Q&A: Neurodynamics Sliders vs Tensioners | Modern Manual Therapy Blog

Q&A: Neurodynamics Sliders vs Tensioners

Today's Q&A asks, when do you use neurodynamic tensioners versus sliders?

Neurodynamic tensioner - using sensitizing components to "stretch" or test the mobility of the nervous system and it's surrounding container, occasionally "pulling" on both ends

  •  i.e. slump test
  • ULNT with head/neck SB away from the involved side - possibly decreasing distal motion and increasing Sx or paraesthesia

Neurodynamic slider - using a sensitizing component to slack one end of the neural container, thus creating increased and often pain and Sx free motion at the other end of the container

  • i.e. slump test, with head in extension
  • ULNT with head/neck SB toward the involved side - increasing wrist extension

Like any form of movement assessment, neurodynamics upper and lower limb testing is used to look at

  • symptom provocation
  • movement quality
  • movement quantity
Recent research from last year suggests asymmetries in the ULNT 1 (median) for dominant versus non-dominant sides, so this should be taken into account when looking at ROM quantity.

I generally say a ULNT or LLNT test is positive when it reproduces Sx, or produces some sort of discomfort, pain, or paraesthesia on the involved side, versus nothing, or merely "a stretch" on the uninvolved side.

So getting back to the original question neurodynamic tensioners are used when there is
  • a loss of ROM on the uninvolved side with oscillations at any of the sensitizing components, i.e. wrist extension, forearm supination, elbow extension for ULNT 1
  • pain or reproduction of Sx, or altered Sx on the involved side
  • chronic complaints - ankle sprain that is not healing, long standing lateral epicondyl-"itis"
  • if the treatment increases ROM, centralizes complaints, and any increased complaints, like pain/paraesthesia do not REMAIN worse as a result
Neurodynamic sliders are used when
  • even light stretching/motion is not tolerated i.e. central sensitization
  • the thought is to decrease the perceived threat of motion, by showing the CNS that the movement that is thought to be a threat is actually not limited or painful
  • this decreases the perceived threat and should increase the pain threshold
  • if tensioners do not increase ROM, try sliders first, some patients/PTs do not think they are helpful because the feeling of "stretch" is not perceived and the PT does not notice resistance during the stretch
  • however, increased motion, is increased motion, and whether you are doing a slider or tensioner, the full neurodynamic mobility should be seen in all joints as components
Hope this clears up the sliders versus tensioners!


3 comments:

  1. So would you say when you have someone who has inc sensitivity to a SLR you would do sliders before tensionsers?
    Could you almost view it as chronic vs acute. If you have a chronic pain from an old ankle sprain, you would rather do a tensioner for the peroneal nerve, correct. Where as the sensitivity to say an SLR may be more of a acute problem?
    I have read through Shadlock's book and tried to absorb it best I can. I really can't wait until Sept when he comes to NYC to teach his 4 day Neurodynamics course. It should help clear up somethings since I am more of a visual learner. I have been told he is very precise and takes his time to make sure you have the hand placements and body mechanics correct.

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  2. Incr sensitivity to any movement or position would be an indication for a slider to increase the motion without provoking the Sx.


    Chronic pain is not the same as CNS sensitivity, so in the prescence of say a chronic lateral ankle sprain, I would assess the peroneal and sural nn, perform the manual techniques, then reassess the test and functional limitation.


    I haven't taken Shacklock's course, only have his text. I have taken most of Butler's courses, he is also very picky about hand placements and taking the tensioners to end range (as he should be)

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  3. A recent evidence supports that addition of either of the two neurodynamic techniques (neural sliders and tensioners) on hamstring stretching help improve hamstring flexibility in healthy individuals. Coaches, sports physiotherapists may consider incorporating neural mobilisation techniques to enhance flexibility of hamstrings and researchers may use this concept to test for other body parts in other populations.

    http://www.physicaltherapyinsport.com/article/S1466-853X(15)00014-0/abstract

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