Another Neurodynamic Progression | Modern Manual Therapy Blog - Manual Therapy, Videos, Neurodynamics, Podcasts, Research Reviews

Another Neurodynamic Progression

Here is a neurodynamic treatment progression I do not use too much, but it does help when indicated, albeit slowly.

My suggested progression for neurodynamic treatment is
1) IASTM or cupping along neurodynamic patterns

  • i.e. median nerve, light IASTM along medial upper arm, and anterior forearm, then retest if the test is still limited
  • pattern work only takes 1-2 minutes of light work to often make rapid changes in neurodynamic ROM
2) compression wrap with EDGE Mobility Bands or similar

  • if IASTM does not work, I wrap the forearm, upper arm, thigh, or calf and then mobilize
  • this often has the effect of taking a painful or very limited neurodynamic test and making it move like a slider
  • keep compressed and mobilize at different parts of the extremity
    • median nerve, wrap forearm and mobilize at the wrist, forearm, then wrap the upper arm and mobilize the elbow, forearm, and shoulder
    • the limb may be oscillated as a normal slider/tensioner Tx, or the band may be rotated for a superficial fascia "twist" simultaneously
3) Neurodynamic sliders
  • sliders are next and taught for HEP because they enable a greater ROM wherever you are oscillating
  • getting to end range is more likely to get lasting improvements ala MDT
4) Neurodynamic tensioners
  • eventually the nervous system should be able to go through a loaded neurodynamic tensioner progression
  • I do not SB the head away too much unless the patient is very lax and other Tx fail to centralize the complaints
5) Eccentric Neurodynamic Tensioners
  • This is the progression I alluded to earlier that I do not have to use too often
  • Two case examples from this year are hamstring pain and heel numbness that initially responded to MDT to the hip, IASTM to the lower leg neurodynamic patterns, compression wrapping, eccentric loading
  • The first case responded to spinal mobilization with movement gapping along with passive SLR in that position - will be filmed later for the OMPT Channel next week
  • The second case responded to eccentric hamstring loading during neurodynamic tensioners in supine for the sciatic nerve
    • both cases were given standing single leg squat eccentric loading in sciatic nerve bias
      • hip flexion, IR, adduction
      • knee extension, ankle dorsiflexion
      • place heel on a table
      • single leg squat with the other leg to raise the involved LE into passive hip flexion while simultaneously pushing the heel downward to active that hamstring eccentricly
      • the patient may give inferior glide at the proximal anterior thigh as well as inferior glide with both hands' webspaces
    • this is a very powerful HEP technique and should only be used as a progression
    • both cases fell into the slow responder or dysfunction category and had decrease in their complaints over weeks as opposed major change in a few visits
  • HEP can be combined with EDGE Mobility Band to make the eccentric loading more comfortable

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