By: Rick Schuster, SPT

Treatment Points Research Indications

Treatment Points
• Neural tension/sliding involves Research Indications
mobilization of the nervous system
• Okay if not “worse,” looking for
centralization
• 2-3 sets of 30 second oscillations
• Begin with sliders and progress to
tensioners
• Oscillate within pain free ranges (“stop
light” rule)
• Red light: any movement that increases
or peripheralizes complaints + remains
worse after 3-5 minutes
• Yellow light: an increase in symptoms
but dissipates after 10-20 seconds
• Green light: decrease in symptoms or
centralization (very good predictor of
success)
 Research
Treatment Points • Recent research shows that neurodynamics
Indications
are effective at treatment of carpal tunnel
syndrome (CTS), with high reliability for
diagnosis.₁

• A study conducted by Rafiq S et al₂

concluded that neurodynamics combined
with cervical isometrics compared to
isometrics alone resulted in significant
improvements in pain, quality of life
(QoL), and deep cervical flexor endurance.

• A comparative study concluded that

neurodynamic sliding techniques combined
with conventional therapy is effective in
the treatment of sciatica in terms of
reducing pain and increasing physical
performance in ADLs/IADLs.₃
 Indications
• Patients with symptoms in the head,
Treatment Points Research neck, arm, thoracic spine, low back, leg
• Post-surgical patients unless unstable
(i.e. spinal cord injury), patients with
chronic pain
• If head/trunk/leg movement alleviates
or increases symptoms peripherally
• Check for full motion (PROM/AROM) at
each joint in the chain
• Upper/Lower Quarter
• Cervical spine
• Shoulder
• Elbow
• Forearm
• Hand/wrist
• Thoracic spine
• Lumbar spine
• Hip
• Knee
• Foot/ankle
• Toes
Radial nerve Median nerve Ulnar nerve
 Radial nerve

• Abduct the shoulder 60° • Ways to increase tension

• Full shoulder IR • Contra-lateral flexion of
• Full elbow extension cervical spine
• Full forearm pronation • Depression of ipsilateral
•

Median nerve
Full wrist/finger flexion shoulder

Ulnar nerve
 Median nerve

• Abduct the shoulder 60° • Ways to increase tension

C6-T1 • Full shoulder ER
• Full elbow extension
• Full forearm supination
•
Radial nerve
• Contra-lateral flexion of
cervical spine
• Depression of ipsilateral

Full wrist/finger extension shoulder

Ulnar nerve
 Ulnar nerve
• Abduct the shoulder 90° • Ways to increase tension
• Full shoulder ER • Contra-lateral flexion of
• Full elbow flexion cervical spine
C8-T1 • Full forearm pronation • Depression of ipsilateral
• Full wrist/finger extension shoulder

Median nerve
Radial nerve
Sciatic Femoral Peroneal Sural Saphenous

Radial nerve Median nerve Ulnar nerve

 Sciatic

• Slump Test • Straight Leg Raise (SLR)

Radial nerve
• Patient seated,
hands behind back
to achieve neutral
spine
• Have patient flex the
Median nerve
• Patient supine Ulnar nerve
• Flex hip ~90°
• Adduct hip with IR
• Extend knee, DF and
invert foot/ankle

Saphenous
Peroneal
Femoral
thoracic and lumbar

Sural
spine, followed by
flexion of cervical
spine
• Have patient extend
knee, then DF the
ankle
 Femoral
• Prone knee bend • Side-lying
• Patient prone • Patient side-lying on
Radial nerve • Flex knee ~90° Median nerve unaffected side Ulnar nerve
• Extend hip to tolerance • Flex knee ~90°
• Extend hip to tolerance

Saphenous
Peroneal

Sural
Sciatic
 Peroneal (PIP)
• Straight Leg Raise (SLR)
• Patient supine
Radial nerve Median nerve
• Flex hip ~90° Ulnar nerve
• Adduct hip with IR
• Extend knee, invert and PF foot/ankle

Saphenous
Femoral

Sural
Sciatic
 Sural (SID)

• Straight Leg Raise (SLR)

Radial nerve Median nerve Ulnar nerve

• Patient supine
• Flex hip ~90°
• Adduct hip with IR
• Extend knee, invert and DF foot/ankle

Saphenous
Peroneal
Femoral
Sciatic
 Saphenous
• Straight Leg Raise (SLR)
• Patient supine
Radial nerve Median nerve• Flex hip ~90° Ulnar nerve
• Adduct hip with IR
• Extend knee, evert and PF foot/ankle

Peroneal
Femoral
Sciatic

Sural
 Saphenous
Treatment Effects Combining Treatments

Radial nerve Median nerve Ulnar nerve

Combining Treatments

Treatment Effects
Peroneal
Femoral

Technique
Sciatic

Sural
 Saphenous
Treatment Effects Combining Treatments
Technique
• Cork Screw Technique (for SLR)
• Patient supine
Radial nerve Median nerve
• Flex hip ~90° Ulnar nerve
• Wrap band around mid-shift of the femur for friction
to provide IR (direction of wrapping does not matter)

Combining Treatments
• Have patient actively flex/extend the knee with ankle

Treatment Effects
DF/great toe extension while the examiner passively

Peroneal
Femoral

adducts and internally rotates the hip, while also

Sciatic

Sural
applying a traction force
 Saphenous
Treatment EffectsTreatmentCombining
Effects Treatments
• Improvement of axoplasmic flow (“blood
Radial nerve Median nerve Ulnar nerve
flow” of the nervous system)
• Improvement of mechanical properties
Combining Treatments (slide & glide) of peripheral nerves

Peroneal
Femoral

• Research has shown that nerves can’t

Sciatic

Sural

Technique
really be “stretched,” rather that
neurodynamics help improve movement
tolerance
• Neurodynamics can be used when
regular treatments (exercise, biophysical
agents, etc.) aren’t receiving positive
outcomes for chronic pain
 Saphenous
Treatment Effects
Combining Combining Treatments
Treatments
• Neurodynamics can be combined with
Radialtreatment
nerve techniques Median
such as: nerve Ulnar nerve
• Joint mobilizations (Maitland and
Kaltenborn techniques) to reduce

Treatment Effects
Peroneal
Femoral

threat by increasing their pain

Technique
Sciatic

Sural
threshold
• Instrument Assisted Soft-Tissue
Mobilization (IASTM)
• Combine neurodynamics with neural
glide techniques for their HEP to see
the most effective outcomes
 Saphenous
References

Radial nerve Median nerve Ulnar nerve

1. Talebi, G. A., Oskouei, A. E., & Shakori, S. K. (2012). Reliability of upper limb tension test 1 in normal
subjects and patients with carpal tunnel syndrome. Journal of Back and Musculoskeletal
Rehabilitation, 25(3), 209–214. https://doi.org/10.3233/bmr-2012-0330
2. Rafiq S, Zafar H, Gillani SA, et al. Effects of Neurodynamic Mobilization on Health-Related Quality of
Life and Cervical Deep Flexors Endurance in Patients of Cervical Radiculopathy: A Randomized
Trial. BioMed Research International. October 2022:1-10. doi:10.1155/2022/9385459

Peroneal
Femoral
Sciatic

3. Chaudhary K, Manjunath H, Singh AK, Rajbanshi SK. Effect of Neurodynamic Slider Technique

Sural
Combined with Conventional Therapy and Conventional Therapy Alone in Sciatica: A Comparative
Study. Indian Journal of Physiotherapy & Occupational Therapy. 2022;16(1):53-62.
doi:10.37506/ijpot.v16i1.17774