Clinical Pilates in Practice: Neurodyamics

Integrating neural mobility exercises into functional movements and clinical Pilates practice can have multiple benefits, regardless of whether a client is displaying neural mechanosensitivity: all tissues in the body need to move!

 

Key Points: Neurodynamics
  • Mechanical and physiological events within the nervous system are dynamically interdependent.
  • Neurodynamics (ND) is the term used to describe the integration of the morphology,
    biomechanics, and physiology of the nervous system." 10
  • In neurodynamics, posture and multi-joint movements are combined to apply force to a nerve.
  • Mobilisation triggers a range of responses in nervous tissues, including tension and pressure changes, and positive impacts on nervous impulses, axonal transport, viscoelasticity, microcirculation, and abnormal impulse-generating sites.
  • Theoretically, neural mobilisation restores homeostasis in and around the nerve, dispersing intraneural oedema in the nerve root and axon, thereby decreasing pressure on the tissues, and supporting optimal function.
  • Increased joint flexibility and decreased sympathetic activity have also been demonstrated with neurodynamic techniques.

  • Non-neural structures are also likely responsible for some symptoms responses during neurodynamic testing.
  • Different mechanical loads are placed on neural structures, depending upon the order of joint movements.
  • The most amount of mechanical load is hypothesised to occur when the joint adjacent to the nerve is loaded first, increasing as more joints are involved.
  • Functional and relevant signs and symptoms of neural mechanosensitivity can be elicited by replicating the order of movement as per symptomatic activities.

Sliding vs tensioning of the median nerve. (Henrique et al, 2015).

  • Nerve sliders apply joint movements to the targeted structure proximally while releasing the movement distally, followed by a reverse movement.
  • Nerve tensioners apply joint movements to the targeted structure proximally and distally at the same time and in the same direction, seeking to increase nerve tension.
  • Nerve tensioners are thought to be more stimulating to the nervous system than nerve sliders.
  • Nerve tensioners are more aggressive than nerve sliders, and are not indicated in clients with impulse conduction impairments.

 

Clinically: Pilates in Practice
  •  Consider that all nerves need to be able to move within their environments, as per all other tissues of the body.
  • Integrating neural mobility exercises *within* a functional movement framework will be beneficial regardless of whether a client is exhibiting neural mechanosensitivity.
  • Understand the neural pathways that are implicated for the functional movement task that the client is working towards.
  • Nerve sliders are a gentler approach, and encouraged over nerve tensioners if a client is experiencing acute neural mechanosensitivity; Drawing the sword on the Reformer with cervical side flexion towards an extended wrist to slide to median nerve; cervical extension during knee flexion during The One Leg Kick to slide the femoral nerve.
  • Simple adjustments can be inserted into exercises to integrate a gentle neural mobility component; add an upper chest lift while hips/knees flex during footwork sprung below on the Trapeze Table (lower the chest curl as legs extend) for sciatic nerve gliding; add hip abduction with the hip and spinal extension component of Eve's lunge on the Reformer for obturator nerve gliding.
  • If a client is displaying neural mechanosensitivity, work only to the edge of sensitivity, maintaining awareness of irritability.
  • Approach nerve sliders and nerve tensioners from different positions, to increase the functional load on the nerve; standing, kneeling, sitting, and long sitting will all place different loads on the nervous system, eg. variations on the rowing series on the Reformer can be performed in all of these positions.

 

 

 

1. Aksoy, Cihan C., Vedat Kurt, ─░smail Okur, Ferruh Tasp─▒nar, and Betül Taspinar. "The immediate effect of neurodynamic techniques on jumping performance: A randomised double-blind study." Journal of Back and Musculoskeletal Rehabilitation 33, no. 1 (2020), 15-20. doi:10.3233/bmr-170878

2. Ballard, Elizabeth, Marty Fontenot, James May, and James R. Scifers. "Neurodynamics." Athletic Training & Sports Health Care 10, no. 4 (2018), 149-153. doi:10.3928/19425864-20180612-01.

3. Butler, David S. The Sensitive Nervous System. Noigroup Publications, 2000.

4. Butler, David S. The Neurodynamic Techniques: A Definitive Guide from the Noigroup Team. 2005.

5. Coppieters, Michel W., and David S. Butler. "Do ‘sliders’ slide and ‘tensioners’ tension? An analysis of neurodynamic techniques and considerations regarding their application." Manual Therapy 13, no. 3 (2008), 213-221. doi:10.1016/j.math.2006.12.008.

6. Ellis, Richard F., and Wayne A. Hing. "Neural Mobilization: A Systematic Review of Randomized Controlled Trials with an Analysis of Therapeutic Efficacy." Journal of Manual & Manipulative Therapy 16, no. 1 (2008), 8-22. doi:10.1179/106698108790818594.

7. Henrique, Herman, Silva Santana, Iasmin Adelia, Victor Fernandes De Oliveira, Êmyle Martins Lima, Alena Ribeiro, Alena Peixoto Medrado, Katia Nunes Sá, Ana Maria Blanco, and Abrahão Fontes Baptista. "Neurodynamic Mobilization and Peripheral Nerve Regeneration: A Narrative Review." International Journal of Neurorehabilitation 02, no. 02 (2015). doi:10.4172/2376-0281.1000163.

8. López López, Laura, Janet R. Torres, Araceli O. Rubio, Irene Torres Sánchez, Irene Cabrera Martos, and Marie C. Valenza. "Effects of neurodynamic treatment on hamstrings flexibility: A systematic review and meta-analysis." Physical Therapy in Sport 40 (2019), 244-250. doi:10.1016/j.ptsp.2019.10.005.

9. Nee, Robert J., and David Butler. "Management of peripheral neuropathic pain: Integrating neurobiology, neurodynamics, and clinical evidence." Physical Therapy in Sport 7, no. 1 (2006), 36-49. doi:10.1016/j.ptsp.2005.10.002.

10. Shacklock, Michael. "Neurodynamics." Physiotherapy 81, no. 1 (1995), 9-16. doi:10.1016/s0031-9406(05)67024-1.

11. Shacklock, Michael. Clinical Neurodynamics: A New System of Musculoskeletal Treatment. St. Louis: Elsevier Health Sciences, 2005.

 

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