Download Neural structures

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Be familiar with the anatomy and function
of the neural structures.
Be familiar with the aim of neural dynamic
tests.
Be familiar with the neural dynamic
evaluation tests.
Be familiar with the clinical presentation of
a patient with neural symptoms.
Be familiar with the general principles of
treatment of neural symptoms.
Be familiar with the contra-indications of neural
mobilisations.
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Neural pain sensitive structures
should always be kept in mind
Especially in patients who were
subjected to trauma
The possibility exists that the
resultant inflammatory process
could also affect the nerve-root and
nerve-root sheaths
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This could lead to abnormalities in
terms of mobility
Meningeal nerve-root sheaths have a
well developed pain receptor system
which is responsible for the strange
pain distribution
Adhesions are generally prevalent as a
result of the weak lymphatic drainage in
the area
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The nerve-root which is an
extension of the dura mater,
can therefore also be responsible
for symptoms in another area –
continuity of the system
The most common cause is
reduced mobility of the neural
structures
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During the normal flexion and extension
movements, the spinal cord moves
approximately 7 – 10 cm and therefore the
surrounding neural structures must be
relatively mobile
Mechanical stimuli of a non-injured nerve is
pain free, but excessive lengthening or
pressure stimulates the nervi nervorum which
results in a pain response and ischemia
Ischemia leads to pins and needles, pain and
muscle spasm
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Rare patterns of referred pain
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Strips of pain
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Pain at pressure points
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Block of pain around a joint
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Burning sensation or swelling
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Symptoms mostly set in after assuming certain
positions or carrying out actions which could
cause stretching
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A neurodynamic test
evaluate/tests the pain
sensitivity/ provocation of
the mechano-sensitive
neural structures and the
reaction of the protective
muscles to lengthen around the
neural tissue
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Passive neck flexion (PNF)
Straight leg raise (SLR)
Mid-slump test
Slump test
Upper limb tension test
(ULTT)
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Explain to the patient what you are
going to do and what they must do
Do one component of the test at a
time
Take into account barriers to movement
(onset of resistance, pain or other
symptoms)
Note the quality of movement
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Consider irritability
Be consistent with starting position (e.g.
pillows)
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Note pain response (area and nature)
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Do not necessarily reproduce the pain
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Watch for and correct antalgic
posture/movement
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Test for symmetry – compare
both sides
Sensitising and desensitising
components can be added
Handle well or don’t bother
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The test is considered positive if:
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the patient’s symptoms are elicited
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pain is reproduced
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if there is more muscle reaction than on the
other side
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if there is any limitation in the mobility
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if it is different from the normal
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Both non-neural and neural
structures must be treated
Soft tissue must be prepared before
the neural structures are mobilised
First mobilises non-neural structures, soft
tissue and then neural structures
Be aware of signs and symptoms in
respect to irritability and intensity
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Always start distal e.g. DF
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Gr II short of pain and resistance, slow
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Dull, constant pain must be avoided
during treatment
Joint or muscle must be in mid-range
since the separation level is more
open in this position
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Work in 20 sec or 20 movements and
increase the treatment by 20 each time
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Re-evaluation signs and symptoms
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Neurological evaluation is very important
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Home exercises may be given after the
second day of treatment
Neural structures must not be rested in
stretched positions
Less movement and more adhesions
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Pins and needles may be experienced during
treatment – should disappear immediately after
treatment
Place nerve in stretched position and then add
the other components
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Through range of movement Grade III and IV
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All components must be evaluated
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Treat in close proximity of the origin of the
symptoms
Can also perform an AP on the radius while the arm is
placed in the ULTT
Get full tension before strong techniques are carried
out e.g. SLR with rotation
Ensure at all times that the joints are able to withstand
strong neural techniques
Patients react well to treatment, but can flare-up
easily – be very careful!
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Acute nerve-root pressure
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Worsening of neurological symptoms
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Pathological conditions that affect the
structures e.g. diabetes
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Cord and cauda equina
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Malignancies
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Acute inflammation
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The slump test must not be carried
out during a possible disc herniation
or instability
Take care with irritable conditions
Always test neurological signs before
and after neural mobilisations
Adhesive spinal cord