It's been 25 years since the concept of neurodynamics entered the physical health sciences!
Here's how it happened.
In the late 1980s and early 1990s, I had been following Robert Elvey's progress on his work on the 'brachial plexus tension test' (1979) in which he showed in cadavers that moving the upper limb in certain ways produced movement of the lower cervical nerve roots. It was basically the creation of the straight leg raise of the upper limb. To me, this was new and innovative and opened doors for a new world of study and clinical possibilities.
Then came David Butler, who wrote the best-seller and ground breaking book Mobilisation of the Nervous System (1991). This in turned created the idea that the nervous system was a new organ and system that we could treat. The way it was written showed the connections between many parts of the nervous system and highlighted the fact that it possesses mechanical functions for clinical practice that had not been previously considered. Soon after that, David, Helen Slater and I were working in our clinic together in Adelaide, Australia, where we had been bouncing ideas off each other in relation to this nervous system thing and we quickly realised that this was going to be huge. Around 1994, when I had been again reading my most hated subject at physiotherapy school (physiology), I felt we needed to expand the subject to include more mechanisms that were scientifically proven to be related to nerve mechanical function. For instance, press on a nerve and its blood flow changes. This may then affect many other issues such as sensitivity and movement of the nerve tissue and, of course, pain. So I came up with the idea that we should integrate more mechanisms and connect them to patient presentations in relation to mechanics and physiology of the nervous system and proposed that we call it "neurodynamics". This involves the word "dyne" (force) and we should integrate that with physiology (also a physical mechanism). Those ideas are in my first peer-reviewed paper in which I made the proposal of using neurodynamics as an integrated subject for clinical practice. It was a theoretical construct on which to base clinical concepts for diagnosis and treatment. That's all very well but my concern about new material has always been "How can this be used for the good of the community?". Since it was only intellectually focused, I felt this it was not enough. The next step, therefore, was to create a system of diagnosis and treatment that connected the scientific cornerstones of how the body works, because that's how nerves (and the musculoskeletal system) function. That was the birth of Clinical Neurodynamics. It too has become a best-seller and is now in seven languages, English, Spanish, German, Polish, Korean, Japanese and Portuguese. It is a round-up of the scientific pillars as to how the nervous system moves in relation to clinical problems. With the emergence of evidence informed practice, it has become clear that not all pathoanatomy hurts, so the emphasis in Clinical Neurodynamics is function (movement) and its relation to symptomatology. It's not medical diagnosis, it's functional diagnosis and treatment. Michael Shacklock DipPT, MAppSc (MT), FACP (by original contribution, as awarded by the Australian College Physiotherapists, Australian Physiotherapists' Association). -- Well deserved acknowledgements to those who have contributed substantially to the field of neurodynamics: Robert Elvey, David Butler, late Louis Gifford, late Dr Alf Breig, Dr Toby Hall, Prof. Michel Coppieters, Assoc. Prof Marinko Rade, Prof. Annina Schmid, Dr Elena Bueno Gracia, Dr Albert Belmunt, Dr Carlo Lopez de Celis, Dr Elena Estebanez, Dr Santos Pollo Caudevilla, Dr Vaness Gonzalez Rueda, Prof. Tom Van Hoof. July 27, 2020. |
Shacklock's Clinical Neurodynamics, the practical extension of his original neurodynamics proposal.
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