Nerve testing for lower limb

Nerve testing


Neural Testing and Mobilization Techniques for the Lower Quadrant

Sciatic Nerve: Straight-Leg Raising with Ankle Dorsiflexion

Patient position and procedure:

The patient is supine. Lift the lower extremity in the straight-leg raise (SLR) position and add ankle dorsiflexion. Several variations may be done; ankle dorsiflexion, ankle plantar flexion with inversion, hip adduction, hip medial rotation, and passive neck flexion. The maneuver may also be performed long-sitting (slump-sitting position—see below) and side-lying. These various positions of the lower extremity and neck are used to differentiate tight or strained hamstrings from possible sites of restriction or nerve mobility in the lumbosacral plexus and sciatic nerve. Once the position that places tension on the involved neurological tissue is found, maintain the stretch position and then move one of the joints a few degrees in and out of the stretch position, such as ankle plantarflexion and dorsiflexion or knee flexion and extension. Ankle dorsiflexion with eversion places more tension on the tibial tract. Ankle dorsiflexion with inversion places tension on the sural nerve. Ankle plantarflexion with inversion places tension on the common peroneal tract. Adduction of the hip while doing SLR places further tension on the nervous system because the sciatic nerve is lateral to the ischial tuberosity; medial rotation of thehip while doing SLR also increases tension on the sciatic nerve . Passive neck flexion while doing SLR pulls the spinal cord cranially and places the entire nervous system on a stretch.



Slump-Sitting

Patient position and procedure:

Begin with the patient sitting upright. Have the patient slump by flexing the neck, thorax, and low back. Apply overpressure to cervical spine. Dorsiflex the ankle and then extend the knee as much as possible to the point of tissue resistance and symptom reproduction. Release the overpressure on the spine and have the patient actively extend the neck to see if symptoms decrease. Increase and release the stretch force by moving one joint in the chain a few degrees, such as knee flexion and extension or ankle dorsiflexion and plantar flexion.

Femoral Nerve: Prone Knee Bend

Patient position and procedure:

 Prone with the spine neutral (not extended) and the hips extended to 0_. Flex the knee to the point of resistance and symptom reproduction. Pain in the low back or neurological signs (change in sensation in the anterior thigh) are considered positive for upper lumbar nerve roots and femoral nerve tension. Thigh pain could be rectus femoris tightness. It is important not to hyperextend the spine to avoid confusion with nerve root pressure from decreased foraminal space or facet pain from spinal movement. Flex and extend the knee a few degrees to apply and release tension. Alternate position and procedure: Side-lying with the involved leg uppermost. 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

Prevention

These maneuvers may be used to prevent restrictive adhesions from developing if done early during treatment after an acute injury or surgery.

Precautions and Contraindications to Neural Tension

Testing and Treatment

There is incomplete scientific understanding of the pathology and mechanisms occurring when mobilizing the nervous system. Use caution with the stretch force; neurological symptoms of tingling or increased numbness should not last when the stretch is released. The clinician should always use caution and perform a thorough systems review and screening examination to rule out “red flag” conditions prior to neural tension testing and treatment.

P R E C A U T I O N S

Know what other tissues are affected by the positions and maneuvers. Recognize the irritability of the tissues involved and do not aggravate the symptoms with excessive stress or repeated movements. Identify whether the condition is worsening and the rate of worsening. A rapidly worsening condition requires greater care than a slowly progressing condition. Use care if there is an active disease or pathology affecting the nervous system. Watch for signs of vascular compromise. The vascular system is in close proximity to the nervous system and at no time should show signs of compromise when mobilizing the nervous system.

C O N T R A I N D I C A T I O N S

Acute or unstable neurological signs Cauda equina symptoms related to the spine including changes in bowel or bladder control and perineal sensation

• Spinal cord injury or symptoms

• Neoplasm and infection

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