The document outlines neural tissue mobilization (NTM), detailing its definition, principles, techniques, and various neurodynamic tests for assessing neural tension. It highlights the mechanical functions of the nervous system, indications and contraindications for NTM, and discusses specific tests such as the passive neck flexion and ULTT for median and ulnar nerves. Additionally, the document addresses precautions and includes references for further reading.

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 –
1. Describe the principles
2. Techniques of NTM
3. Different tests for NTM
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3. Contents
• Introduction
• Precautions
• Contraindications
• Tension testing
• UL & LL
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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.11-04-2018 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,
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6. • NS includes neural tissue in the body –
Neurons – cells that send & receive
signals & Neuroglia – cells that support &
protect neurons
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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.
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8. • Primary mechanical functions of the
nervous system – tension, sliding,
compression
• Tension – 1st primary mechanical events in
the NS is generation of tension.nerves are
lengthened by elongation.
• Sliding – 2nd event is movt of NS relative to
their adjacent tissues.
• Compression- neural structures can
change their shape when pressure is
exerted on them.
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10. • How nerve move - by all three mechanical
events.
• movements of joints
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11. Neurodynamic testing
• Cervical spine
• Upper limb
• Lower limb
• Lumbar spine
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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.11-04-2018 NTM 12

13. Cervical spine
• Passive neck flexion –
- preparation – pt. position
- normal response / abnormal response
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14. ULTT
• Median nerve –
• Position
• Movement
• response
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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.11-04-2018 NTM 15

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17. Radial nerve
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18. Slump test
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19. Prone knee bend test
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20. SLR
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21. Tibial Nerve
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22. Peroneal nerve
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23. Indications & contraindications
• Indications
1. Nerve root injuries
2. Thorasic N. root
syndrome
3. Whiplash injury
4. Coccydynia
5. Spondylolysthesis
6. Post lumbar spine
injuries
• Contraindications
• Recent onsetof or
worsning
neurological signs
• Cauda equina
lesion
• SCI
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24. Precautions
• Irritability to nervous system
• Dizziness
• Circulatory disturbances
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25. Summary
• Definition
• Principles
• Tests
• Indications
• contraindications
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26. References
• Clinical Neurodynamics – MICHEL
HACKLOCK
• Manual Therapy Approaches in
Neurophysiotherapy – Dr. Suvarna Ganvir
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27. THANK YOU…….
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