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NEUROGENIC DISORDER TREATMENT
Neurogenic disorders are common and their incidence is probably underestimated (Bennett 1997).
With many recent developments in their management, it is merciful that they can now be treated with non-invasive physical methods.
The notion of adverse neural mechanics has been present for many
years and probably longer than we know.
Wittingly or unwittingly, the first known description of a neurodynamic
test was on the Edwin Smith Papyrus by Imhotep in 2800 BC, in which a leg straightening manoeuvre was performed in the diagnosis of low back pain in workers injured whilst building the Egyptian pyramids (Beasley 1982; Dyck 1984).
However, between then and now, much has happened and it is fascinating to note that, in addition to the neurodynamic tests for the lower quarter, the three major tests for the upper limb nerves (median, radial and ulnar) had been documented and illustrated
pictorially by the 1920s and 1950s (Bragard 1929; Von Lanz & Wachsmuth 1959). Their antitension counterpart postures were also illustrated
next to these neurodynamic tests.
In the context of therapy, neural mobilization has undergone massive development, particularly in the last thirty-five years since Gregory Grieve, Geoffrey Maitland, Robert Elvey and David Butler published
their work. Such an awareness of mechanical function of the nervous system has developed to the point where, for therapists dealing with pain and the musculoskeletal system, proficiency in neurodynamics has become a standard requirement.
Nevertheless, an author whose work passed relatively unnoticed was Grieve (1970). The reason this paper is important is that in it Grieve commented on, for the first time that I am aware of in the physiotherapy literature, the notion of sensitivity of neural tissues being a key factor in whether they produce symptoms. He remarked on the possibility that inflamed neural tissues may well be more likely to produce abnormal neurodynamic tests as opposed to those on which pressure was exerted by pathologies such as disc bulges. He also alluded to the possibility that nervous system processing could be a means by which neurodynamic tests might change with spinal manual therapy. These aspects have undergone somewhat of a renaissance and they turn out to be key facets of current thinking in clinical neurodynamics.
Nevertheless, an author whose work passed relatively unnoticed was Grieve (1970). The reason this paper is important is that in it Grieve commented on, for the first time that I am aware of in the physiotherapy literature, the notion of sensitivity of neural tissues being a key factor in whether they produce symptoms. He remarked on the possibility that inflamed neural tissues may well be more likely to produce abnormal neurodynamic tests as opposed to those on which pressure was exerted by pathologies such as disc bulges. He also alluded to the possibility that nervous system processing could be a means by which neurodynamic tests might change with spinal manual therapy. These aspects have undergone somewhat of a renaissance and they turn out to be key facets of current thinking in clinical neurodynamics.
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