At the completion of this chapter, the reader will be able to:
Summarize the various types of neurodynamic examination and mobilization techniques.
Describe the proposed mechanisms behind the neurodynamic examination and mobilization techniques.
Apply knowledge of the various neurodynamic mobilization techniques in the planning of a comprehensive rehabilitation program.
Recognize the manifestations of abnormal nervous tissue tension and develop strategies using neurodynamic mobilization techniques to treat these abnormalities.
Evaluate the effectiveness of a neurodynamic mobilization technique when used as an intervention.
Neurodynamics is the study of the mechanics and physiology of the nervous system. The nervous system is an electrical, chemical, and mechanical structure with continuity between its two subdivisions: the central and peripheral nervous systems (see Chapter 3). In addition to permitting inter- and intraneural communication throughout the entire network, the nervous system is capable of withstanding mechanical stress as a result of its unique mechanical characteristics. Nervous tissue, a form of connective tissue, is viscoelastic. This viscoelasticity allows for the transfer of mechanical stress throughout the nervous system during trunk or limb movements. This adaptation results from changes in the length of the spinal cord during movement and the capacity of the peripheral nerves to adapt to different positions. The peripheral nerves adapt through a process of passive movement relative to the surrounding tissue via a gliding apparatus around the nerve trunk.1,2 Three mechanisms appear to play an important role in this adaptability:2
Elongation of the nerve against elastic forces. In normal daily movement, nerves may slide up to 2 cm in relation to surrounding tissues and contend with a strain of 10%.3
Longitudinal movement of the nerve trunk.
An increase and decrease of tissue relaxation at the level of the nerve trunk.
The efficiency of this mechanism partially depends on the capacity of the loose connective tissue around the nerve (adventitia, conjunctiva nervorum, perineurium) to allow any traction forces to be distributed over the whole length of the nerve. If this distribution of forces is compromised, an unfavorable rise in traction forces can occur at certain segments, depending on the anatomic site (see next section).3
The role that tension on the neural tissue plays in pain and dysfunction has been studied for over a century. During this time, a number of specific tests have been designed to examine the neurological structures for the presence of adaptive shortening and inflammation.3–6 The more common of these neurodynamic mobility tests are described in this chapter.
Once detected, any lack of neural mobility that appears to be contributing to a patient’s signs and/or symptoms can be addressed using a number of neural mobilization techniques. Neurodynamic mobilizations, which use specific combinations of active or passive movements that aim to reduce mechanosensitivity and restore symptom-free function, have been advocated ...