Neural tissue mobilization

A 3 part system –
- Mechanical interface – a/k/s – nerve bed – consist of bone, tendon, muscle, Ivdisc, ligaments, fascia, blood vessels.

- Neural structures – brain, nerve roots, C.N, peripheral nerves, spinal cord

- Innervated tissues – all tissues which are innervated by nervous system.

1. Neural Tissue Mobilization Dr. Maheshwari Harishchandre Assistant Professor M.P.Th (Neurosciences ) Asst. Professor DVVPF College of Physiotherapy, Ahmednagar

2. Objectives At the end of the topic learner should be able to describe – Describe the principles Techniques of NTM Different tests for NTM 10/04/18 NTM 2

3. Contents Introduction Precautions Contraindications Tension testing UL & LL 10/04/18 NTM 3

4. Introduction A 3 part system – - Mechanical interface – a/k/s – nerve bed – consist of bone, tendon, muscle, Ivdisc , ligaments, fascia, blood vessels. - Neural structures – brain, nerve roots, C.N, peripheral nerves, spinal cord - Innervated tissues – all tissues which are innervated by nervous system. 10/04/18 NTM 4

5. Introduction Anatomy – connective tissue - tissue that connects, supports, binds or separates other tissues or organs and including cartilaginous, fatty, and elastic tissues. Neurons Nerve fibres – motor – AHC – NMj , sensory – receptors Layers – endineurium , perineurium , epinurium 10/04/18 NTM 5

6. NS includes neural tissue in the body – Neurons – cells that send & receive signals & Neuroglia – cells that support & protect neurons 10/04/18 NTM 6

7. Definition Neural tissue mobilization is a manipulative technique by which neural tissues are moved & stretched either by movement relative to their surroundings or by tension development . 10/04/18 NTM 7

8. Primary mechanical functions of the nervous system – tension, sliding, compression Tension – 1 st primary mechanical events in the NS is generation of tension.nerves are lengthened by elongation. Sliding – 2 nd event is movt of NS relative to their adjacent tissues. Compression- neural structures can change their shape when pressure is exerted on them. 10/04/18 NTM 8

9. 10/04/18 NTM 9

10. How nerve move - by all three mechanical events. movements of joints 10/04/18 NTM 10

11. Neurodynamic testing Cervical spine Upper limb Lower limb Lumbar spine 10/04/18 NTM 11

12. Passive neck flexion Purpose: To assess the contribution of neural tension to the patient's symptoms. Test Position: Supine. Performing the Test: Patient actively performs upper cervical nod. Examiner passively flexes lower cervical spine. A reproduction of pain or other neural symptoms in the thoracic spine is a positive test. A stretching sensation is normal. 10/04/18 NTM 12

13. Cervical spine Passive neck flexion – - preparation – pt. position - normal response / abnormal response 10/04/18 NTM 13

14. ULTT Median nerve – Position Movement response 10/04/18 NTM 14

15. ULTT – Ulnar nerve Purpose: To assess the contributions of neural tension to the patient’s symptoms. Test Position: Supine. Performing the Test: Stand at the side of the tested limb, facing towards the patient’s head. Use the hand closer to patient to depress shoulder and punch into table to keep shoulder in depressed position. Use farther hand on patient’s hand to flex elbow to about 115 degrees, with the forearm pronated. Keep patient’s wrist and fingers extended. Laterally rotate the patient’s shoulder to end range and abduct the patient’s shoulder until neural symptoms are reproduced. Have patient laterally flex or rotate their head away (worsens pain/symptoms) and toward the arm (relieves pain/symptoms) - a positive test. 10/04/18 NTM 15

16. 10/04/18 NTM 16

17. Radial nerve 10/04/18 NTM 17

18. Slump test 10/04/18 NTM 18

19. Prone knee bend test 10/04/18 NTM 19

20. SLR 10/04/18 NTM 20

21. Tibial Nerve 10/04/18 NTM 21

22. Peroneal nerve 10/04/18 NTM 22

23. Indications & contraindications Indications Nerve root injuries Thorasic N. root syndrome Whiplash injury Coccydynia Spondylolysthesis Post lumbar spine injuries Contraindications Recent onsetof or worsning neurological signs Cauda equina lesion SCI 10/04/18 NTM 23

24. Precautions Irritability to nervous system Dizziness Circulatory disturbances 10/04/18 NTM 24

25. Summary Definition Principles Tests Indications contraindications 10/04/18 NTM 25

26. References Clinical Neurodynamics – MICHEL HACKLOCK Manual Therapy Approaches in Neurophysiotherapy – Dr. Suvarna Ganvir 10/04/18 NTM 26

27. THANK YOU……. 10/04/18 NTM 27