traction on the lumbosacral nerve roots from L4 to S2 The evaluation of the findings from the SLR test requires that the range of motion measured, and the symptoms produced, are compared with the contralateral side and with expected norms

Straight Leg Raise test It is generally agreed that the first 30º of the straight leg raise serve to take up the slack or crimp in the sciatic nerve and its continuations Between 30-70º, the spinal nerves, their dural sleeves, and the roots of the L4, L5, S1 and S2 segments are stretched with an excursion of 2-6 mm

Straight Leg Raise test After 70°, while these structures undergo further tension, other structures also become involved: The hamstrings The gluteus maximus The hip, lumbar and sacroiliac joints

Sensitizers The following sensitizers can be used: Dorsiflexion of the ankle Cervical flexion Internal rotation of the hip

Crossed Straight Leg Sign Three recognized types: A SLR that produces pain in the contralateral leg, but not when the contralateral leg is raised A SLR that produces pain in both legs A SLR of either leg that produces pain in the contralateral limb The crossover sign is thought to be more significant than the SLR test in terms of its diagnostic powers to indicate the presence of a large disc protrusion

Bilateral Straight Leg Raise By performing a bilateral straight leg raise and incorporating both neck flexion and dorsiflexion, central protrusions may be detected

Bowstring tests The Bowstring tests do not impart a sufficient stretch of the dura to detect chronic adhesions However, they can be used to make a prognosis about acute disc herniations A positive bowstring test is a strong indicator for surgery, but it need only be performed if the straight leg raise is positive with the addition of dorsiflexion

Bowstring tests Two types: Cram’s Tibial Nerve Test Common Peroneal Test

The Slump Test The slump test, popularized by Maitland, is a combination of other neuromeningeal tests; namely the seated SLR, neck flexion, and lumbar slumping Maitland asserted that the slump test enables the tester to detect adverse nerve root tension caused by spinal stenosis, extraforaminal lateral disc herniation, disc sequestration, nerve root adhesions, and vertebral impingement

Prone Knee Bending Test The prone knee bending (PKB) test stretches the femoral nerve using hip extension and knee flexion to stretch the nerve termination in the quadriceps muscle, and has been used to indicate the presence of upper lumbar disc herniations, particularly when hip extension is added

Upper Limb Tension Tests The upper limb tension tests (ULTT), or brachial plexus tension tests, involve an ordered sequence of movement of the shoulder girdle, arm, elbow, forearm, wrist and hand Because there are a number of tissues in the cervicobrachial region that could be stressed by these maneuvers, cervical side bending, or cervical flexion is added

ULTT 1 (Median nerve dominant) Components include: Shoulder girdle depression Humeral abduction to approximately 110° Forearm supination Elbow, wrist and finger extension

ULTT 2 (Radial nerve dominant) Components include: Shoulder girdle depression Humeral abduction and external rotation Forearm pronation Elbow extension Wrist and finger/thumb flexion

ULTT 3 (Ulnar nerve dominant) Components include: Shoulder girdle depression Humeral abduction Forearm supination Elbow flexion Wrist extension