This document discusses various neurodynamic mobilization techniques used to assess and treat neural tension. It begins by defining neurodynamics and describing principles of neural mobilization including applying gentle oscillatory movements when tension is detected. Several upper and lower extremity neural tension tests are then described in detail, including the upper limb neurodynamic test for the median, radial and ulnar nerves, the straight leg raise for the sciatic nerve, slump-sitting maneuver, prone knee bend for the femoral nerve. Precautions for each technique are provided. The document concludes by briefly defining carpal tunnel syndrome.

1. NeurodynamicMobilization
Gabriel Turner, SPTA
Concorde Career College

2. Objectives
2
• Neurodynamics
• Principles of Neural Mobilization
• Test for Provocation
• Technique
• Upper limb neurodynamic test (ULNT)
• Straight leg raise (SLR)
• Slump-Sitting Maneuver (SSM)
• Femoral Nerve: Prone Knee Bend (PKB)
• Carpal Tunnel Syndrome

3. Neurodynamics
Is a concept of changes in the plasticity of the nervous
system.
Neurodynamic test maneuvers
• Are preformed to detect tension or compression in the
neural tissue.
Nerve flossing
• A gentle way to soothe compressed nerves and regain
range of motion, when combined with physical therapy.
3

4. Principles of Neural Mobilization
• Based on anatomic and biomechanical properties of
peripheral nerves and their response to stress and
strain.
• The goal is to increase the excursion of the nerve while
reducing the strain.
• Important to note that clinicians often make the error
of being to aggressive with the techniques.
• Intensity of the technique should be related to the
irritability of the tissue and patient’s response and
changes in symptoms
• The greater the irritability the gentler the technique
• When applied properly – technique should be symptom
free, with slow and rhythmic oscillatory motion
4
(Manvell, Manvell, Snodgrass, & Reid,
2015)

5. Precautions / Contradictions
• Precautions:
• Vascular compromise or insufficiency
• Inflammation
• Edema
• Contraindications
• Cauda equina symptoms
• Changes in bowel and bladder control and
perineal sensation
• Spinal cord injury
• Neoplasm
• Infection 5

6. Test for Provocation
Test positions elongate the nerves across multiple joints,
every joint in the chain must be examined separately for
limitations in ROM, mobility, and symptoms of provocation
so that any restrictions that occurs during the test is not a
result of joint prearticular tissue limitations
General testing procedure
• Slowly and carefully elongated the nerve across each
joint in succession until there is an onset of symptoms
or tissue restriction is felt
• Symptoms are the result of tension being placed of
some component of the nervous system.
6

7. Positive test
1. For the test to be considered positive it must reproduce
the patient symptoms pain or paresthesia
2. Must demonstrate differences from side to side, with a
known normal response
3. Support findings full examination to include symptoms
pattern, location, strength, ROM and joint mobility.
4. Sensitizing maneuvers alters patient’s symptoms
7
Sensitizing maneuvers
• Produce pain or paresthesia when neurological
system is elongated across multiple joints or is
relieved when one joint is moved into a slackened
position

8. Technique
Neural sliding flossing
• Position the patient at the point of tissue
resistance or the onset of symptoms then move
joints in the chain simultaneously so that the
neural tissue glides proximally or distally
• Example: to glide the median nerve proximally
once at the position of tissue resistance or onset
of symptoms, perform elbow flexion
simultaneously with contralateral cervical flexion
or wrist flexion simultaneously with elbow flexion.
8

9. Technique
Neural Glide
• Patient position the same as in neural sliding. Offload
the nerve by placing the neural tissue on slack by
laterally flexing the proximal segment toward the
involved side or by releasing the position of the distal
segment. Then slowly oscillate using large movements,
gently move one segment in and out of the point of
tissue resistance.
9

10. Upper Limb NeurodynamicTest
(ULNT)
10
The ulnar, median, and radial nerve upper limb
neuro-dynamic test is used to detect peripheral
neuropathic pain. By assessing the interaction
between the mechanics and physiology of the three
major nerves of the arm.
(Manvell, Manvell, Snodgrass, & Reid,
2015)

11. Median Nerve ULNT1
11
Maneuver used when examining and treating
symptoms related to median nerve distribution,
including carpal tunnel syndrome
(Kisner, Colby, & Borstad, 2018)

12. Median Nerve ULNT1
• Begin with patient in supine, place your fist at the superior aspect
of the patient’s shoulder, pushing fist into the table to control
elevation of the shoulder during abduction
• Abduct the arm to 110° while keeping the elbow flexed at 90°.
• Maintain the elbows position ext. wrist & fingers
• Supinate the forearm followed by lateral rotation
• Slowly extend the elbow, while keeping wrist & shoulder position
constant, stop the movement if the patient reports symptoms or
you feel tension in the tissue.
• To sensitize the maneuver as the patient to lat. flex the cervical
spine away from test side and then towards test side and ask if
movements increase or decrease symptoms 12
ULNT 1

13. Radial Nerve ULNT 2
13
This maneuver is used when examining and treating
symptoms related to shoulder girdle depression,
radial nerve distribution, differentiating between
tennis elbow, radial tunnel syndrome.
(Kisner, Colby, & Borstad, 2018)

14. Radial Nerve ULNT 2
• Begin with the patient in supine, apply gentle shoulder
girdle depression then slightly abduct shoulder 10°,
• Extend the elbow, and medially rotate the whole arm.
• With elbow in extension add wrist, finger and thumb
flexion then add ulnar deviation.
• Maintaining this position, slowly abduct the shoulder
until reproduction of symptoms or tension is felt in
tissue.
• To sensitize the maneuver as the patient to lat. flex the
cervical spine away from test side and then towards test
side and ask if movements increase or decrease
symptoms
14
ULNT 2

15. Ulnar Nerve – ULNT 3
15
This maneuver is used when symptoms are related to
lower brachial plexus or ulnar nerve distribution and
differentiating between medial epicondylosis and
pronator syndrome.
(Kisner, Colby, & Borstad, 2018)

16. Ulnar Nerve – ULNT 3
• Begin with the patient in supine.
• Extend the wrist and fingers, pronate the forearm and flex
the elbow.
• While maintaining this position laterally rotate the
shoulder and depress the shoulder girdle.
• Finally abduct the shoulder 110° or until symptoms are
felt.
• To sensitize the maneuver as the patient to lat. flex the
cervical spine away from test side and then towards test
side and ask if movements increase or decrease symptoms
16
ULNT 3

17. Sciatic Nerve – Straight Leg
Raising SLR
This maneuver is used as the main test to diagnosis lumbar disc
herniations. SLR can also distinguish tight or strained hamstrings
caused by possible restriction in the lumbosacral plexus and sciatic
nerve.
Changes in position of the ankle in combination with various hip and
knee positions are used to differentiate foot impairments such as
plantar fasciitis and tarsal tunnel syndrome.
Research has found that with hamstring tears, that neural glides with
an emphasis on sciatic nerve glides as part of a treatment program
could have a prophylactic effect of preventing scar tissue from
developing and entrapping nerve structures which lie near hamstring
muscle bellies.
17
(Aggen, PT & Reuteman, PT, 2010)

18. Place the patient in supine, lift the lower extremity into SLR
position and add ankle DF. Serval variations may be done to
assist in differentiating the neural load.
• Ankle DF w/ eversion places tension on the tibial tract
• Ankle DF w/ inversion places tension on the sural nerve
• Ankle PF w/ inversion places tension on the common peroneal
tract
• Hip Adduction while in SLR places further tension on Sciatic
nerve - same as medial rotation increases tension on Sciatic
• Passive neck flexion while in SLR pulls the spinal cord cranially,
placing the entire nervous system on a stretch.
• Ankle DF with toe extension increases tension on medial and
lateral plantar nerves
18
(Kisner, Colby, & Borstad, 2018)

19. Slump-Sitting Maneuver
• The Slump is a more sensitive test, used identify
herniations in which the SLR is negative.
• Like the SLR test the slump is used as the primary test
to diagnosis lumbar disc herniations and found to have
high correlation with findings on operation since its
sensitivity is high in only disc herniations leading to root
compression that may eventually need surgery.
• The Slump test applies traction to the nerve roots by
incorporating spinal and hip joint flexion into the leg
raising and would warn the therapist of the presence of
nerve root compression when there is a negative SLR
test.
19
(Kisner, Colby, & Borstad, 2018)

20. • Begin with the patient sitting upright.
• Have the patient slump by flexing the spine and neck.
• Apply gentle over pressure to cervical spine flexion
• To sensitize the maneuver, dorsiflex the ankle and then
extend the knee to the point of resistance and reproduction
of symptoms.
• Release the over pressure of the spine and have patient
actively extend the neck to see if symptoms subside.
• Increase and release the stretch force by moving one joint in
the chain a few degrees
• Knee Flex/Ext
• Ankle DF/PF
• Note Response 20

21. Femoral Nerve: Prone Knee Bend
21
This maneuver is used when symptoms are related to pain in
the low back or neurological signs of sensation in the anterior
thigh are considered a positive sign for upper lumbar nerve
roots and femoral nerve tension. Thigh pain could indicate
rectus femoris tightness.
(Kisner, Colby, & Borstad, 2018)

22. 22
• With the patient in prone position spine neutral and the
hips to 0° of extension. Flex the knee to the point of
resistance and reproduction of symptoms.
• An alternative position can be done in side-lying
• With the involved leg in the uppermost position.
• Stabilize the pelvis and extend the hip with the knee
flexed until symptoms are reproduced.
• Maintain knee flexion, release and apply tension
across the hip by moving it a few degrees at a time.
Femoral Nerve: Prone Knee Bend

23. CarpalTunnel Syndrome -CTS
23
Is the result of irritation and compression or stretching the
median nerve as it passes through the carpal tunnel in the
wrist along with extrinsic finger flexor tendons on it way to
the hand.
Symptoms include tendonitis, pain, paresthesia,
inflammation and tendinosis ( scarring of the tendon
sheaths).
CTS is classified as a cumulative trauma or overuse syndrome.

24. 24
• Begin with position A and slowly progress to each
following position until the median nerve symptoms are
provoked.
• That is the maximum position to use, then shift through
each proceeding position before the point of
provocation.
• Once patient can move into the maximum position
without pain then patient can proceed to the next
position.
• Nerve gliding with standard care, such as splint or
tendon/carpal mobilization, found that all participants
improved independently with nerve gliding application.
• Research found that almost all the participants receiving
nerve gliding avoided the surgical intervention.
Median Nerve Mobilization
(Ballestero-Perez, PhD, et al., 2016)

25. Video Demonstration
https://youtu.be/Fv_EJV8q2E0
25

26. Questions
Gabriel Turner
+1 760-681-1745
Gabriel.turner@CASAN.concorde.edu

27. References
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Aggen, P. D., & Reuteman, P. (2010). Conservative Rehabilitation of Sciatic Nerve Injury
Following Hamstring Tear. North American Journal of Sports Physical Therapy, 5(3), 143+.
Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2971645/
Ballestero-Perez, R., Plaza-Manzano, G., Urraca-Gesto, A., Romo-Romo, F., Atin- Arratibel, M. D.,
Pecos-Martin, D., Romero-Franco, N. (2016, Nov 11). Effectiveness of Nerve Gliding
Exercises on Carpal Tunnel Syndrome: A Systematic Review. Journal of Manipulative &
Physiological Therapeutics, 40(1), 50-59. doi:https://doi.org/10.1016/j.jmpt.2016.10.004
Kisner, C., Colby, L. A., & Borstad, J. (2018). Therapeutic Exercise Foundations and Techniques
(Seventh ed.). Philadelphia: F.A. Davis Company.
Manvell, N., Manvell, J. J., Snodgrass, S. J., & Reid, S. A. (2015). Tension of the Ulnar, Median, and
Radial Nerves During Ulnar Nerve Neurodynamic Testing: Observational Cadaveric Study.
Physical Therapy, 95(6), 891+. doi:http://dx.doi.org/10.2522/ptj.20130536