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

2. 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.

3. 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.

4. 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.

5. 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)

6. 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).

7. OUR CASE…
a 39-year old patient after implantation of the endoprosthesis in left hip
date of surgery:
Admission date:
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

8. 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

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

10. 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

11. 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

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

13. 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)

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

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

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

17. 11. del (education)

18. Thank you for your attention…