Chapter 12
Neurodynamic Mobility
Overview

Neurodynamic mobility testing is
designed to examine the neurological
structures for adaptive shortening and
inflammation of the neural structures
Neurodynamic
Dysfunction

Proposed mechanisms:
– Theoretically, increased dural tension may be felt
throughout the neuromeningeal system, and can
potentially affect the range of motion available
to the trunk and to an extremity
– Neural tissue responds in the same way to
trauma that a ligament or tendon does by
evoking the cascade of the inflammatory
process, resulting in pain when stressed
Mechanisms of injury
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Adverse posture
Direct trauma
Extremes of motion
Electrical injury
Compression/ischemia
Double Crush Injuries
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Theoretically, if the axoplasmic flow is
partially reduced at a proximal site of
injury, further reduction can occur at a
distal compression site
Evidence is inconclusive
Neurodynamic Mobility
Examination

Consist of a series of tension tests
– The tension tests are designed to apply
controlled mechanical and compressive
stresses to the dura and other
neurological tissues, both centrally and
peripherally
– Employ a sequential and progressive
stretch to the dura until the patient’s
symptoms are reproduced
Neurodynamic Mobility
Examination

Positive symptoms for the presence of
neuropathic dysfunction include pain,
paresthesia, and spasm
Straight Leg Raise test

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The SLR test places a tensile stress on the
sciatic nerve, and exerts a caudal traction
on the lumbosacral nerve roots from L4 to
S2
The evaluation of the findings from the SLR
test requires that the range of motion
measured, and the symptoms produced, are
compared with the contralateral side and
with expected norms
Straight Leg Raise test


It is generally agreed that the first 30º
of the straight leg raise serve to take
up the slack or crimp in the sciatic
nerve and its continuations
Between 30-70º, the spinal nerves,
their dural sleeves, and the roots of
the L4, L5, S1 and S2 segments are
stretched with an excursion of 2-6 mm
Straight Leg Raise test

After 70°, while these structures
undergo further tension, other
structures also become involved:
– The hamstrings
– The gluteus maximus
– The hip, lumbar and sacroiliac joints
Sensitizers

The following sensitizers can be used:
– Dorsiflexion of the ankle
– Cervical flexion
– Internal rotation of the hip
Crossed Straight Leg Sign

Three recognized types:
– A SLR that produces pain in the contralateral leg,
but not when the contralateral leg is raised
– A SLR that produces pain in both legs
– A SLR of either leg that produces pain in the
contralateral limb

The crossover sign is thought to be more
significant than the SLR test in terms of its
diagnostic powers to indicate the presence
of a large disc protrusion
Bilateral Straight Leg
Raise

By performing a bilateral straight leg
raise and incorporating both neck
flexion and dorsiflexion, central
protrusions may be detected
Bowstring tests
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The Bowstring tests do not impart a
sufficient stretch of the dura to detect
chronic adhesions
However, they can be used to make a
prognosis about acute disc herniations
A positive bowstring test is a strong
indicator for surgery, but it need only be
performed if the straight leg raise is positive
with the addition of dorsiflexion
Bowstring tests

Two types:
– Cram’s Tibial Nerve Test
– Common Peroneal Test
The Slump Test
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The slump test, popularized by Maitland, is
a combination of other neuromeningeal
tests; namely the seated SLR, neck flexion,
and lumbar slumping
Maitland asserted that the slump test
enables the tester to detect adverse nerve
root tension caused by spinal stenosis,
extraforaminal lateral disc herniation, disc
sequestration, nerve root adhesions, and
vertebral impingement
Prone Knee Bending Test

The prone knee bending (PKB) test
stretches the femoral nerve using hip
extension and knee flexion to stretch
the nerve termination in the
quadriceps muscle, and has been used
to indicate the presence of upper
lumbar disc herniations, particularly
when hip extension is added
Upper Limb Tension Tests
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The upper limb tension tests (ULTT), or
brachial plexus tension tests, involve an
ordered sequence of movement of the
shoulder girdle, arm, elbow, forearm, wrist
and hand
Because there are a number of tissues in
the cervicobrachial region that could be
stressed by these maneuvers, cervical side
bending, or cervical flexion is added
ULTT 1 (Median nerve
dominant)

Components include:
– Shoulder girdle depression
– Humeral abduction to approximately 110°
– Forearm supination
– Elbow, wrist and finger extension
ULTT 2 (Radial nerve
dominant)

Components include:
– Shoulder girdle depression
– Humeral abduction and external rotation
– Forearm pronation
– Elbow extension
– Wrist and finger/thumb flexion
ULTT 3 (Ulnar nerve
dominant)
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Components include:
– Shoulder girdle depression
– Humeral abduction
– Forearm supination
– Elbow flexion
– Wrist extension