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98 m a s s a g e & b o d y w o r k j u l y / a u g u s t 2 0 1 6 technique SCIENCE OF NERVES Nerve compression is a recognized cause of soft-tissue pain and disability for many people. Nerve compression syndromes, and especially upper-extremity nerve disorders, came to the forefront in the last few decades as a result of increasing injuries among those whose occupations require repetitive activities. Carpal tunnel syndrome (CTS) is the most well-known of the upper-extremity nerve disorders. However, there are at least five other locations along the median nerve that can lead to pain and disability. CLINICAL NEURODYNAMICS Understanding more about neural movement (neurodynamics) is essential for those working with nerve-related disorders. There are two key biomechanical forces that cause mechanical injury to peripheral nerves: compression and tension (note that the term mechanical injury is used to differentiate mechanical causes of nerve dysfunction from those of other systemic disorders like diabetes or multiple sclerosis). Nerve compression injury occurs as a result of two main factors: force load and time. Force load is the amount of pressure applied to the nerve. Time refers to the amount of time that compressive load is applied. Note that significant nerve injury can occur with a very light force load if it is applied for a long time (like nerve compression in the wrist). The other form of neurodynamic stress is tension, and it is much less frequently recognized. Tension forces on a nerve indicate that the nerve tissue is being pulled. All soft tissues are subject to compression and tension forces, but some are more resilient to them than others. For example, muscle tissue can easily withstand tension forces because the muscle has such a high degree of elasticity. Nerve tissue, on the other hand, does not stretch, so when tension forces are applied to it, significant nerve dysfunction can result. Exploring Upper-Limb Neurodynamics By Whitney Lowe Becoming familiar with the anatomy, assessment, and treatment of the full length of the median nerve can help prevent or resolve these issues in your clients. Physical assessment is still at the core of most nerve disorder evaluation. The upper-limb neurodynamic test (ULNT) can assist in determining what section of the nerve may be impaired or have issues. Like other special tests that have varying degrees of accuracy (sensitivity and specificity), the ULNT is best used in conjunction with a comprehensive evaluation, rather than relied on as a sole assessment tool. Today, we have more information about nerves and how they function than any time previously. This article explores some of the advances that have been made in nerve treatment, then looks at the ULNT #1 testing procedure and its role in median nerve pain. BACKGROUND Nerve compression disorders are often perceived as a biomechanical problem involving static pressure on a nerve in a specific location. While this certainly can occur, this model ignores one of the most important facets of the nervous system—the fact that nerves must be able to move, and restriction of their movement is at the root of many nerve-related pain complaints. For years, focus had been placed on localized nerve compression syndromes. Not as much attention was paid to the need for free and healthy movement of nerves until the publication of David Butler's groundbreaking book Mobilisation of the Nervous System. 1 Butler is an Australian physiotherapist whose body of work and publications were some of the very first to shine light on the unique biomechanical properties of the nervous system. So what does "movement of the nervous system" mean? As the result of normal movement, tissues throughout our body are moved along with the motion of the bones. While some tissues, like muscles, are able to extend and stretch, other tissues must adapt by sliding and gliding through tunnels, against adjacent structures, and around joints during movement. Subsequent to Butler, the term neurodynamics was adopted and is more frequently used to describe this aspect of neural tissue movement. These concepts are also explored in great detail in another excellent clinical text by Michael Shacklock called Clinical Neurodynamics. 2