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NEURAL STRUCTURES

NEURAL STRUCTURES. Outcomes. 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

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NEURAL STRUCTURES

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  1. NEURAL STRUCTURES

  2. Outcomes 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.

  3. Introduction 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

  4. Introduction 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

  5. Introduction 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

  6. Introduction 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 nervinervorum which results in a pain response and ischemia Ischemia leads to pins and needles, pain and muscle spasm

  7. Clinical presentation Rare patterns of referred pain Strips of pain Pain at pressure points Block of pain around a joint Burning sensation or swelling Symptoms mostly set in after assuming certain positions or carrying out actions which could cause stretching

  8. Aim 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

  9. Evaluation techniques Passive neck flexion (PNF) Straight leg raise (SLR) Mid-slump test Slump test Upper limb tension test (ULTT)

  10. General principles 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

  11. General principles Consider irritability Be consistent with starting position (e.g. pillows) Note pain response (area and nature) Do not necessarily reproduce the pain Watch for and correct antalgic posture/movement

  12. General principles Test for symmetry – compare both sides Sensitising and desensitising components can be added Handle well or don’t bother

  13. Positive test The test is considered positive if: the patient’s symptoms are elicited pain is reproduced if there is more muscle reaction than on the other side if there is any limitation in the mobility if it is different from the normal

  14. Treatment 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

  15. Treatment Always start distal e.g. DF Gr II short of pain and resistance, slow 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

  16. Treatment Work in 20 sec or 20 movements and increase the treatment by 20 each time Re-evaluation signs and symptoms Neurological evaluation is very important Home exercises may be given after the second day of treatment Neural structures must not be rested in stretched positions

  17. Treatment Less movement and more adhesions Pins and needles may be experienced during treatment – should disappear immediately after treatment Place nerve in stretched position and then add the other components Through range of movement Grade III and IV All components must be evaluated

  18. Treatment 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!

  19. Contra-indications Acute nerve-root pressure Worsening of neurological symptoms Pathological conditions that affect the structures e.g. diabetes Cord and caudaequina Malignancies Acute inflammation

  20. Contra-indications 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

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