Daily physical activity constantly causes changing tension in various types of tissues, including the nervous system, whose primary function is to conduct nerve impulses. Every movement in the body affects the change in length, volume, and tension not only in muscles, ligaments, fascia, or blood vessels but also in the nervous system itself. Neural structures, like any other structures in our body, need to adapt to the movements of our body, both during simple everyday activities such as sitting, bending, brushing teeth, and during more complex and demanding activities like cycling, playing tennis, dancing, or exercising at the gym. A simple example can be the movement of elbow extension, during which the median and radial nerves become lengthened and tense, while the ulnar nerve on the opposite side of the joint becomes shortened. If there is a disruption in the mobility of neural structures or surrounding tissues, the nervous system itself can become a source of symptoms. There can be various causes for the development of problems, such as osteophytes, herniated discs, increased muscle tension, or different types of injuries and traumas.
What then? What factors and symptoms may indicate a disruption in the proper mobility of neural structures?
Predisposing factors may include sustained positions during work, a past injury, or a lack of lasting improvement after muscle and joint therapy. In addition, symptoms such as pain, tingling, numbness, burning, pins and needles, decreased or excessive sensory perception, or their localization in “predisposed” areas, such as deep in the buttock, wrist canal area, or the head of the radius bone, can also be indications for the examining therapist. It is worth noting the simultaneous occurrence of symptoms in two seemingly distant areas of the body (e.g., cervical spine disorders and “tennis elbow” or “carpal tunnel syndrome”). Gathering all this information may indicate the need for a neurological examination.
The therapist can clinically test the nervous system by conducting a neurological examination, neurodynamic tests, and nerve palpation. A neurological examination, which evaluates muscle strength, sensation, and reflexes, allows for the assessment of nerve conduction. Neurodynamic tests, on the other hand, assess the mechanical and physiological flexibility of the nervous system.
Examples of neurodynamic tests that a physiotherapist may perform include:
– Slump test (which assesses the tension, mobility, and irritation of the nervous system along with the dura mater of the spinal cord)
– Tests for the lower limb: Straight Leg Raise (SLR), Prone Knee Bend (PKB)
– Tests for the upper limb: Upper Limb Neurodynamic Test (ULNT)
If symptoms are elicited during such tests, there are differences between the left and right sides, and in combination with the information obtained during the patient’s interview and examination, the therapist may consider one of the tests to be clinically significant, it may be necessary to apply neurodynamic mobilization techniques performed by the physiotherapist or self-mobilization techniques that the patient can perform at home (in accordance with the therapist’s recommendations).
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