Chapter 6: Planning the Physical Examination

This is a Chapter 6 summary of “Clinical Neurodynamics” by Michael Shacklock.

Observe

When assessing the patient, you must look at the following information:

  • Symptom location, extent, quality, and behavior.
  • Movement resistance.
  • Range of motion.
  • Compensatory patterns.
  • Breathing quality.
  • Tone of voice.
  • Facial expression
  • Protective muscle tone.
  • Avoidance.
Always mind your patient...and your surroundings.
Always mind your patient…and your surroundings.

When planning the exam, you can tier to what extent you ought to assess someone.

Level 0: neurodynamics are contraindicated for physical or psychosocial reasons.

Level 1: Limited exam where symptoms are minimally provoked. Full neurodynamic tests are not performed, and are tested separately from musculoskeletal structures. The neurodynamic tests are performed with relieving-based structural differentiation.

Level 1 is indicated when…

  • Symptoms are easily provoked and take a long time to settle after movement.
  • Severe or latent pain is present.
  • Potential pathology.
  • Neurological deficit.
  • Progressive worsening prior to exam.

Level 2: Standard examination in which neurodynamics, interfaces, and innervated tissue are tested separately. Standard neurodynamic sequences are used and symptoms can more readily be brought on.

Level 2 is indicated when…

  • Less severe, latent, or easily provoked symptoms.
  • Absent/minor neurological symptoms.
  • Stable problem that is not rapidly deteriorating.

Level 3: It’s gettin’ real. Here we see greater force localization and sequences that start at the problem. Sensitizers are often used as well.

Level 3 is indicated when…

  • Level 2 exam is normal or provides insufficient information.
  • Symptoms are not severe or easily provoked.
  • Problem is stable.
  • No evidence of pathology.
It's science...or math or something....whatever read on.
It’s science…or math or something….whatever read on.

There are four examination types here:

  • 3a) sensitizers are added.
  • 3b) Begin neurodynamic tests with a motion near the problem area.
  • 3c) Combine neurodynamic tests with interface tests such as muscular contraction or stretching.
  • 3d) Add neurodynamic testing to movements that bother the patient.

Do Sweat the Technique

Technique is everything with neurodynamic tests, as making small changes can lead to profound differences in findings. Realize that the literature suggests that there is not a best sequence to perform the tests, as this order will be patient-specific.

When communicating with the patient, a simple introduction to the test ought to be performed, but do not go into detail on its purpose. The explanation can affect the test outcome. It is also important that the patient not move during the test, as this error can bias results. Ask the patient to verbally describe what is felt.

The most important aspect of test performance is maintaining applied movements. If the position of body parts are not maintained, the test changes. Small variation can lead to completely different results.

Unless you are Eric B or Rakim, you should sweat the technique.
Unless you are Eric B or Rakim, you should sweat the technique.
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