This document provides an overview of neurodynamics, including: 1. The history and key figures in the development of neurodynamics from the 1920s to present. 2. Anatomy of the peripheral nervous system, including gross anatomy of major nerves in the upper and lower limbs, microanatomy of nerves, and biomechanics of nerve movement. 3. Applications to clinical examination including common nerve pathoanatomies and how joint movement affects nerves. 4. Research on neurodynamic techniques and their effects on nerve displacement and strain.

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Title
Name
Neurodynamics: Anatomy, Biomechanics,
and Physiology
Kerry K. Gilbert, PT, ScD
Professor/Program Director- Doctor of Physical Therapy Program
Director- Anatomy Research and Education
Director- Clinical Anatomy Research Laboratory
Department of Rehabilitation Sciences
School of Health Professions
Texas Tech University Health Sciences Center
Lubbock, Texas, USA
Butler’s Seven Points for Consideration NVMT (2017):
1. Aim to make neurodynamics central and essen8al to Neurology
-Goal: to provide mechanically permissible movement
2. Biopsychosocial considera8ons
-all parts are important to treatment
3. Confident Clinicians are cri8cal
-Pa8ents respond to confident clinicians
4. Educa8on is therapy- Neurodynamics enriches therapy
-educa8on is especially important with pain pa8ents; explain the con8nuum of the nervous system; odd
symptom paLerns are not surprising; “Nothing about your condi8on surprises me.”
5. Recognize the Neuroimmune cascade
-not just neuro, but neuroimmune; ac8vated inflamma8on
6. Consider CNS mobiliza8on
-cord movement; meninges movement; CSF flow
7. Consider Neurodynamics with reasoned judgment (in context of clinical exam)
-s8ff, s8cky, stuck – mobilize the nervous system;
There is an “awakening to Neurodynamics”
-David Butler, NVMT 2017
Pa#ent
Social
Screening
Examina#on
Clinical
Examina#on
Educa#on Imaging
History/
Observa#on
Bio/Patho/
Physiological
Psychological
Assessment
Treatment Plan
Re-Examina#on
Special Tes#ng
(Neurodynamics)
Clinical Examina8on
Take Home Message: Neurodynamic tes#ng is a small (but vital) part of the overall clinical examina#on picture.
Research:
Reliability/Validity
Outcomes

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Anatomy/
Biomechanics
Neurodynamic
Treatment
Neurodynamic
Tes8ng
• History of ND
• Macro Anatomy
• Micro Anatomy
• Biomechanics
• Rela8on to Tes8ng and
Treatment
• Recent Findings
NVMT 2017
1929- Nerve Extension upper lim
b- Bragard
1959- Upper Lim
b- Von Laniz & W
achsm
uth
1960-1980- Adverse M
echanical Tension- Breig
1970’s-sensi8vity of NS- Grieve; Slum
p- Cyriax/M
aitland
1980’s- Adverse NT- Butler; M
aitland; Elvey;
8
History of Neurodynamics
2800 BC? –Im
hotep
1982- Pain- M
elzack and W
all
1991- M
obiliza#on of the NS- Butler
1880’s- Nerve Stretching- Cavafy,; Sym
ington; M
arshall
1979- Brachial Plexus Tension Test (ULNT)- Elvey
1960-1980- Nerve Com
pression/Tension- Rydevik,
Sunderland, Olm
arker, Lundborg
1993- LNR Disp.- Sm
ith and M
assey
2005- Clinical Neurodynam
ics- Sequencing- Shacklock
2012- ND Validity-Nee, Coppieters, Schm
id
2011- Tibial Nerve Fluid Dynam
ics- Brown, Gilbert
2007- LNR-SLR Displacem
ent and Strain- Gilbert
9
History of Neurodynamics
2017– Neuroim
m
une; Rx- Coppieters, Schm
id
2017-Beyond-
“ND Aw
akening”-Butler
2008- Treatm
ent Effi
cacy- Ellis; In Vivo US- Dilley
2000- Sensi#ve NS- Butler
2013- Entrapm
ent Neuropath-Schm
id and Coppieters
2015- CNR Displ/Strn-Foram
inal Ligs- Lohm
an and Gilbert
2015-Fluid Disp- Gilbert, Sobczak
2000- ND Tes8ng Reliability- Coppieters
Macro
(Gross)
Anatomy:
Median and
Ulnar
Nerves

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Clinical Applica8on: Pathoanatomy
• Upper Limb Neural Pathoanatomy
– Axillary Arch
• Anomalous bands of the la8ssimus dorsi muscle
• Bands compressed the underlying neurovascular structures during ABD/ER including the axillary vessels, musculocutaneous,
median, and ulnar nerves.
• Similar reports have shown this type of 8ssue to aLach to coracoid process, pectoralis major, and coracobrachialis muscle.
• Authors suggest clinical manifesta8on similar to TOS symptoms and suggest a clinical test using ABD/ER and palpa8on.
11 Smith AR, Cummings JP. The Axillary Arch: Anatomy and Suggested Clinical Manifesta#ons. JOSPT, 2006; 36(6):425-429.
Clinical Applica8on: Pathoanatomy Ulnar Nerve
• Upper Limb Neural Pathoanatomy
– Archade of Struthers
12
Macro (Gross)
Anatomy:
Radial Nerve
Clinical Applica8on: Pathoanatomy Median Nerve
• Upper Limb Neural Pathoanatomy
– Ligament of Struthers
– Pronator Syndrome
– Carpal Tunnel Syndrome
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Clinical Applica8on: Pathoanatomy Radial Nerve
• Upper Limb Neural Pathoanatomy
– Fracture of humeral shal- radial nerve injury
– Radial Tunnel Syndrome- Archade of Frosche
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Clinical Applica8on: Pathoanatomy Radial Nerve
• Upper Limb Neural Pathoanatomy
– Fracture of humeral shal- radial nerve injury
– Radial Tunnel Syndrome- Archade of Frosche (Calavert, 2009)
16
Macro (Gross)
Anatomy:
Radial Nerve
Macro (Gross)
Anatomy:
Tibial and Common
Fibular Nerves
Moore & Dalley:.Ch 5;
NeLer: plate 528
Gilroy: Fig 29.1-29.28
18
Summary:
Lower Limb
Innerva8on
Distribu8on:
Scia8c and
Posterior Cut.
Nerve of the
Thigh

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Moore & Dalley:.Ch 5;
NeLer: plate 529
Gilroy: Fig 29.1-29.28
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Summary: Lower
Limb Innerva8on
Distribu8on:
Tibial Nerve
Moore & Dalley:.Ch 5;
NeLer: plate 530
Gilroy: Fig 29.1-29.28
20
Summary: Lower
Limb Innerva8on
Distribu8on:
Common Fibular
(Peroneal) Nerve
Dermatomes vs. Cutaneous Innerva8on
Moore & Dalley:.Ch 5;
NeLer: plate 470; 530
Gilroy: Fig 29.27-29.28
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The Anatomy of the PNS
• Peripheral Nervous System (PNS) Layout:
– Mechanical interface
• “con8nuum”– Butler, 1989
• “container” – Shacklock 1995
• “nerve bed” consists of anything that lies next to the nervous system (tendon,
muscle, bone, IV disc, ligaments, fascia, blood vessels)
– Neural structures
• Actual nerve 8ssue
– Innervated 8ssues
• The actual 8ssue innervated by the neural structures
Butler, 1988; Shacklock, 1995; 2005
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The micro Anatomy of a Nerve
• Endoneurium
– Surrounds axons
• Perineurium
– Surrounds fasicles
• Epineurium
– Surrounds nerve
• Mesoneurium
– Outside the epineurium
Butler 1991
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The Anatomy of a Nerve
• Blood Flow
1. Extrinsic
2. Intrinsic
• 2a-superficial intrinsic
arterioles
• 2b-interfascicular
arterioles
• 2c-endoneurial capillary
networks
3. Vascular “coils”
4. Spinal dura
5. Root sheath
Nordin & Frankel, Fig 5.5; Olmarker 1991
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Biomechanics- Movement of Nerves
• Mechanical func8ons of all nerves:
– Tension
• Perineurium – 18-22% strain before failure (Sunderland & Bradley, 1961;
Sunderland 1991)
• Leads to decrease of cross-sec8onal area and “transverse compression”
– Sliding
• Movement of neural structures within the container or nerve bed (McLellan &
Swash 1976; Wilgis & Murphy 1986)
• AKA- “excursion,” “displacement,” or “gliding”
• Longitudinal or transverse movement; dissipates strain
• Mesoneurium-sliding in the nerve bed;
• Interfascicular epineurium- interfascicular gliding; (Millesi 1990)
– Compression
• Bone, tendon, muscle, fascia, etc., pressing on the nerve
Shacklock 2005
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Movement of Nerves
• Movement of joints
– Related to the posi8on of the nerve to the joint
axis
– “convergence”- movement of the nerve 8ssue
toward the joint that is moved/moved most.
(Smith 1956; McLellan & Swash 1976)
– Bending of a joint à tension and compression of
nerve
• Movement of the innervated 8ssues
– Causes elonga8on; “sensi8zing maneuvers”
• Movement of the mechanical interface
– Opening (ê pressure) vs. Closing mechanisms
(épressure)
• These concepts are important for clinical diagnosis
Shacklock 2005
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ULNT Tension (Strain)
Kleinrensink GJ, et al. Upper limb tension tests as tools in the diagnosis of nerve and plexus
lesions. Anatomical and biomechanical aspects. Clin Biomech (Bristol, Avon). 2000; 15(1):9-14.
• Median nerve bias caused
the most ten>on (strain)
• ‘it is unlikely that any of
the six tests studied will
selec>vely stress specific
cervical nerve roots’
• ‘So, based on tensile force
distribu>on and
considering both
sensi>vity and specificity,
exclusively the median
nerve ULTT and ULTT+ can
be seen as specific nerve
tension tests’
Upper Limb NDM Displacement and Strain
Coppieters MW, Alshami AM. Longitudinal excursion and strain in the median nerve during
novel nerve gliding exercises for carpal tunnel syndrome. J Ortho Rsch. 2007; 25(7):972-80.
• Sliding technique elicited
the most displacement
and the least strain in the
median nerve at the
carpal tunnel.
• Allowing movement of
other joints during NDM
leads to less strain.
• This sliding strategy is
recommended for use in
order to maximize
displacement but
minimize strain to the
nerve >ssue.
The Nerve “Con8nuum”
• The nervous system is a long organ
– Movement (gentle or aggressive) has an effect on the nervous system/
path. Important for clinical tes8ng and sequencing.
• Structural differen8a8on
– Performed during all neurodynamic tests to determine whether the
nervous 8ssue is involved in the pathology (i.e., a pain generator).
– Differen8a8on occurs when nerve 8ssue is moved in a region of interest
without moving the musculoskeletal 8ssues in the same region.
– **Change in symptoms with the differen8a8ng maneuver may indicate a
neural mechanism.
Butler, 1989, 1991; Shacklock 2005
29
Nerve Movement PaLerns
• Joint movement leads to movement of the nerves closest to the movement
(force) first and then…tension passes to the more remote nerve path in a
delayed fashion as the movement takes up the slack.
• Mid-range, slack is taken up and sliding occurs of the nerve within its nerve
bed or container.
• End range, tension ensues to the en8re system.
• Applica8on to treatment
– If the desired mechanical input is sliding- apply large amplitude movement in mid-range.
– If the desired mechanical input is tension- apply smaller amplitude movement at the end
range.
– Or, combine the techniques- large range amplitude up to the end-range of mo8on.
– Or, incorporate minimal amplitude movement to simply take up the slack in the nerve…
early-range.
– Olen the pa8ent’s symptoms will indicate which mobiliza8on approach is most
appropriate…don’t work into the painful movement.
Shacklock 2005
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Physiology of Nerve Tissue
• Mechanics and physiology of the nervous system have been
described as “interdependent.” This concept forms the basis for
neurodynamics according to Shacklock. While not described this
specific manner, Butler discussed nerve physiology as well (1989
and 2000).
• This is an important considera8on in that we can not consider only
mechanical or only physiological aspects of neural 8ssue in clinical
prac8ce. We must consider both.
Shacklock 2005
31
Physiology of Nerve Tissue
• “Improving physiology through treatment of mechanical func>on is
also an integral part of the concept of neurodynamics and can be
highly effec>ve in both diagnosis and treatment. Releasing
pressure or tension in a nerve could improve its physiology and
clinical correlates.” – Shacklock, 2005
– Note the mechanical focus to the physiological benefit. Is it possible the
physiological benefit by itself may be sufficient to lead to posi>ve clinical
outcomes?
Shacklock 2005
32
Intraneural Blood Flow
• Blood flow is redundant and designed to maintain flow in light of
mechanical influence/stress.
• Changes in blood flow, especially secondary to inflamma8on, may
contribute to painful response to neurodynamic tes8ng without
the objec8ve findings of changes in conduc8on velocity.
• Vasodila8on-nocicep8ve (C fibers)àincrease of intraneural blood
flowàinflamma8on and edemaàmay lead to fibrosis
• Vasoconstric8on- sympathe8c NSà reduc8on of intraneural blood
flowàoverac8vity of sympathe8cs may lead to decreased blood
flow to nerve
Shacklock 2005
33
Mechanical Stress on Intraneural Blood Flow
• Movement has an effect on intraneural fluid movement (Browne, Gilbert, et al 2011;
Gilbert et al 2015a; Gilbert et al 2015b; Gilbert et al 2017 (unpublished); Sobczak et al, 2015 (submiLed)
• Movement is expected to have an effect on intraneural blood flow.
• Tension- reduces intraneural blood flow
– 8% elonga8on- diminished venular flow (Lundborg & Rydevik 1973)
– 15% elonga8on- cessa8on of arterial and venular flow (Lundborg & Rydevik 1973)
– Time dependent- 6% strain for 1 hour decreases conduc8on by 70%; longer dura8on =
longer recovery 8me necessary (Lundborg & Rydevik 1973)
• Movement has an effect on neural blood flow.
• Compression- 30-50mmHg leads to hypoxia, decreased flow, conduc8on, and
axonal transport (Gelberman et al 1983; Ogata & Naito 1986, Remel et al
1999)
• Same occurs in nerve roots (Olmarker et al 1991; Rydevik 1993)
• Tension and compression can be cumula8ve in effect- “double crush”
(Lundborg & Rydevik 1973)
34

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Mechanical Stress on Intraneural Blood Flow-Physiology
• Inflamma>on à intraneural edemaàê func>on, blood supply and
venous drainage. (Butler 1989; Butler 2001)
• “physiology must be included in management of mechanical problems in
the nervous system.”- (Shacklock 2005; Shacklock 1995a)
• Clinical applica8on note: these were big steps to recognize the role of
physiology in the recovery of nerve pathology. However, this is s8ll in
the context of there being a “mechanical problem” to manage. Is it
possible that the problem is chemical, fluid, pressure, neuroimmune
related instead of mechanical alone? Or that a nerve could adapt to the
mechanical challenge if the chemical/pressure issues were resolved?
Shacklock 2005
35
Inflamma8on and PNS
Shacklock 2005
36
Lundborg G, Myers R, Powell H. Nerve
compression injury
and increased endoneurial fluid pressure: a
‘‘miniature compartment
syndrome’’. J Neurol Neurosurg Psychiatry
1983;46:1119–24.
Brown C, Gilbert KK, Brismee JM, James CR,
Smith, MP, Sizer PS. The effects of neurodynamic
mobiliza8on on fluid dynamics within the 8bial
nerve at the ankle: An unembalmed cadaveric
study. Journal of Manual & Manipula>ve
Therapy, 2011; 19:26-34.
• Serial Neurodynamic sequences
– Shacklock suggests that if the sequencing is different, then the test is completely
different.
– Topp et al, 2013 suggests no difference in excursion or strain (scia8c or 8bial nerves) at
the end posi8on regardless of the sequencing of the test.
– Nee et al, 2010 suggests no difference in strain and rela8ve posi8on between different
sequences of ND tes8ng. However, the paLern of mo8on and loading may change
with varying sequences.
• Considera8on: What’s the goal of tes8ng?
– To determine whether the peripheral nervous system 8ssue is involved in the
pathological problem at some level.
– Is it possible for some people to respond differently and therefore, is it helpful (in light
of a history that might lead us to think of neurogenic involvement) to approach the
clinical tes8ng from a variety of direc8ons…to “sneak up” on it? Proximal vs. Distal
ini8a8on?
Shacklock, 2005; Topp et al, 2013;
37
Nee RJ1, Yang CH, Liang CC, Tseng GF, Coppieters MW. Impact of order of movement on nerve strain
and longitudinal excursion: a biomechanical study with implica8ons for neurodynamic test sequencing.
Man Ther. 2010 Aug;15(4):376-81. doi: 10.1016/j.math.2010.03.001. Epub 2010 Mar 31.
Rela8on to Neurodynamic Tes8ng Rela8on to Neurodynamic Treatment
Summary of Treatment Recommenda8ons:
• First, do no harm (nonmaleficence); Be gentle and get the pa8ent moving
• Treat the primary problem (e.g., disc, muscle, tendon) that is affec8ng the
nerve
• If the nerve is the primary problem, then treat the nerve.
• If irritable, consider sliding; work away from painful segment
• If less irritable, consider tensioning; work closer to painful segment
• Play with posi8oning using one and two-ended approaches to get the desired
input into the system
• Manage reps, sets, dura8on, etc. based on pt. response and desired outcomes.
• Consider external sol 8ssue mobiliza8on as adjunct Rx
• Nee et al 2013a and 2013b-Baseline indica8ons may help predict efficacy,
(absence of NP pain, older age, small ROM deficits); and RCT supports use of
ND Mobiliza8on with no adverse effects
Butler, 1991; Butler, 2000; Shacklock, 2005
38

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Theory of Neurodynamic
Summary Tes8ng and Treatment
Review of Neurodynamic Tes8ng:
• Aler the systems review (CP, NM, Msk, Integ, etc.) screening.
• Aler the Basic Clinical Exam (AROM/PROM/RROM)
• Special Tes8ng to rule in or out (ND tes8ng)-Sequencing
• Tissue specific diagnosis
Review of Clinical Treatment:
• Treatment aimed at the problem (e.g., disc, nerve, etc.)
• Tissue specific- slide/tension, etc.
• Restore func8onal ability- (posture, strength, stretch)
• Educa8on and daily management
39
• 1994- SLR; Slump; ULTT; TOS; Carpal Tunnel (Phil Sizer, PT, PhD and Omer Mattijs, PT, ScD)
• 1997- Frustration as a clinicianà IAOM-US (Valerie Phelps, PT, ScD) (“Diagnosis Specific Orthopaedic
Management”- Maitland History, Cyriax Examination, Butler ND, Kaltenborn mobilization
• 2000/2002- COMT IAOM-US- Spine and Extremities
• 2003- Elbow Study- Soft Tissue Mobilization dorsal forearm (posterior interosseous nerve)
• 2004- ScD Dissertation- L4, L5, S1 root movement during SLR
• 2007- K. Gilbert-Lumbosacral NR Displacement Strain Parts 1 and 2- SPINE Young Investigator Award 2006;
• Dilemma- if < 1mm movement at the root level, how is NDM helping…won’t break scar tissue...must be
physiological health of the nerve tissue...but how. (Butler 1989; Shacklock 2005)
• Breig- extension of spine = slack to lumbar roots—relation to Mackenzie Ext Protocol…maybe it’s not the Disc
afterall...
• 2009-Intraneural Fluid Dispersion-
• 2011- C. Brown- Tibial Nerve; 2015- K. Gilbert- Simulated Sciatic Nerve; 2015- K. Gilbert- L4 Root; 2016- S.
Sobczak- Median Nerve; 2018- N. Burgess- Cervical NR
• 2015-C. Lohman- Cervical NR Displacement and Strain Parts 1 and 2- Spine Young Investigator Award 2015
• 2016- R. Ellis; S. Sobczak; P. Sizer; S. Pol; A. Ali—continuing to seek ways to evaluate nerve tissue…stay tuned.
• In vitro à In situ à In vivo (desire to progress from passive system to active system in order to build on
physiological nerve health).
Recent Findings and My Neurodynamic Story
• Novel method for neural marking
(lumbar roots) that spared
foraminal ligaments
• Computer digitization and
analysis:
--L4, L5, S1 move less than
previously reported (Smith &
Massie, 1993)
--Relatively large SLR ROM
needed to provide lumbar
root displacement
--SLR NPP moved more than
SLR DF
--distal initiation (DF) may
increase strain
• SLR NPP and SLR DF are
useful clinical tools that provide
displacement and strain to the
lumbar roots.
• Clinical applica8on of ULNTT is not limited
to the brachial plexus or within upper
extremity.
• Provides mechanical founda8on for
provoca8ve neurodynamic tes8ng of the
roots. Kleinrensink, 2000 could not
measure roots
– Bolsters the exis8ng clinical research
that has validated ULNTT for
symptom reproduc8on in pa8ents
with neck pain and radiculopathies
(Sandmark & Nisell, 1995; Wainner et
al., 2003)
• May be useful in the examina8on of
pathology of the cervical nerve roots
• Clinical implica8ons of foraminal ligaments
are unclear
– Hypothesized they paly a role in
compression pathologies (Nowicki &
Haughton, 1992; Park et al., 2001)
– Foraminal ligaments appear to
protect cervical nerve roots by
limi8ng transfer of strain to prox root

11. 4/7/17
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Fluid Dynamics- Peripheral Nerve Tissue-
Scia8c (in vitro)-JMMT 2015
Fluid Dynamics- Tibial Nerve
(in situ)- JMMT 2011
Fluid Dispersion with Neurodynamic
Mobilization
20.65
20.84
21.77**#
20
20.2
20.4
20.6
20.8
21
21.2
21.4
21.6
21.8
22
Pre-mobilization Post-mobilization
Time
LongitudinalDye
Spread(mm)
Control
Experimental
15.3
16.3
15
15.2
15.4
15.6
15.8
16
16.2
16.4
16.6
16.8
17
Pre Post
Distance (mm)
Time (premobiliza#on to post mobiliza#on)
Rela#ve Fluid Movement
Compared to Baseline
Experimental
Fluid Dynamics- Lumbar Nerve Root-
(in situ) JMMT 2015 Nerve Tissue Fluid Dynamics
Series of studies examining the dynamics of intraneural fluid:
• Scia8c Nerve – in vitro
• Tibial Nerve – in situ
• Lumbar (L4) Root– in situ
• Median Nerve- in situ (In prepara>on; emphasize tension vs. slide)
• Boudier-Revéret M., Gilbert K.K., Allégue D.R., Moussadyk M., Brismée J-M., Feipel V., Sizer P.S., Dugailly P-
M., Sobczak S., Carpal Tunnel Syndrome: Effect of Specific Neural Mobiliza8on on Median Nerve Edema
Dispersion: A Cadaveric Inves8ga8on. Best Scien>fic Poster, Texas Society for Hand Therapy 22nd Annual
Educa8on Conference San Antonio, March 24-26, 2017.-Poster Presenta8on.
• Cervical Roots– in situ (data collec>on)
Neurodynamic (mechanical) input moves intraneural fluid aler it has
stabilized over 8me.

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Nerve Tissue Fluid Dynamics (Pressure)
Study Pedigree:
• Displacement not as large as originally thought…
(Gilbert et al, 2007a; Gilbert et al, 2007b); perhaps
another mechanism dealing with intraneural fluid
mechanics; flushing/pumping
• NDM causes intraneural fluid to move: scia8c nerve
sec8on; 8bial nerve, lumbar root, (Median), (Cervical
root).
• Next line of direc8on will deal with intraneural
pressure changes associated with neural mobiliza8on.
• Pilot Study- N=1: Intraneural pressure of CNR during
ULNT incorpora8ng Median Bias
• Significant at C5 and C6
• SB increased intraneural pressure at C5 but not C6.
• Poster submission
Theory of Neurodynamics
Summary- Current Literature
So, what do we take away from these areas of study?
1. Anatomy/Biomechanics- structure and func8on****
– Nerves are meant to move but do not tolerate tension and compression as well as other
8ssues
2. Pathophysiology- blood flow and chemical response***
– Tension/compression can alter blood flow, axoplasmic flow, and lead to pain,
inflamma8on, and intraneural edema
3. Tes8ng**
– Tes8ng has been shown to be valid and reliable as long as clinicians fully examine
pa8ent; 1) reproduc8on of pa8ent symptoms; 2) change in response resul8ng from
differen8a8ng maneuvers; 3) asymmetrical presenta8on?
4. Treatment*
– Seems to work; not really sure why; may have something to do with mechanical input,
but evidence is moun8ng to suggest that the physiological component of treatment is
beneficial and may work to “pump” out inflamma8on and restore appropriate blood
flow.
48
Nerve Related Pain Research Model
Mechanical Anatomical/
Physiological
Clinical
Engineering
(CARL/TTU-ME)
Cadaveric / Animal / Normals
(CARL) / (LARC) / (Msk/Bm/PC)
Clinical Research
(UMC/TTUHSC/Grace)
• Theore8cal Modeling
• Valida8on Modeling
• Clinical Tes8ng
• Interven8on
• Outcomes
Ques#ons:
1. Can we improve pain/func8on in pa8ents with nerve related pain?
2. Is improvement in pain/func8on correlated with nerve movement or fluid dispersion/
change in pressure?
3. What parameters of interven8on provide the best clinical outcomes?
Grant Progression:
1. SPFàSHP 2012
2. SHP 2012àCH Found
3. SHP 2014àNSF
4. SHP NicheàR15
5. R15àR01
Copyright: Gilbert, Sizer, Brismee, Sobczak, Pol, 2013
Byorn Rydevik-ISSLS Hong Kong TTUHSC/TTU/AUT/UQ Research
Team:
Lel to Right: Suhas Pol, PhD; Richard Ellis, PT, PhD;
Kerry Gilbert, PT, ScD; Stephane Sobczak, PT, PhD;
Not pictured: Jean-Michel Brismee, PT, ScD; Phil
Sizer, PT, PhD

13. 4/7/17
13
Selected References
• Butler, David S. (1989). Adverse mechanical tension in the nervous system: a model for assessment and treatment. The Australian Journal of
Physiotherapy, 35(4), 227–238.
• Butler, David Sheridan, & Jones, M. A. (1991). Mobiliza>on of the nervous system: CIP >tle. Elsevier Health Sciences.
• Brown C, Gilbert KK, Brismee JM, James CR, Smith, MP, Sizer PS. The effects of neurodynamic mobiliza8on on fluid dynamics within the 8bial
nerve at the ankle: An unembalmed cadaveric study. Journal of Manual & Manipula>ve Therapy, 2011; 19:26-34.
• Boyd BS1, Topp KS, Coppieters MW. Impact of movement sequencing on scia8c and 8bial nerve strain and excursion during the straight leg raise
test in embalmed cadavers. J Orthop Sports Phys Ther. 2013 Jun;43(6):398-403. doi: 10.2519/jospt.2013.4413. Epub 2013 Apr 30.
• Coppieters MW1, Hough AD, Dilley A. Different nerve-gliding exercises induce different magnitudes of median nerve longitudinal excursion: an in
vivo study using dynamic ultrasound imaging. J Orthop Sports Phys Ther. 2009 Mar;39(3):164-71. doi: 10.2519/jospt.2009.2913.
• Coppieters MW, Alshami AM. Longitudinal excursion and strain in the median nerve during novel nerve gliding exercises for carpal tunnel
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Dank Je!/Thank You!