1. Neurodynamic Mobility
Chapter 12
Neurodynamic Mobility

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

3. 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

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

5. 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

6. 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

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

8. 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

9. 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

10. 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

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

12. 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

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

14. 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

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

16. 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

17. 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

18. 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

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

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

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