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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