IPHREHAB: APPROACH FOR NEUROGENIC DISORDER TREATMENT

IPHREHAB

APPROACH FOR NEUROGENIC DISORDER TREATMENT

Approach for neurogenic disorder treatment 

With the above in mind, I felt the need to produce an approach that is in some ways uniquely useful to the clinician. 

The approach is therefore characterized by the following:

1. links between mechanics and physiology of the nervous system

2. integration of neurodynamics with musculoskeletal functions

3. a new movement diagram that enables the clinician integrate musculoskeletal and neural mechanisms

4. a new system for determining the kind and extensiveness of examination and treatment based on

neurodynamics and neuropathodynamics

5. the concept of neurodynamic sequencing and various options in assessment and treatment

6. new diagnostic categories of specific dysfunctions based on neuropathodynamics

7. treatment progressions derived from the above.

Nevertheless, it is common for therapists to diagnose more frequently the problems they have recently learned about, which raises the possibility of false diagnosis due to raw enthusiasm. At all times, the reader will realize that clinical neurodynamics is only one aspect of management of the person in pain and all other relevant information should be included in clinical decision making. For instance, the existence of a neural problem does not necessarily mean that a treatment with a neurodynamic technique is warranted. This could be because other treatments may attack the causative mechanisms more effectively or neurodynamic application may be contraindicated. Clearly, the biopsychosocial approach to neural problems will place this

book in its rightful place as just a modality of treatment that will be effective in some patients and not in

others.

Clinical neurodynamics is for clinicians dealingwith musculoskeletal disorders with peripheral neurogenic pain mechanisms, including those of the nerve root and peripheral nerve. There is no assumption that all problems are as such, or that the treatments presented in this book act only on peripheral mechanisms. The clinician will naturally and responsibly establish that it is appropriate to treat patients with clinical neurodynamics before doing so.

IPHREHAB: NEUROGENIC DISORDER TREATMENT

IPHREHAB

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.