More Neurodynamic Progressions | Modern Manual Therapy Blog

More Neurodynamic Progressions

I am getting ready to teach Neurodynamics in a few weeks, so here are a few neurodynamic progressions for you.

I am currently sans interns for a few weeks, so I will not be able to film these for a few weeks, you'll just have to use your imagination! The focus today is on the sciatic slump test.

Pt: The sciatic slump test is performed in sitting, with LEs dangling from the table. Assess baseline Sx.

Technique:

Tensioner: Ask the patient to flex their trunk and head while simultaneously extending the knee and then dorsiflexing the ankle. Reassess Sx.

  • tensioners are normally used to increase the neurodynamic mobility and often help to centralize radiating complaints
  • assess sciatic slump for chronic radiculopathies, derangements that are not centralizing, and peripheral complaints like chronic hamstring "strains"


Slider: Perform the same test with sitting upright and the head and neck extended. Reassess Sx and LE ROM. This is a slider.

  • under normal conditions, this should increase the LE ROM and decrease the Sx associated with the movement
  • sliders are recommended as a movement regression to increase pain free movement and decrease CNS sensitivity
  • just a few sets of sliders may increase the pain free range, increase movement tolerance and make the patient ready for some tensioners
Some Butler "Getting Jazzy" progressions along with some of my own
  • place patient in slump tensioner on neural load (at end range to tolerance or close to end range) and combine with
    • STM or IASTM on the paraspinals
    • P/A mobs to thoracic spine
    • MWM to thoracic and lumbar spine P/A or unilateral rotatory while patient actively extends knee and dorsiflexes the ankle
    • hip long axis distraction, knee, or ankle distraction on slump/neural load
  • have the patient keep the knee extended and ankle dorsiflexed while they rotate the trunk toward the extended LE for a slider or away for a tensioner
    • combine this with bilateral UEs overhead for further tensioning
The possibilities are endless and limited only by your imagination! Combining techniques with neurodynamics is a creative way to get a patient moving! Any creative progressions out there? Please share in the comments below! Vids as soon as I have time, ETA to more interns is 2-3 weeks!

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