NEURAL MOBILIZATION

Neurodynamics
• Definition : Clinical neurodynamics is essentially the
clinical application of mechanics and physiology of the
nervous system as they relate to each other and are
integrated with musculoskeletal system.
• General layout of the system :
Mechanical interface : It is defined as that tissue or
material adjacent to the nervous system that can move
independently to the system.
• Neural structures
• Innervated tissues
The first is that they provide the basis for some causal
mechanisms that therapists should pay particular
attention.
The second reason is for making specific reference to
the innervated tissues is that they provide the therapists
with the opportunity to move nerves.
The third reason is for the treatment basis(Laban et al
1989).
 Mechanical functions
• Tension :
The first primary mechanical events in the nervous
system is generation of tension.
Since the nervous system is attached to each end of the
neural container the nerves are lengthened by
elongation.

Perineurium : This is the primary guardian against excessive

tension and is effectively cabling in the peripheral
nerve(Sunderland 1991).
• Dense connective tissue and forming
packed this possess
fascicle each considerable longitudinal and
elasticity.
• It allows peripheral nerve to withstand approx. 18-22 %
strain before failure(Sunderland 1991).
Sliding of nerves : The second event is movement of
nervous system relative to their adjacent tissues.This is
called excursion or sliding(Wilgis &Murphy 1986).
It is of longitudinal and transverse .
• Longitudinal sliding :The sliding of nerves down the
tension gradient enables them to lend their tissue
toward the part at which elongation is initiated.
• This way tension is distributed along the nervous system.
• For eg. Median nerve at elbow
• Transverse sliding: It occurs in two ways –
The first is to enable the nerve to take the shortest
course between two points when tension is applied.
The second means by side way pressure by
neighbouring structures such as muscle and tendons.
Sliding of peripheral nerve in the nerve bed is
provided by mesoneurium and internal sliding of the
fascicles.
• Compression : Neural structures can change their shape
when pressure is exerted on them.
• A clinical example ulnar nerve in elbow flexion .
• The epineurium is the padding of the nerve and it
protects the axons from excessive compression.
• It contains finer and less densely packed connective
which gives them spongy qualities and enables the nerve
to spring back when pressure is removed.
 How nerves move
Movement of joints :
Convergence –The nerves move in the direction of the joint
because that is where elongation is initiated. The effects
of the two ends produce little or no movement of the
nerves relative to joint roughly at the midpoint.
convergence ocurs in limbs (Smith&Swash
1976) and spine at most mobile segments(C5-6,C4-5)
during sagittal movements(Adams&Logue1982).
• Nerve bending:
The bending of the nerural structure around
the interface is a good example of the combining of
fundamental events to produce a more complex action.
Ex: Ulnar nerve at elbow
• Movement of innervated tissues:
In addition to longitudinal forces being applied to
the nervous system from the adjacent to the nerve, the
innervated tissues can be used to produce such
events.
For instance Dorsiflexion of foot and toes used to apply
tension on sciatic nerve.
Movement of interface
• Nervous system responses to movement.
Neurodynamic sliders
Neurodynamic tensioners
General Neuropathodynamics

Mechanical interface
dysfunctions

Neural Dysfunctions

Innervated tissue
dysfunctions
 Mechanical interface dysfunctions
• Reduced closing
Closing dysfunctions • Excessive closing

Opening • Reduced opening

dysfunctions • Excessive opening

Pathoanatomica • Eg .Spondylolisthesis
l dysfunctions • Malignancy

Pathophysiological • Inflammation
dysfunctions
Neural dysfunctions

Neural sliding
dysfunction

Neural
tension
dysfunction

Hypermobilit
y
 Neurodynamis tests
• What to observe – changes in movement, movement
diagram.
• Planning the examination.
• Levels.
• General points on technique:
• Explanation to patient
• Bilateral comparison
• Test the unaffected side first
• Maintain each movement precisely
• Be gentle and donot hurry
• Evoke versus Provoke
• Short duration of testing.
 Standard neurodynamic testing
• Slump test
• Straight leg raise
• Prone knee bend
Steps in slump