Neurodynamics is a critical area of physical therapy practice. Every day, PTs use Neurodynamics techniques to diagnose pathologies and treat patients with neural issues. So it’s helpful for PT students to get an understanding of what this approach is.
This article is an introduction to Neurodynamics that provides an overview of what this technique is, how it’s used for assessment and why should Neurodynamics be used as a treatment technique.
So open up a Word doc and start taking notes because we’re about to give you lots of valuable insights backed by research. Let’s begin.
What does Neurodynamics mean in Physical Therapy?
Neurodynamics is the relationship of the nervous system with the other systems of the body particularly the musculoskeletal (MSK).[i] The nerves in our bodies travel from the brain and spinal cord to the peripheral regions, and in doing so interact and communicate with the muscles, tendons, joints and other structures.
Physical therapists use Neurodynamic techniques and principles to diagnose and treat various MSK and neurological pathologies such as radiculopathies and nerve compression syndromes.
The mobilization of nerves serves as a treatment approach for reducing pain. The goal of Neurodynamics is to improve the nervous system’s health by mobilizing the nerves.
Neurodynamic Assessment
As the name indicated, Neurodynamic assessment involves checking the functionality of your nervous system. That means the length, mobility and compression of your nerves. The Neurodynamic assessment in physical therapy is divided into upper and lower limb tests.
Just like the MSK tests are defined for each region and joint, there are different tests for checking the various nerves as well.
You have to apply the test on the asymptomatic side first. That gives you an accurate assessment of the flexibility and normal ranges of your subject. Then you can begin the test on the symptomatic side by adding one component at a time until pain is provoked.
Pro Tip
You have to apply the test on the asymptomatic side first. That gives you an accurate assessment of the flexibility and normal ranges of your subject. Then you can begin the test on the symptomatic side by adding one component at a time until pain is provoked
If your patient experiences reproduction of pain, loss of sensation, numbness or tingling and decrease in mobility as compared to the contralateral side, then the test is positive and you can confirm a compression of the nerve. Feeling a stretch or slight discomfort are not positive findings.
In this section, we’ll give an overview of the upper and lower limb Neurodynamic tests and mention some indications for using them.
Upper limb Neurodynamic Tests
The upper limb Neurodynamic assessment mainly revolves around the brachial plexus. That’s why the Upper Limb Tension Tests (ULTT) are also called the Brachial Plexus Tension Tests.
In these tests, the therapist moves the shoulder, forearm, wrist, fingers and neck in various positions to apply pressure on the nerves and check compression along the route. The order of joint positioning is critical and the accuracy of the results depends on it.
Each new movement component that is added to further extend the nerve is called sensitiser.[ii] You only add the sensitizers until symptoms are provoked.
Here are the different types of the ULTTs:
- ULTT-1 Median Nerve Bias (nerve roots C5-C7)
- ULTT-2A Median Nerve Bias
- ULTT-2B Radial Nerve Bias
- ULTT-3 Ulnar Nerve Bias (nerve roots C8-T1)
- ULTT Musculocutaneous (nerve roots C8-T1)
You can click on these links to watch the demonstration of each of these tests.
Physical therapists can use the ULTTs to investigate different upper limb neurological conditions such as cervical radiculopathy, carpal tunnel syndrome and thoracic outlet syndrome.[iii]
Various studies have confirmed the validity[iv], reliability and diagnostic accuracy of ULTTs.[v] These tests have a sensitivity of 60.46% and low to moderate specificity in acute cervical radiculopathy patients.
Lower limb Neurodynamic Tests
The lower limb Neurodynamic tests apply tension to the entire nervous system. Here, you move the neck, trunk, hips and ankle and these are the movement components or ‘sensitizers’ for the lower limb Neurodynamic tests.
Here are the three tests:
You can use the lower limb Neurodynamic tests to diagnose lumbar radiculopathy, impairment in the disc, and excessive nerve compression anywhere along the route causing radiating symptoms.
These tests are validated by research.[vi] [vii] A 2015 study found that the slump test has a sensitivity of 0.91 and specificity of 0.7 in diagnosing neuropathic pain in the lower limb.
Similarly, the femoral nerve tension test has a high sensitivity of 1 and specificity of 0.83 in diagnosing lumbosacral radiculopathy.
The slump test is also an accurate tool for lumbar disk herniation assessment with a sensitivity of 0.52 and specificity of 0.89.
Precautions
These tests involve many structures and joints so be cautious not to aggravate other regions or joints that are not the primary areas of pain for your patient.
Getting a thorough history from the patient can be helpful to know what pathology you’re looking to confirm or reject. An accurate subjective exam also tells you of comorbidities that may affect the outcome of your test.
Neurodynamic Treatment
The Neurodynamic techniques are also used as a treatment modality.
The conditions you can treat include peripheral neurological pain, recalcitrant neck or arm pain unresponsive to conservative management, radiculopathy and other such conditions.[viii]
The Physiological Mechanism Behind Neurodynamic Techniques
The exact bio-physiological mechanism of how the Neurodynamic techniques decrease pain and improve the function of the nerve is not yet clear. But animal studies have demonstrated that it might be because these movements decrease proinflammatory Cytokine.[ix]
Carta et al. (2021) studied the effects of Neurodynamic treatments in vitro. They concluded that these treatments promote cell differentiation, neurite outgrowth, and neuron survival. These changes are especially observed in the nociceptive neurons.
Another 2012 animal study by Santos et al. showed that Neurodynamic treatments reduce hyperalgesia due to changes in the glial cells.
Efficiency of Neurodynamic Treatment Techniques
Nevertheless, the efficiency of Neurodynamic for treatment is well established. Studies have shown that it reduces pain and neural stiffness.[x] A recent RCT by Hamed et al. (2021) showed encouraging results of using nerve flossing treatments to improve nerve conduction and decrease pain.
Another 2020 study showed similar results where Neurodynamic mobilizations in tetraplegia patients resulted in decreasing spastically and improving upper limb function.[xi]
A systematic review by Lopez et al. (2019) showed that Neurodynamic treatments increase hamstring flexibility as compared to no interventions and other treatments.
Hence, the key benefits of Neurodynamic treatment techniques as shown by the current best evidence are:
- Reduced pain
- Improved muscle flexibility
- Improved nerve conduction
- Reduced neural stiffness
- Decreased spasticity
Guide to Neurodynamics – In Summary
Neurodynamics in physical therapy is a diagnostic and therapeutic technique.
Here, you mobilize the nerves by moving the bones and joints in different positions, in a specific order. Physical therapy students study this to understand the interrelationship of the neural structures and the mechanical body components.
This is a vast field and our guide is simply an introduction and overview of what the assessment tests are and why we use Neurodynamics for treatment. If you want to know more, then read the reference articles cited in this article and learn all about Neurodynamics!
[i] https://www.worldcat.org/title/tidys-physiotherapy/oclc/842909069
[ii] https://www.jospt.org/doi/pdf/10.2519/jospt.2001.31.5.226
[iii] https://www.sciencedirect.com/science/article/pii/S0741521407007343
[iv] https://www.sciencedirect.com/science/article/abs/pii/S026800339900042X
[v] https://pubmed.ncbi.nlm.nih.gov/2641994/
[vi] https://www.mdpi.com/1660-4601/17/19/7046
[vii] https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-016-1383-2
[viii] https://www.youtube.com/watch?app=desktop&v=QuPVnj7XPjY
[ix] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=29309710