I must confess, I’m what you would call a “nerve-head.” I took a combo course of Explain Pain and The Sensitive Nervous System over a decade ago, and have loved assessing and treating neurodynamic dysfunction ever since. Like many modern manual therapy clinicians, as my approach evolved, I began to change the way I thought about my current assessments and treatments.
Is patient discomfort really justified?
Prior to this paradigm shift, I normally used neurodynamic tensioners more than sliders. Even though my patients were experiencing “lightning shock” sensations down their arm, the discomfort seemed justifiable as long as they felt and moved better in the long run. Since The Eclectic Approach uses modern pain science as its basis, I instruct that all tests, movements, and positions are essentially inputs to the central nervous system (CNS).
In doing its job, the CNS can make one of two decisions:
- red light an input as being dangerous
- green light an input as being safe
These judgments are based on experience, beliefs, current health, and many other variables. Since most patients are in a “CNS lock-down” about their current complaint, the last thing you want to do is reproduce it, or use a treatment or movement that still has a perceived threat associated with it.
Limiting the use of neurodynamics
My new paradigm uses neurodynamic bias movements in pre- and post-tests only. Moving away from causing discomfort in any treatments, I started using neurodynamics to test under the following conditions:
- Symptoms did not centralize with repeated loading of the spine
- Peripheral complaints were chronic in nature, resembling tendinosis or chronic sprains
Assessing movement prior to neurodynamic testing
Prior to testing for neurodynamic dysfunction, you should check if:
- Repeated motions of the spine centralize the complaints
- Remember passive overpressure in the directional preference
- All of the joints in the periphery have the capacity for normal movement passively
The last point is important. I have been fooled in the past when using neurodynamic movement testing for a “positive” movement for median bias was limited and painful or reproduced symptoms. It turned out that the shoulder had limited passive range of motion in external rotation.
Also, when joints have full motion, you know the patient is a Rapid Responder. If all joints have full and pain-free passive motion in one session, there should be some sort of novel input you can introduce to the system to make the neurodynamic test have full and pain-free motion.
Non-threatening treatment techniques
My go-to treatments include:
- Repeated loading of the spine in the directional preference to centralize the complaints
- IASTM along the neural container (first in neutral, then with movement if needed)
- EDGE Mobility Band compressive wrapping to modulate stretch perception
- Joint mobs of the periphery to introduce novel input along the entire chain and reduce threats
In summary, many of our treatments have the potential to be uncomfortable and downright painful at times. When a patient comes to you in pain, why cause them more discomfort? Instead, treat them using novel, non-threatening techniques and watch their mobility improve rapidly. Your patients can kiss post-treatment soreness good-bye!