x Preface

(ii) Ulnarneurodynamic test (von LanzT andWachsmuth W 1959Praktische Anatomie, Springer-Verlag,

Berlin, p.41, with permission).

(iii) Radial neurodynamic test (von LanzT andWachsmuth W 1959Praktische Anatomie, Springer-Verlag,
Berlin, p.47, with permission).

Fiaure P.' (Confiatled)


become a standard requirement. Nevertheless, an
author whose work passed relatively unnoticed was
Grieve (1970). The reason this paper is important
is that in it Grieve commented on, for the first time
that.I am aware of in the physiotherapy literature, the
notion of sensitivityof neural tissues being a key fac-
tor in whether they produce symptoms. He remarked
on the possibility that inflamed neural tissues may
well be more likely to produce abnormal neurody-
namic tests as opposed to those on which pressure was
exerted by pathologies such as disc bulges. He also
alluded to the possibilitythat nervous systemprocess-
ing could be a means by which neurodynarnic tests
might change with spinal manual therapy. These
aspects have undergone somewhat of a renaissance
and they turn out to be key facetsof current thinking
in clinicalneurodynarnics.
Publications on neural problems are often com-
plex, making it difficult for the clinician to apply
neurodynamic techniques safely and effectively. My
experience in teaching the approach around the
world has led me to the conclusion that there is a gap
in clinical expertise and resources. My intention with
this book therefore is not to provide a detailed review
of the literature but to quench the thirst in the clini-
cian for a practical book that is balanced with enough
theory to make sense of the practical application, with
emphasis on selection and application of manual
techniques that attack the causative mechanisms. For
that reason, I have written this for the clinician who
requires an understanding of the fundamentals of,
and advances in, neurodynamics in relation to the
musculoskeletal system. Emphasis in the early parts is
on theoretical neurodynamics. What then follows is a
system of how to work out patient problems; includ-
ing classificationsof dysfunctions; how to plan a safe
and appropriate physical examination; how not to
provoke pain, yet still have a beneficial effect;how to
establish whether the nervous system is abnormal and
how to construct a treatment regimen using a pro-
gressive system of mobilization techniques.
Functional neuroanatomy has been presented in
numerous peer reviewed journals and is summar-
ized well in other monographs (Breig 1960, 1978;
Sunderland 1978, 1991; Butler 1991), so this aspect
is not presented, other than some of the key points
relevant to neurodynamics. New aspects that have
not been presented elsewhere are proposed, such as
a practical and systematic method of working
Preface xi
through neurodynamic problems, with the final
outcome being that the therapist understands, and
can practise, this exciting subject more proficiently.
This book is also intended to be an update so as to
provide new options for treatment that the clinician
may never have previously considered. One of the
key aspects is the treatment of neurodynamic prob-
lems in conjunction with the musculoskeletal sys-
tem. After all, many neural problems have their
causes in the musculoskeletal system and, unfortu-
nately, the emphasis in the past has been on mobiliz-
ing the nervous system per se, at the expense of
integrating treatment of the musculoskeletal system.
Neural mobilizations, particularly stretches, have at
times been the mainstay of treatment, rather than
being applied in a way that addresses how the body
really moves, that is, in an integrated fashion that
includes the relational dynamics between both the
neural and musculoskeletal systems.
The general format of this book follows the
process of clinical neurodynamics from beginning
to end, from the perspective of the therapist. Even
so, much of what therapists generate in treatment
comes from our patients which makes it tempting to
start this book from the patient's presentation, work
backwards into the theory of what might be wrong,
then finish with the anatomy and biomechanics.
This is actually the way I do most of my learning,
because many of the best questions come from the
clinic. However, this can not easily be achieved in a
book because learning is a circular process that
involvesconstant revisiting and reorganizing knowl-
edge so that it eventually grows into a flexible con-
struct on which to base treatment. Some knowledge
of the basic framework is required to start with.
Hence, the first few chapters consist of theoretical
neurodynamics and pathodynamics (general and
specific) and the basis for diagnosis and treatment
and are referred to in the later chapters.
One of the key principles in this book is that
mechanics and physiology of the nervous system
must be linked in the clinician's mind so that safe
and effective decisions can be made. For too long
now, the terms 'neural tension', 'neural stretch' and
'neural provocation' have been dominant and, even
though the situtation is improving, more change is
necessary. Hence, the concept of neurodynamics, as
I originally conceived it (Shacklock 1995a, b), is the
mainstay of this book.
xii Preface
With the above in mind, 1felt the need to produce
an approach that is in some ways uniquely useful to
the clinician. The approach is therefore character-
ized by the following:
1. links between mechanics and physiology of the
nervous system
2. integration of neurodynamics with musculoskele-
tal functions
3. a new movement diagram that helps the clinician
integrate musculoskeletal and neural mechanisms
4. a new system for determining the kind and exten-
siveness of examination and treatment based on
neurodynamics and neuropathodynamics
5. the concept of neurodynamic sequencing and
various options in assessment and treatment
6. new diagnostic categories of specific dysfunctions
based on neuropathodynamics
7. treatment progressions derived from the above.
This text is about a particular modality in the
treatment of neuromusculoskeletal disorders. As
such, the approach is peripheralist and will have limi-
tations that the reader should bear in mind. 1 am not
a peripheralist (1 am actually a biopsychosocialist),
but 1still believethat afferent mechanisms playa great
role in producing pain and suffering. Nevertheless, it
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is common for therapists to diagnose more frequently
the problems they have recently learned about, which
raises the possibility of false diagnosis due to raw
enthusiasm. At all times, the reader will realize that
clinical neurodynamics is only one aspect of manage-
ment of the person in pain and all other relevant
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neurodynamic technique is warranted. This could be
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others.
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nerve root and peripheral nerve. There is no assump-
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