After taking David Butler's Courses in 2002, I was all about neurodynamics! I had always used "nerve stretching," but not to the extent I did for the next 2-3 years. Everyone received them as patients! Whether or not there was referred or radicular complaints!
A few years before that, when I was studying at the University of St. Augustine, I wrote in a case study that I was doing an upper limb tension test. Dr. Patla asked if it was only for provocation testing, because "you should never stretch a nerve." I replied yes, only because I was doing it for testing, and as it was a current patient, I stopped doing it as treatment. A little white lie.
Over the years, I have definitely found uses for neurodynamic tensioners (current term for nerve loading or stretching). For example, chronic medial and lateral epicondylagia that didn't respond to the traditional treatments, and persistent leg pain/paraesthesia that didn't centralize with MDT. They are also useful to show someone for home exercises.
Conversely, as I got into more tissue work, both functional and tool assisted, I found myself using them only during evaluation. For example, on a patient with chronic lateral epicondylagia, I would test radial nerve, find a limitation, maybe at the elbow, forearm, wrist, or all of the above. I would take a functional measure next, possibly grasping with or without elbow movement. I would then perform some TASTM on the bony contours of the radius, both posteriorly where the symptoms are, AND anteriorly. Maybe some radial head lateral glide (MWM) and/or thrust like Mill's manipulation would also help. Function and radial nerve neurodynamics were then retested. More often than not, it would be better. The neurodynamic tensioner was instructed as a home stretch to be performed 5-7 times/day, for 2-3 sets of thirty second oscillations.
As treatment your choices are this...
Use neurodynamics as tensioners to those who can tolerate them (stretching)
- oscillate at different joints, shoulder depression, shoulder ER, elbow extension, forearm supination, wrist extension for median
- hip flexion, IR, adduction, knee extension, ankle dorsiflexion for sciati
- median: head bent toward, then shoulder abduction to 60
- full shoulder ER, elbow extension, FULL supination, wrist extension
- sciatic: head extension in supine or slump (may also sit upright)
- hip flexion, IR, adduction, knee extension, ankle dorsiflexion
use neurodynamics as pre-test and post-test, treat the neural container
- screen all adjacent joints along the path of the nerve
- perform STM/TASTM along areas of dysfunction
- retest after treatment
as a progression for step 3
- combine and "get jazzy" as Butler would say
- put someone in neural load, i.e. median stretch
- perform wrist mobilization P/A for extension in load
- perform TASTM to anterior forearm or medial upper arm in load
If you choose steps 1-2 and be a "nerve head" or 3-4 and only use it as testing, you will find many patients that you can help with chronic conditions. Questions? Comments? I'll be posting some videos of examples this week. Be sure to check out the OMPT Channel and subscribe for notifications!