The document discusses neurodynamics, detailing the systems involved, types of dysfunctions, and assessment techniques. It emphasizes the significance of differentiating between neurological and musculoskeletal origins of pain, using various assessments to evaluate mechanical interfaces. The neurodynamic examination is categorized into levels of sensitivity and appropriate testing sequences to identify and address dysfunctions effectively.

1. Neurodynamics-II
The Assessment
Radhika Chintamani

2. CONTENTS
Neurodynamics in brief
Systems involved in neurodynamics
Assessment of Mechanical interface
Diagnostic neurodynamic
Levels of neurodynamic examination
Types of neurodynamic dysfunctions

3. MECHANICAL INTERFACE DYSFUNCTION
General Mechanical interface dysfunction
Aches and pains more prominent than dysaesthetic sysmptoms
Occur in the distribution of the related musculoskeletal
structures +/- neural structures
Provoked by movements of the interface that are related to the
specific dysfunction eg: opening/closing

4. Inflammatory or degenerative component is common
History of disease process, trauma or habitual irritating
movement in interface

5. Physical examination includes
Interface finding more prominent than neural findings,
includes;
a. Soft tissue palpation: for temperature, tenderness, trigger
points, spasm
b. Cuts, wounds and scars
c. Fibrosis

6. d. Muscle Tightness
e. Ligament injury
f. Capsule adherence or injury
g. Bursal irritation
Neurodynamic tests often reveal covert abnormal findings
includes;
a. ULTT for: radial, median and ulnar nerves
b. LLTT for: femoral, sciatic, common peroneal, obturator, tibial
and sural nerves.

7. DIAGNOSTIC NEURODYNAMIC

8. Description of the flowchart
Subject complaining of pain
Either: neurological/musculoskeletal origin
Structural differentiation: structural assessment as said above by
mechanical interface assessment and neurological assessment
If neurological assessment gives positive result: consideration of
normal or abnormal reaction towards test
If abnormal reaction is seen: check for covert or overt response

9. COVERT AND OVERT RESPONSE
COVERT OVERT
Hidden or secretive pain Blatant or out in open
Varying symptom: difficult to
diagnosable
Perfect symptoms regarding
structures affected: easily
diagnosable
Pain present throughout the day
and night/ sudden occurrence of
pain anytime during any
movement
Pain only during certain activities
Diffuse pain/irrelevant to the
structure affected
Localised pain/ relevant to the
structure affected

10. LEVELS OF NEURODYNAMIC
EXAMINATION

11. Levels Extensiveness and type of
technique in physical
examination
Meaning
0 Contraindicated Not indicated for
neurodynamics as the
subject is very sensitive
1 Limited Neurodynamic can be
used for assessment as
well as treatment but in
a very limited way.
(remember the force
application and multiple
component sequencing:
both should be reduced)
2 Standard Standard neurodynamic
can be followed for
assessment as well as
treatment

12. Level Extensiveness and type
of technique in
physical examination
Meaning
3
3a Neurodynamically
sensitized
This suggests that; the tests are performed to
assess the neural sensitivity towards it. If the
perception towards the test is high: then this
level is marked.
3b Neurodynamic
sequencing
Every neurodynamic test/treatment must be
followed sequence wise. This point suggests
that; following sequence wise is painful
suggests that: addition of sequential
component stretches the nerve at every point:
suggesting the increased tension in the nerve.
Point of painful is held, on further adding the
sequential joints will aggravate the pain
3c Multi-structural Multiple joints are added so that the nerve gets
stretched at every single point.
3d Symptomatic position/
movement
Particular movement/position producing pain
is chosen for the therapy

13. TYPES OF NEURODYNAMIC
DYSFUNCTION
1A: Reduced Closing 1B: Excessive Closing
-Closing movements provoke
symptoms
-Closing movements often restricted
-Contralateral list possible
-Pathology, disease process or
derangement more likely
-Usually no great restriction of closing
movement
-Hypermobility in closing direction often
present
-No list
-Often habitual movement or posture in closing
direction
2A: Reduced Opening 2B: Excessive opening
-Opening movements provoke pain
-Ipsilateral list possible
-Trauma or dysfunction in opening
direction
-Neurodynamic tests often abnormal
-Provoked by opening
-Often hypermobility/postural/repetitive
component
-Neurodynamic tests often normal or only
subtle abnormalities are present

14. THANK YOU