Chapter 12: Lower Limb

This is a Chapter 12 summary of “Clinical Neurodynamics” by Michael Shacklock.

Piriformis Syndrome

Piriformis syndrome often involves the fibular tract of the sciatic nerve. It has the capacity to create symptoms from the buttock down to the anterolateral leg. Testing the neurodynamics with a fibular nerve bias is essential.

To attempt to isolate this problem, we must best differentiate interface from neurodynamic components. Using Cyriax principles –palpation, contraction, and lengthening –can be beneficial in this regard. Keep in mind that below 70 degrees hip flexion the piriformis produces external rotation, and above 70 degrees it is an internal rotator.

When treating this problem, the goal is to change pressure between the piriformis muscle and the sciatic nerve.

Level 1a – Static opener

VID – KF, ER

Level 1b – Dynamic opener

VID – Passive ER

Level 2a – Closer mobilization using passive IR.

VID – Passive IR

Level 2b – We finish with a passive piriformis stretch

VID – Tailor stretch

If there is a neurodynamic component to things, slightly modify things by using sliders. We start things off with the same opener as the interface above.  As the patient progresses, you can add proximal or distal components eventually finishing with a fibular nerve-based slump.

VID – Building the slump

To combine interface and neural treatments, contract-relax can be utilized.

Sciatic Nerve in the Thigh

Oftentimes with hamstring strains, sciatic nerve sensitivity can increase. The slump and straight leg raise tests can be utilized to help differentiate a pure hamstring issue from neural problems.

To treat this issue, sliders can be utilized, eventually working to a slump tensioner:

VID – PF at top for proximal dysfunction, DF at bottom for distal sliding…progress with spinal lateral flexion (done in slump

Knee and Thigh Pain

Implicating neurodynamic problems in this population is challenging, as these tests often show covert abnormal responses. These can be treated with simple sliders and tensioners. These are not in the Shacklock book, but are what I have been currently using.

VID of FS slider and tensioner

Fibular Nerve

Here is an example of a slider and tensioner for fibular nerve impairments.

VID

Sural Nerve

And for the sural nerve.

VID

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