Since the 1970s, when these procedures were first introduced, the treatment of neural tissue has remained a common component of diagnostics and treatment in manual physiotherapy (Elvey 1979; Butler 1991, 2000; Shacklock 1995, 2005; Hall & Elvey 1999).

Theoretically, neurodynamics is just another name for neural mobilisation or neural mobilisation combined with certain additional neurosciences, according to some therapists. Moving neural tissues is just one component of the topic’s much more extensive and varied clinical use. The first physical test for the neural structures involved in musculoskeletal disorders was described in 2800 BC by the Egyptian physician Imhotep as a “leg straightening manoeuvre” in the physical examination of people with back pain. Physical tests for this purpose have been around for quite some time. Since then, there has been a lot of debate regarding the exam, influenced by a number of notable authors, including Lasègue in 1864 and Forst in 1881, Charnley in 1951, von Lanz and Wachsmuth in 1959, and Breig in 1978.

A lesion or illness affecting the peripheral nerve system might cause leg pain associated with low back pain and arm pain related to neck pain. Common entrapment neuropathies like carpal tunnel syndrome and cubital tunnel syndrome damage the peripheral nervous system, and disorders like lateral epicondylalgia may also have an impact (Josiah D. Sault, et al. 2020) and plantar heel pain (Álvaro Cuñado González, et al. 2021). Most frequently in the lumbar or cervical spine, radicular pain is brought on by mechanical (usually compressive) or chemical stimulation of a spinal nerve or nerve root (Tom Jesson, et Al. 2020).

Upon reaching the definition, By mobilising the neural system or the structures around the nervous system, neurodynamics is described as an intervention aimed at restoring equilibrium in and around the nervous system (Tom Jesson, et Al. 2020). Through manual methods or exercise, neural mobilisation promotes mobility between brain structures and their surroundings (interface).

The mechanics and physiology of the nervous system are frequently dynamically interconnected in our patients, which is one of numerous fundamental hypotheses that support the idea of neurodynamics.  Blood flow fluctuates in response to pressure and tension changes in the nervous system (Kobayashi S, et al., 2003; Lundborg G, et al., 1973; Ogata K, et al., 1986), mechanosensitivity and inflammation in the neural tissues (Calvin WH, et al., 1982; Tal M, and Eliav E, 1996; Bove GM, et al., 2003) This may have significant clinical ramifications. Similarly, modifications to the neural system’s physiology may result in modifications to how it functions.

The nervous system has a strong chance of remaining healthy and symptom-free if it is exposed to an ideal or normal mechanical environment. The mechanics and physiology of the nervous system are interdependent. Pathomechanics, on the other hand, can result in a cascade of pathological processes in the neural tissues.

There are numerous physiological effects of neurodynamics, including: 

• promotes intraneural fluid dispersion and decreases intraneural edoema.
• decreases mechanical and thermal hyperalgesia.
• inhibits the heightened immune responses that occur after nerve damage.

Therefore, keep in mind that pathomechanical and pathophysiological factors may both be implicated in the case of aberrant brain function. In any event, mechanical treatment is carried out to enhance both features.

Three components make up the neurodynamics system from a structure and function perspective: 

1. Mechanical interface.
2. Neural tissue.
3. Innervated tissue.

With this architecture, the physician has many important opportunities to comprehend how to move the nervous system, particularly, and to create diagnostic categories related to improper neurodynamics (Shacklock M., 1995, 2005).

To precisely address patient presentations involving brain mechanosensitivity, neural mobilisations were advised (Elvey 1979, 1997). Increased sensitivity of peripheral nerve trunks to pressure or tension is a clinical indicator of neural mechanosensitivity (Butler 2000). In addition to the subjective interview, where the pain behaviour may support this provisional assessment, six particular indications must be present to support the concept of a neurogenic illness (Elvey, 1997) :

1. chronic musculoskeletal conditions.
2. Dysfunction of active movement caused by one or more nerve trunks not functioning properly.
3. Specifically correlated with active movement dysfunction is passive movement dysfunction.
4. Adverse reactions to nerve trunk palpation and tests to provoke neural tissue in anatomically defined ways.
5. Indications of musculoskeletal dysfunction, which could point to a cause of the neurogenic illness and be treated with physical therapy.
6. Repeated spinal motions had little effect on the symptoms in the lower or upper extremities (Delitto A, et al., 1995).

Despite these early suggestions, it is still not apparent if neural mobilisations are effective for patients with spinally referred pain without obvious evidence of nerve mechanosensitivity as well or whether they are equally advantageous for patients with confirmed elevated nerve mechanosensitivity. A study conducted in 2022 by Murape, T., et al. provided the answer to this issue and came to the conclusion that:

Independent of the criteria employed to interpret neurodynamic tests, neural mobilisations appear to be helpful to reduce pain and disability in spinally related leg pain. These findings are encouraging for patients with lower extremity pain caused by the low back, but they cannot be applied to patients with upper extremity pain caused by the cervical spine.

This blog’s final section discusses “the best and most scientifically supported technique.” According to the study conducted in 2017 by Basson A. et al.,

• Pain relief with cervical lateral glide mobilisation for nerve-related neck and arm pain (level A).
• Slump and SLR mobilisation reduce nerve-related low back pain’s discomfort and impairment (level A).
• Carpal tunnel syndrome (upper-limb neurodynamic test 1) and nerve-related low back pain (slump and SLR) both benefit neurophysiologically from neural mobilisation. (level A).

As a result, it has been demonstrated that Slump and SLR mobilisation, as well as a cervical lateral glide technique, can reduce pain and improve function in patient populations who are frequently resistant to therapy, such as those with chronic nerve-related low back pain and nerve-related neck and arm discomfort. But take care—conclusions could alter over time because of the scanty evidence and frequently tiny study sizes. Furthermore, Basson et al. omitted to say whether it is superior to alternative therapies.

In the end, we derive the following data:

• Neurodynamic testing or techniques involve moving peripheral nerves and targeting their surrounding tissue.
• neurodynamic treatments are unlikely to make patients worse.
• Neural mobilisations can be administered regardless of clinical results.
• Treatments such as cervical lateral glide, slump, and SLR mobilisation can reduce pain and improve function.

References:

1. Álvaro Cuñado González, Sergio Belda Berenguer, Juan Manuel Luque Mañas, Aitor Martin-Pintado-Zugasti. 2021. Validation of a sham novel neural mobilization technique in patients with non-specific low back pain: A randomized, placebo-controlled trial. Musculoskeletal Science and Practice 53, 102378.
2. Basson A, Olivier B, Ellis R, Coppieters M, Stewart A, Mudzi W. The Effectiveness of Neural Mobilization for Neuromusculoskeletal Conditions: A Systematic Review and Meta-analysis. J Orthop Sports Phys Ther. 2017 Sep;47(9):593-615. doi: 10.2519/jospt.2017.7117. Epub 2017 Jul 13. PMID: 28704626.
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