What is the result of the movement of the nervous system
Nutrition of the nerves and the nerves target tissues
What occurs to the nerve root with hip flexion in SLR
It moves out of the ipsilateral IVF and contralateral nerve root gets pulled relatively in through the IVF
- There is also some lateral shifting of spinal canal contents
Normal fixation points of the slumps test
- Popliteal region, C6, T6, L4
- Normal to feel symptoms and/or tightness here
What are abnormal fixation points
- Scarring from muscle injury - Past disc injury where there is fibrous tissue where disc has remodelled
- Ligament hypertrophy - leading to narrowing of passageway
When do fixation points matter
- Different left and right
- Relates to their presentation (complaint)
What are some subjective findings that would lead you to think it may be neurodynamic related.
- Weird description of pain
- Previous or persistent injury
- Increase repetition or speed of work or sport
- Lines of symptom distribution (may not relate to nerve root or peripheral nerve distribution)
- Aggravated in positions of neural tension
_ multiple problems in the same limb
What are some compensations you will see during SLR? What does the use of a compensatory pattern indicate?
- Chin lift
- Hip hiking
- That you have gone past R1
Neck flexion =
Chin to chest
Cranial vertebral flexion =
Chin to throat
Does neck flexion or cranial vertebral flexion add more tension to the system
cranial vertebral flexion
in the slump test CV neck extension will cause…
relief of symptoms
When should you ask about symptoms in the slumps test
at each new addition
In a slump test, adverse neural mobility is likely a part of the problem if what occurs…
- Pts symptoms or something similar are reproduced with testing (+/- abnormal endfeel)
- Range achieved with testing is less than contralateral side or expected normal
- ROM or symptoms of test change with movement of remote areas
What can cause referred pain to a dermatome, myotome, of sclerotome
a segmental ligament, muscle, or joint (around the facets)
What type of neurodynamic treatment should you begin with
first a slider then tensioners
What is the rule of thumb for which joints to move for sliding
start with those located remote of the symptom and then progress to closer
Goal of slider. How to perform?
to promote movement.
As you add tension to one part of the system decrease it in another
Goal of tensioner. How do you perform?
To improve nutrition Add tension to both ends of the system (head down, leg up)
Contraindication for neurodynamic mobility treatment
- In the present of hard neuron signs
- Worsening symptoms
- Undiagnosed symptoms
- Severe irritability
What is indirect treatment
Add on to gliders and tensioners
- Interface
- Posture
how many reps of Sliders do you give?
10-50reps 1-3 sets (max out at 50)
how do you progress treatment
- Go further into range or resistance (don’t provoke pain just mild-moderate stretch)
- Increase reps
- Add movement through components closer to symptomatic area
- Incorporate additional sources of tension
- Treat the interface with or without neural tension
What do you want to determine before moving into greater sensation producing movements
The latent response
