Q&A: Neurodynamics Sliders vs Tensioners | Modern Manual Therapy Blog - Manual Therapy, Videos, Neurodynamics, Podcasts, Research Reviews

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!

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