Neurodynamic Mobility

1
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 patients 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

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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
• Crams 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

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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