This is a summary of chapter XV of “The Sensitive Nervous System” by David Butler.
In this chapter we discuss many specific neurodynamic pathologies and implementing the nervous system into treatment approach.
Conservative Nervous System Decompression
Here is a general step-by-step approach to decreasing threat throughout the nervous system.
1) Decrease tissue sensitivity by removing relevant stimuli and decreasing CNS threshold.
2) Improve container tissue health.
3) Improve the nerve tract’s ability to absorb traction forces.
4) Assess and improve the nerve to container relationship.
5) Assess/modify any adverse ergonomic or environmental factors.
Carpal Tunnel Syndrome
Tests to perform.
- ULNT1 & reverse.
- ULNT2 (median) & reverse.
- Compression (can add ULNT).
- Phalens and reverse Phalens.
- Phalens + ULNT.
There are several options to treat carpal tunnel syndrome. Mobilizing not only the median nerve, but radial and ulnar is beneficial because the nerves are closely connected. Movement is critical because nerve inflammation and swelling does not leave the carpal tunnel easily. This problem is because there are minimal lymphatic channels in the tunnel.
Nerve Root Complex
Nerve root issues often have corresponding postural adaptations.
- Cervical – forward head posture.
- Lumbar – Flat lumbar spine with knees flexed, positioned toward the injured sign. In acute instance, it may be okay to let the patient rest in these antalgic postures until AIGS settle.
Other presentations indicative of nerve root complex pathology include numbness/tingling down the extremities. Other possibilities include coldness, shooting, tiredness. Pain rarely goes into the extremities.
Double crush is a phenomenon where two AIGS or compressive locations are present on a single nerve. Currently, the literature is mixed on its existence. However, Butler feels that the second pain that occurs with this phenomenon is likely an old problem showing itself.
The Foot & Neurodynamics
The biggest take home point here was regarding heel spurs. With these pathologies, there is evidence of concomitant peripheral neuropathic pain. The likely involved nerves include the lateral plantar nerve or medial calcaneal nerve. With these, it is important to check eversion and implement this movement into the straight leg raise.
Neurodynamics and the Thorax
A couple suggested treatments include sliders and tensioners in the slump long sit, as well as Anterior to posterior glides of the thoracic spine. Butler feels these lead to more thoracic spine movement.
Rapid changes can frequently occur with these conditions, and often this speed is due to patients altering the way they think and feel about the problems.