DPT and MS-PT students can avail.

1. Neurodynamics
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Dr. Abid Ullah (PT)
Physiotherapist
Department of Physiotherapy
Lady Reading Hospital-MTI
Peshawar
abid.ullah@lrh.edu.pk

2. OBJECTIVES
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 At the end of this lecture, the students will be able to:
 Summarize the various types of neurodynamic
examination and mobilization techniques.
 Describe the proposed mechanisms behind the
neurodynamic examination and mobilization techniques.
 Apply knowledge of the various neurodynamic
mobilization techniques in the planning of a
comprehensive rehabilitation program.

3. SLUMP TEST
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 The slump test, popularized by Maitland
 Maitland asserted that the slump test enables the tester
to detect adverse nerve root tension caused by spinal
stenosis, extraforaminal lateral disk herniation, disk
sequestration, nerve root adhesions, and vertebral
impingement.
 Full spinal flexion or flexion of the cervical, thoracic,
and lumbar regions of the spine produces lengthening
of the vertebral canal.
 This elongation of the vertebral canal stretches the
spinal dura and transmits tension to the spinal cord,
lumbosacral nerve root sleeves, and nerve roots.

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 When extension of the cervical spine is introduced,
the dura and the nerve roots slacken as the
vertebral canal begins to shorten.
 Extending the thoracic and lumbar spines increases
the slack in the neural tissues as the vertebral canal
continues to shorten.
 The only advantage of the slump test over the SLR
test is that it increases the compression forces
through the intervertebral disks and will highlight
the presence of dural adhesions.

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 The patient is positioned sitting with the hands
behind the back, the popliteal creases just off the
edge of the bed and a slight arch in the back and
the head flexed and then placed in neutral.
 This initial position is then followed by a slump of
the lumbar and thoracic spine with a posterior
pelvic tilt as the clinician maintains the patient,s neck
in neutral.

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 If the test is still negative, the patient is asked to
flex the neck by first applying a chin tuck and
placing the chin on the chest and then to straighten the
knee asmuch as possible.
 Overpressure is then gently applied to the upper
thoracic and the lower cervical spine and maintained
throughout the examination.
 The subject,s ankle is then passively dorsiflexed to the
point of slight resistance, while the knee is slowly
passively extended to full extension or to the point
when the subject reports an onset of neural mediated
symptoms.

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11. Straight Leg Raise
 Recognized as the first neural tissue tension test.
 It was first described by Lasegue well over 100 years ago.
 Positioned supine with no pillow under the head.
 The patient’s trunk and hip should remain neutral, avoiding internal
or external rotation, and excessive adduction or abduction.
 To ensure that there is no undue stress on the dura, the tested leg is
placed in slight internal rotation and adduction of the hip and
extension of the knee.
 The clinician holds the patient's heel, maintaining the extension and
neutral dorsiflexion at the ankle, and raises the straight leg until
complaints of pain or tightness in the posterior thigh are elicited
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13.  The first 30° of the SLR serves to take up the slack
or crimp in the sciatic nerve and its continuations.
 Pain in the 0- to 30-degree range may indicate the presence of
 Between 30 and 70 degrees, 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.
Acute spondylolisthesis
Tumor of the buttock
Gluteal abscess
Very large disk protrusion
or extrusion
Acute inflammation of the
dura
Malingering patient
The sign of the buttock
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14.  An SLR test is positive if
 The range is limited by spasm to less than 70 degrees,
suggesting compression or irritation of the nerve roots.
 A positive test reproduces the symptoms of sciatica,
with pain that radiates below the knee, not merely
back or hamstring pain.
 When the SLR is severely limited, it is considered
diagnostic for a disk herniation.
 The pain reproduced is neurologic in nature.
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15. Braggard,s test
The straight leg raise with ankle dorsiflexion.
Passive dorsiflexion of the ankle (Braggard,s test)
may be used as sensitizers for the SLR test.
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16. Soto-Hall test
The straight leg raise with active cervical flexion.
In addition, further internal rotation or extreme adduction of the hip
may also be added to the SLR. These additional maneuvers increase
the tension exerted on the spinal cord, spinal dura, and lumbosacral
nerve roots
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17. Modified SLR
❑ Modifications place stress through
different branches of the sciatic and common fibular
(peroneal) nerves by adjusting the ankle and foot
position, to differentially diagnose.
 The following ankle and foot adjustments can be
made:
◼ Dorsiflexion, foot eversion, and toe extension stress the tibial
branch.
◼ Dorsiflexion and inversion stress the sural nerve.
◼ Plantar flexion and inversion stress the common fibular
(peroneal) nerve (deep and superficial).
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18. Crossed SLR Sign
 The crossed SLR sign is associated with
the SLR test.
 There are three recognized types:
 SLR that produces pain in the contralateral leg but not
when the contralateral leg is raised.
 SLR that produces pain in both legs.
 SLR of either leg that produces pain in the contralateral
limb. For example, SLR of the right leg produces pain in
the left leg and SLR of the left leg produces pain in the
right leg.
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19.  The crossed SLR is highly specific and
 is thought to be more significant than the SLR test in
terms of its diagnostic powers to indicate the
presence of a large disk protrusion.
 The following findings are strongly predictive of
disk herniation:
 Severely limited SLR.
 Positive crossover SLR.
 Severely restricted and painful trunk movements.
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20. Bilateral SLR
The bilateral straight leg raise.
A limitation of the unilateral SLR is that it may not highlight
the presence of a central disk protrusion, particularly a soft disk protrusion.
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21. Bowstring Tests
SLR bowstring (popliteal space pressure).
Both the tibial and the common fibular (peroneal) nerves can be tested
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22. Prone Knee Bending Test
 The (PKB) test stretches the femoral
Nerve using hip extension and knee flexion to stretch
the nerve termination in the quadriceps muscle.
 used to indicate the presence of upper lumbar disk
herniations.
 Procedure: the patient is positioned prone, and the
clinician stabilizes the ischium to prevent an anterior
rotation of the pelvis.
 The clinician then gently moves the lower extremity into
knee flexion, bending the knee until the onset of
symptoms.
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23.  The zone at which the dura is stretched is 80–100
degrees of knee flexion.
 Knee flexion greater than 100% introduces both a
rectus femoris stretch and lumbar spine motion into the
findings.
 The test is positive if there is a reproduction of
unilateral pain in the lumbar area, buttock, posterior
thigh, or a combination in the 80–100 degree range of
knee flexion which could indicate an L2, L3, or L4 nerve
root impairment although an acute L4–S1 disk
protrusion may also produce positive findings.
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24. Prone Knee Bending Test
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