Neuro Anatomy Lumbar Spine

Neuro Anatomy Important for neurological assessment Helps with tension testing and neurodynamic treatments Knowing anatomy will help identify potential causes of radicular pain or radiculopathy E.G paraesthesia in the hand- is this in a dermatome pattern or a peripheral nerve pattern

Spinal Nerves

Spinal Nerves

Lumbar Plexus

Lumbar Plexus

Femoral Nerve

Obturator Nerve

Lumbosacral Plexus

Lumbosacral Plexus

Sciatic Nerve

Peroneal Nerve

Tibial Nerve

Sural Nerve

Dermatomes and Myotomes Vs Peripheral Nerve Remember the cutaneous and motor distribution of a peripheral nerve IS NOT the same as dermatome and myotome patterns Nerve roots will progress into multiple peripheral nerves E.g C8 nerve root is present in ulnar, median and radial peripheral nerves

Neurodynamics Lumbar Spine

The Neurodynamic System Interaction of 3 components Mechanical Interface Neural Structures Innervated Tissues

Abnormal Neurodynamic System Can be the result of one or a combination of: Dysfunctional Tension Dysfunctional Sliding Dysfunctional Compression

Tension

Sliding

Compression

Movement of the Neural System The nervous system will generally slide towards the moving joint distally and proximally to increase the available slack

Femoral Nerve Testing

Sciatic Nerve Testing

Peroneal Nerve Testing

Tibial Nerve Testing

Sural Nerve Testing

Slump Testing Upper Lumber Nerve Roots

Look for….. Pain ROM Paraesthesia or Numbness

Structural Differentiation Perform the test Make a change 2 joints away from the symptoms Does it increase or decrease symptoms? Does it make no change?

Dermatomes

Dermatomes

Dermatomes

Myotomes L2 L3

Myotomes L4 L5

Myotomes S1 S1

Myotomes S1 - 2

Management Soft tissue release Joint mobilisations Sliders and Tensioners

Sliders

Tensioners

Manual Therapy Corkskrew

Home Exercise Programme Leg Swings

Home Exercise Programme Heel To Sky

Home Exercise Programme Femoral Nerve

Home Exercise Programme Cranio Cervical Flexion Straight Leg Raise

Home Exercise Programme Seated Slump Part 1

Home Exercise Programme Seated Slump Part 2

Home Exercise Programme Seated Slump Part 3

Home Exercise Programme Seated Slump Part 4

Neurodynamic Treatments Be inventive Decide on what aspect of the nerve you need to target Decide whether you need to perform a slider or a tensioner Decide if you want to tension the entire spinal cord and dura mater HEP or Manual Therapy? Eg MTrP release in neural load, Hip distraction mobilisations in neural load