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Neurodynamics (neural tightness case)
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Neurodynamics (neural tightness case) - August 7, 2008 3:42:40 PM
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torques
Posts: 59
Joined: July 18, 2008
From: Marion, IN
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Hi everyone,
I can't find much research on Butler's neurodynamic technique. I have a patient which I suspect have a true UE neural dysfunction. I am wondering if Butler's intervention is effective in this case. My patient is asking me about prognosis and I have no clue on what to tell him. I have cleared most musculoskeletal impairments. Nerve tension is still highly provocative. Does anybody have experience with similar case? I know the patient info is very limited but my question is: can neurodynamics actually affect the plasticity of tight neural tissues similar to stretching of other muscle/connective tissues? or does it just glide the neural structure from adhered myofascial structures? Any info on research articles or from experience will be greatly appreciated.
Julius Quezon PT MTC CPed
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RE: Neurodynamics (neural tightness case) - August 10, 2008 9:56:01 AM
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eam
Posts: 290
Joined: February 5, 2004
From: New York, NY 10028
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Hi Julius,
There was a recent article by Michael Shacklock on neurodynamic testing in the UE in Manual Therapy. I do it alot and it does work. I may still have the article, if you PM me with your fax number (if you are in the US) I can send it to you.
Erica
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RE: Neurodynamics (neural tightness case) - August 10, 2008 11:30:05 AM
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TexasOrtho
Posts: 540
Joined: December 22, 2007
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What is the nature of the neural dysfunction? Can you provide information on the case?
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Rod Henderson, PT
Board Certified Orthopedic Specialist (or Super-Freak)
Certified Strength and Conditioning Specialist
www.texasorthopedics.blogspot.com
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RE: Neurodynamics (neural tightness case) - August 11, 2008 2:31:45 PM
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torques
Posts: 59
Joined: July 18, 2008
From: Marion, IN
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Hi Rod,
My impression is nerve tightness(tension) versus entrapment. Patient was originally diagnosed with bilateral thoracic outlet symptom when he was around 18. Patient recalled that his condition exacerbated by carrying heavy back pack when he was in the military. He also states that at that time he also grew ~5" to 6" in height. His main complaint at that time was burning, sharp pain in both UE down to both hands and in some occasion complete numbness. He underwent partial osteotomy of first L rib (the surgeon accidentally severed the phrenic nerve) hence he has respiratory problem as well.He noted no relief from surgery. He is still very active but his symptoms persist. Symptom get provoked with arm elevation overhead. He denies vascular symptoms in both UE (swelling, tropic changes, cyanosis et al). Review of system is unremarkable other than shortness of breath(from phrenic nerve injury). I wont bore you with physical findings but just the residual impairment remaining which is the provocative upper limb neurodynamic tension test (median nerve bias) + the initial positive neuro signs- paresthesia, sensory and reflex deficit, he has negative spurling, scalene muscle used to be tight but now okay, first rib in optimal position, posture also in optimal alignment. I did structural differentiation (neurodynamic test) with tensioning/slacking and it is consistently positive- symptoms get provoke in different location of neural chain from shoulder to both hands. I would compare this findings with a LBP/tight hamstring in young adult but actually neurogenic in origin using slump/SLR test with structural differentiation test (Butler). Anyhow, my strategy is to incorporate neurodynamic exercises but I don't have much knowledge on its effectivity in this specific case. I cannot fully ruled out nerve entrapment (brachial plexus location).
Julius
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Julius Quezon PT DPT MTC CPed
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RE: Neurodynamics (neural tightness case) - August 12, 2008 1:47:02 PM
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torques
Posts: 59
Joined: July 18, 2008
From: Marion, IN
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I would like to thank Erica for the article. Coppieters MW, Butler DS "Do "slider" slide and "tensioners" tension? An analysis of neurodynamic techniques and considerations regarding their application. Manual Therapy. 2008; 13:213-221.
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Julius Quezon PT DPT MTC CPed
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RE: Neurodynamics (neural tightness case) - August 12, 2008 7:15:07 PM
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TexasOrtho
Posts: 540
Joined: December 22, 2007
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For folks with this type of presentation, I have good results with proximal to distal nerve flossing. I will perform these activities manually at first and then gradually teach the patient how to perform them. There is also a technique to floss the peripheral nerves distally to proxmally across some of the more common entrapment areas such as the carpal tunnel, cubital tunnel etc...
It isn't instant gratification, but over a few weeks the patient may find the paresthesias begin to improve. I've had experience with this myself (bilateral cubital tunnel syndrome) and it has helped me a lot. I've seen it do well for patients with CTS and cubital tunnel, but have had recent success with flossing more proximally into the brachial plexus and cervical nerve roots. The results can be significant at times, but most of the time the progress is slow and steady. I rarely tension the nerve anymore other than for diagnostic purposes.
That article you posted is very good eventhough only two cadavers where studied. Other studies have found similar results and the rationale for their use is sound.
< Message edited by TexasOrtho -- August 12, 2008 7:50:29 PM >
_____________________________
Rod Henderson, PT
Board Certified Orthopedic Specialist (or Super-Freak)
Certified Strength and Conditioning Specialist
www.texasorthopedics.blogspot.com
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RE: Neurodynamics (neural tightness case) - August 14, 2008 7:06:14 AM
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torques
Posts: 59
Joined: July 18, 2008
From: Marion, IN
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Thanks for the info Rod.
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Julius Quezon PT DPT MTC CPed
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