NDS Neurodynamic Solutions

SOMETIMES WE MISS THE NERVE, especially in high-functioning patients such as athletes when the problem is caused by pressure from the adjacent muscle.

NERVE FLOSSING - There is a lot of material out there on “nerve flossing”. These techniques are basically neural mobilisation and are, in part, artificial, or at least, incomplete because people don't normally move that way.

MOVEMENT - Muscles normally apply pressure to nerves but it's when the pressure becomes excessive or the nerve can't tolerate the force that symptoms develop. The most common cause of radiculopathy and neuropathy in the MSK context is compression which, when combined with movement, can also irritate the nerves. Compression can be caused by the piriformis muscle.

Standard slump test - The standard slump test elongates the sciatic nerve instead of reproducing compression by the muscle and nerve flossing mostly slides the nerve so these are not specific to the problem. We need something better that targets the interactions between the muscle and sciatic nerve.

PIRIFORMIS SLUMP TEST

Who is it aimed at?

This aimed at high function people with isolated buttock pain; no referred pain, no neurological symptoms. These patients often don't have any symptoms that suggest neural involvement so we often don't test for it. Instead, we treat the muscle by default.

TWO PROBLEMS THAT FAIL THE DIAGNOSIS.

A. Not testing neurodynamics because there are no symptoms of a neural problem.

B. Only doing basic or standard testing "... just to exclude the nerve".

This can miss the neural aspect because it's not testing the neurodynamics at the patient's high level of function.

SOLUTION - here is how to solve the problem.

1. Test standard slump first:
- What to look for: reproduction of symptoms - usually buttock and upper/lateral thigh.
- See If differentiation supports a neural aspect.

2. If this doesn't find anything (which is common in high function patients), you can do the piriformis slump test.

PIRFORMIS SLUMP TEST

Aims
- Test the nerve and muscle together.
- Apply pressure to the nerve during the neurodynamic test.
- Test the interactions between the muscle and nerve instead of one system in isolation.
- Target the nerve by reproducing the patient's relevant movements.

How To Do It

- Set the patient up for the standard slump test.
- Do a small amount of hip adduction to prevent the consequent abduction during the hip external rotation. This ensures that the hip is in neutral abd/add during the critical step.
- External rotation - this is because piriformis is allegedly an internal rotator above 60-70˚ of hip flexion. External rotation therefore stretches the muscle onto the nerve.
- Knee extension to elongate the sciatic nerve whilst under pressure from piriformis.
- Dorsiflexion or plantarflexion inversion for the tibial or fibular nerve for more tension and/or differentiation.

SEE VIDEO OF THE TECHNIQUE