Nerve movement in 2015 - 20th Anniversary of neurodynamics in physical and manual therapy.
Neurodynamics first entered physiotherapy as a specific subject in 1995 (Shacklock, Physiotherapy).
Last year, 2015, was 20 years since my paper “Neurodynamics, 1995” was published in which I proposed the neurodynamics concept in physiotherapy. It came from being interested in developing the subject beyond pulling on, and sliding, nerves as a rudimentary way of treating such problems and a need to consider more mechanisms in our patients.
Some of those mechanisms consisted of convergence, neurodynamic sequencing, progressions, and functional and patient-derived categories of problems so we could move nerves more specifically and make diagnosis and treatment more specific to the patient’s individual needs, including musculoskeletal. We also needed more on physiology (eg. nerve blood flow and sensitivity) so we could make techniques safer and more sensitive.
In that paper, specific cornerstones formed the conceptual basis for integrating mechanics and physiology of the nervous system and connecting these to the musculoskeletal system. These cornerstones have remained unchanged.
Recent advances in neurodynamics - ultrasound imaging of nerve movement
So much has neurodynamics become a natural part of physical and manual therapy practice that the subject continues to develop rapidly, and it has started to feature regularly in biomedical research.
One of the big scientific developments in neurodynamics is non-invasive measurement of peripheral nerve movement. This has been achieved with high resolution ultrasound in which the benefit is that it is non-invasive, sensitive and reliable.
Alterations in mechanical behaviour of nerve have now been shown to exist in a number of studies of clinical populations with nerve problems.
Part of my current work involves in vivo measurement of nervous system behaviour and one of the reasons I’ve been very quiet on the subject is that I believe that, whilst the current developments in the use of ultrasound in this area are in the right direction and give us many new insights, there are significant issues.
For many technical reasons, our ability to inject these findings into the clinical situation has not yet been realised. It, still being a laboratory procedure with many complexities needing be solved, I believe there is a long way to go before this will, or should, occur.
HOWEVER - what we can see is a number of things that DO relate closely to clinical practice.
Enjoy this short video of nerves moving!
DipPhysio, MAppSc, FACP
SO - AFTER SEEING THIS VIDEO, CAN NERVES BE MOVED SPECIFICALLY?
Can nerves be moved specifically?
This relates to the concept of neurodynamic sequencing in which the way the body moves (eg. sequence of joint movement) determines the sliding pattern of the nerves and the forces in the nervous system also.
Here is my ultrasound video of peripheral nerve that was taken in relation to this specific question.
At first there will be orientation, then nerve movements that do three things.
Understand one thing: the recording was live and there was NO editing or rehearsal, so the timing is authentic, as it occurred in the lab. It may not be very convenient, so you can move forward and play around if you want.
There are three parts to this video (see left):
Coming soon - contralateral slump test and cadaver experiment on the lumbar nerve roots.