Neurodynamics

Original Editor - Rachael Lowe

Top Contributors - Evan Thomas, Lucinda hampton, Rachael Lowe, Laura Ritchie and Kim Jackson

Neurodynamics

Nervous system diagram.png
Neurodynamics refers to the communication between different parts of the nervous system and to the nervous systems relationship to the musculoskeletal system. It has been shown that the nerves move independently from other tissues.[1] The term Neurodynamics first made an appearance in 1989 and has since been further developed over the last 30 years. Neurodynamics is now seen as an important part of injury assessment and treatment.[1]

Neurodynamics in the sense implied here is the mobilisation of the nervous system as an approach to physical treatment of pain. The treatment and or assessment relies on influencing pain physiology via the mechanical treatment of neural tissues and non-neural structures surrounding the nervous system. This mobilisation activates a range of mechanical and physiological responses in nervous tissues. eg neural sliding, pressurisation, elongation, tension and changes in intraneural microcirculation, axonal transport and nervous impulse movements.[2]

The video below gives a good full description of the principles of neurodynamics

[3]

Neural mobilization to treat neurodynamic dysfunction to date is still needing justiifcation through research of high quality homogenous studies. To date however most studies have shown positive therapeutic effects through the use of neurodynamic treatment. [4]

Neural Basics

To apply the principles of neurodynamics a good understanding of the neural basics, as defined below, is needed.

  • Neuroanatomy
  • Neurophysiology - study of the function of the nervous system.
  • Neurobiomechanics - based on the research of bioengineering researchers, neuro-surgery, orthopedic surgery and biomechanists, then utilised by neurosurgeons, orthopedic surgeons and by integrated physical medicine practitioners (eg physiotherapists, chiropractors, nurse practicioners). These practitioners focus on aiding people in the restoration of biomechanics of the skeletal system in order to measurably improve nervous system function, health, function, quality of life, reduce pain and the progression of degenerative joint and disc disease.[5]
  • Neuropathology- study of diseases of the nervous system.

Two fold Neural Examination involving

Babinski's.png

1.Neural (Traditional) Examination H Reflex Testing.jpg

2.Neural Provocation Tests Scheuermann's Kyphosis Pectoral Stretch.jpg

For a guide to the below tests, look to the one link here Neurodynamic Assessment

  • ULTT1 (median nerve bias)
  • Neuron Part 1.png
    ULTT2a (median nerve, musculocutaneous nerve and axillary nerve bias)
  • ULTT2b (radial nerve bias)
  • ULTT3 (ulnar nerve bias)
  • PNF (Lhermitte’s Test)
  • SLR (sciatic, tibial, and peroneal nerve biases)
  • PKB (femoral nerve bias)
  • Slump (dura)

Conditions with neurodynamic involvement

A few examples

Ankle sprain; Cervical and Lumbar Nerve Root Injury; Colles Fracture; Carpel Tunnel Syndrome; Failed Back Surgery Syndrome; Hamstring Injury; Meralgia Paresthetica; Myelopathy; Plantarfasciitis; Post Lumbar Surgery; Whiplash Associated Disorders; Thoracic Outlet Syndrome; Sciatica;Cyclists Palsy; Double crush syndrome; Tarsal Tunnel Syndrome

Presentations

For an indepth look at neurodynamic testing look at the below resources.
http://www.eimqa.com/Fellowship/FellowPresent/KargelaUENeurodynamics.movUpper-Limb-Neurodynamics.png
Upper Limb Neurodynamics

This presentation, created by Mark Kargela as part of the Evidence In Motion OMPT Fellowship, discusses the upper limb neurodynamics.

View the presentation

https://vimeo.com/65773894Cervicothoracic disorders ppt.PNG
Adverse Neural Dynamics Related to Cervicothoracic Disorders and Symptoms

This presentation, created by Damian Rodriguez, Allison Rose, David Self, Blake Spoon; Texas State DPT Class.

View the presentation

http://www.eimqa.com/Fellowship/FellowPresent/KargelaUENeurodynamics.movAdverse neural dynamics presentation title.png
Adverse Neural Dynamics: Treatment Considerations for Neck and Arm Pain

This presentation, created by Jason Grandeo, as part of the Evidence In Motion OMPT Fellowship, discusses the adverse neurodynamics in the upper quadrant.

View the presentation

https://youtu.be/QuPVnj7XPjYAdverse neural dynamics upper ex exam presentation title.png
Adverse Neural Dynamics - Upper Extremity Examination

This presentation, created by Jason Grandeo, as part of the Evidence In Motion OMPT Fellowship, reviews indications for using upper-limb neurodynamic tests, describes normal sensory responses for each of the upper limb neurodynamic tests, reviews the validity of the upper limb neurodynamic tests, and describes positive findings with upper limb neurodynamic tests.

View the presentation

  1. 1.0 1.1 Lohkamp M., Herrington L. Small K. Tidy's physiotherapy. London Elsevier 2013
  2. Shacklock M. Neurodynamics. Physiotherapy. 1995 Jan 1;81(1):9-16. Available from: https://www.physiotherapyjournal.com/article/S0031-9406(05)67024-1/pdf (last accessed 16.4.2019)
  3. Ed Mulligan. CORE principles of neurodynamics. Available from: https://www.youtube.com/watch?v=ct5pOXyO5oc&feature=youtu.be (last accessed 16.4.2019)
  4. Ellis RF, Hing WA. Neural mobilization: a systematic review of randomized controlled trials with an analysis of therapeutic efficacy. Journal of manual & manipulative therapy. 2008 Jan 1;16(1):8-22. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2565076/ (last accessed 16.4.2019)
  5. Wikipedia. Neuro biomechanics. Available from: https://en.wikipedia.org/wiki/Neuro_biomechanics (last accessed 20.4.2019)