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Patients often associate pain with muscle, tendon, or ligament injury. However, irritated NERVES may also become the primary source of pain.  Tensile stretch or compression of nerves often results in symptoms. Unfortunately, radiculopathies are often the most difficult diagnoses to treat. Without quick symptomatic relief, patient compliance diminishes.

Achieve Quick and Measurable Results for Radiculopathies

This blog will discuss how to incorporate neurodynamic testing into your management of radicular arm pain – including a video demonstration from Dr. Taylor Premer.

 

Nerve Tension Tests Serve Four Primary Roles

1. Evaluation (Nerve Tensioning)

Nerves are dynamic structures that need to glide and stretch. (1) Edema and fibrosis can impair this normal movement, and often translates into neurogenic complaints. Symptomatic nerve roots are wider than asymptomatic nerve roots due to the presence of edema. (2)

You would not consider evaluating sciatica without a neurodynamic test (straight leg raise), so why wouldn’t you consistently do the same for upper extremity complaints. The following tests can allow you to quickly identify irritated primary tracts:

2. Management (Nerve Flossing)

Nerve flossing aims to restore normal neurodynamics and may help resolve the associated symptoms. Flossing entails tensioning one end of the nerve while simultaneously releasing the tension on the other end. This repetitive motion glides the nerve back and forth through its path and aims to release adhesions that have developed along the way. Nerve flossing is typically executed in-office and as part of a home care program.

Clinicians may perform in-office nerve flossing of the Radial Nerve at the Elbow, Median Nerve Release at the Pronator Teres, and Ulnar Nerve at the Elbow.

Check out the following at-home self-floss exercises

3. Clinical Audit Process (CAP)

The clinical audit process measures how a condition changes as a result of treatment.  Most chiropractors use range of motion (ROM) as their primary clinical audit process. For example, a patient may have pain with lumbar flexion at 25 degrees.  After spinal manipulation and lumbar traction, the ROM has increased to 55 degrees before reproduction of pain. It appears treatment was successful with measurable improvement in lumbar ROM.

Nerve pain is often slower to subside as compared to ROM.  For radiculopathies, consider using nerve tension tests as your CAP.  Improvements in radicular pain will improve post-treatment if you have selected the correct intervention.  In-office care that diminishes the compression or stretch of the irritated nerve will result in reduced pain with subsequent centralization of symptoms.

Watch our friend Dr. Taylor Premer of Winchester Spine and Sport and Gestalt Education explain how nerve tension signs are affected by directional therapy in the cervical spine. 

Nerve tension tests should be performed before and after treatment. Your treatment will vary based on the diagnosis and your individual skillset.  Always select treatments that positively affect the post treatment audit.  Treatment options including spinal manipulation, traction, nerve flossing, directional therapy, and soft tissue manipulation are all well-established treatments for cervical radiculopathy. If treatment does not positively affect the nerve tension test post-intervention, then it’s time to reconsider your treatment pathway!

4. Patient Education

Patient compliance and satisfaction will improve when your treatments diminish pain and improve function.  Patients will trust your assessment and comply with your care if you can demonstrate short-term success for challenging diagnoses. Measuring progress will boost confidence in your in-office and at-home exercise selection for radicular pains.

Looking for an easy way to educate your patients? You’re going to want to check out ChiroUp. And before you ask, no. We are not JUST an exercise program…we are so much more.

ChiroUp is a system that improves patient compliance with our reports, tracks your clinical outcomes, and most importantly, builds a relationship with every patient that you see. All in a matter of seconds.

Want to see ChiroUp in action? Do yourself a favor and check out our 14-day free trial!

References
  1. Wilgis EF, Murphy R. The significance of longitudinal excursion in peripheral nerves. Hand Clin. Nov 1986;2(4):761-6.
  2. Okmen BM. et al. Investigation of the Effect of Cervical Radiculopathy on Peripheral Nerves of the Upper Extremity With High-Resolution Ultrasonography. SPINE. 43(14):E798–E803, JUL 2018

About the Author

Dr. Taylor Premer

Dr. Taylor Premer

Dr. Taylor Premer is the co-founder of Gestalt Education and a Chiropractic Physician at Winchester Spine and Sport in Troy, MO. Dr. Premer was the president of the Motion Palpation Club at CUKC where he fell in love with teaching and learning manual/rehabilitative skills. Dr. Premer is a certified DNS exercise trainer and is versed in a multitude of manual and rehabilitative techniques including MDT, Functional Soft Tissue/Taping, Dry Needling, and neurodynamics. Him and his fiancé Taylor enjoy exploring new coffee shops or traveling to new destinations.

Dr. Brandon Steele

Dr. Brandon Steele

DC, DACO

Dr. Steele began his career at The Central Institute for Human Performance. Dr. Steele has trained with experts including Pavel Kolar, Stuart McGill, Brett Winchester, and Clayton Skaggs. He has been certified in Motion Palpation, DNS, ART, and McKenzie Therapy. Dr. Steele lectures extensively on clinical excellence and evidence-based musculoskeletal management. He currently practices in Swansea, IL and serves on the executive board of the ICS.

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