Neurodynamics & Clinical Pilates

Integrating neural mobility exercises into functional movements and clinical Pilates practice can have multiple benefits, regardless of whether a client is displaying neural mechanosensitivity: all tissues in the body need to move!

Neurodynamics

Mechanical and physiological events within the nervous system are dynamically interdependent. Functionally, that means that nerves have to be able to move in order to work optimally.
Neurodynamics is essentially the dynamic movement of the peripheral nerves of the body, although clinically and in rehab, the term neurodynamics pertains to nervous system mobilization for neuropathic pain.
In practice, when performing neurodynamic exercises, posture and multi-joint movements are combined to apply force to a nerve.

Mobilisation triggers a range of responses in nervous tissues, including tension and pressure changes, and positive impacts on nervous impulses, axonal transport, viscoelasticity, microcirculation, and abnormal impulse-generating sites.

Theoretically, neural mobilisation restores homeostasis in and around the nerve, dispersing intraneural oedema in the nerve root and axon, thereby decreasing pressure on the tissues, and supporting optimal function.
Increased joint flexibility and decreased sympathetic activity have also been demonstrated with neurodynamic techniques.

Neural Sliders Vs Neural Tensioners

Different mechanical loads are placed on neural structures, depending upon the order of joint movements.
The most amount of mechanical load is hypothesised to occur when the joint adjacent to the nerve is loaded first, increasing as more joints are involved.
Replicating the order of movement as per symptomatic activities can elicit functional and relevant signs and symptoms of neural mechanosensitivity.
Both with neural sliders and neural tensioners, we want to move the neural tissue – don’t hold the stretches.
Nerve sliders apply joint movements to the targeted structure proximally while releasing the movement distally, followed by a reverse movement.
Nerve tensioners apply joint movements to the targeted structure proximally and distally at the same time and in the same direction, seeking to increase nerve tension.

Nerve tensioners are thought to be more stimulating to the nervous system than nerve sliders.

Sliding vs tensioning of the median nerve. (Henrique et al, 2015).

Key Points: Neurodynamics

Move the nerves; they don’t like to be stretched.
If you’re just starting out with someone, try sliding movements, rather than tensioning movements. Be aware that many of the videos showing nerve gliding on YouTube, etc are tensioners.
Move at a slow and steady pace, as this allows you and your client to check in with any sensations that might be new or different.
Pacing the movement with controlled breath, as we do with all Pilates exercises, can give clients a feel for a rhythm. Don’t worry too much about whether the movement is on an inhale or an exhale.
Stop immediately if symptoms arise.

Neurodynamics: Contraindications

Neural symptoms can arise quickly: do not practice neurodynamics in symptomatic clients unless directed by a healthcare provider.
In your Pilates practice, avoid active mobilization of the nervous system in the following conditions:
→ Acute nerve root issues.
→ Worsening neurological symptoms.
→ Central sensitisation, which is a condition of the nervous system that is associated with the development and maintenance of chronic pain.
→ Neurological conditions such as multiple sclerosis, and Guillain-Barre syndrome, which both affect the peripheral nerves.
→ Neoplasm or malignancies, such as cancer or other tumors.
→ Inflammatory diseases like Rheumatoid arthritis and ankylosing spondylitis.
→ Spinal cord lesions.
→ Vertebrobasilar insufficiency, which is decreased blood flow in the posterior circulation of the brain.
→ Instabilities such as fractures or trauma
→ Recent peripheral nerve repair.
→ Severe night pain.
→ Complex regional pain syndrome.
→ Recent paresthesia, which is a loss or change of sensation.

Clinical Pilates in practice

Consider that all nerves need to be able to move within their environments, as per all other tissues of the body.
Integrating neural mobility exercises *within* a functional movement framework will be beneficial regardless of whether a client is exhibiting neural mechanosensitivity.
Understand the neural pathways that are implicated for the functional movement task that the client is working towards.
Nerve sliders are a gentler approach, and encouraged over nerve tensioners if a client is experiencing acute neural mechanosensitivity.
→ Drawing the Sword on the Reformer with cervical side flexion towards an extended wrist to slide to median nerve.
→ Cervical extension during knee flexion during The One Leg Kick to slide the femoral nerve.
Simple adjustments can be inserted into exercises to integrate a gentle neural mobility component.
→ Add an upper chest lift while hips/knees flex during footwork sprung below on the Trapeze Table (lower the chest curl as legs extend) for sciatic nerve gliding.
→ Add hip abduction with the hip and spinal extension component of Eve's Lunge on the Reformer for obturator nerve gliding.
If a client is displaying neural mechanosensitivity, work only to the edge of sensitivity, maintaining awareness of irritability.
Approach nerve sliders and nerve tensioners from different positions, to increase the functional load on the nerve.
Standing, kneeling, sitting, and long sitting will all place different loads on the nervous system, eg. variations on the rowing series on the Reformer can be performed in all of these positions.

References

1. Aksoy, Cihan C., Vedat Kurt, İsmail Okur, Ferruh Taspınar, and Betül Taspinar. "The immediate effect of neurodynamic techniques on jumping performance: A randomised double-blind study." Journal of Back and Musculoskeletal Rehabilitation 33, no. 1 (2020), 15-20. doi:10.3233/bmr-170878

2. Ballard, Elizabeth, Marty Fontenot, James May, and James R. Scifers. "Neurodynamics." Athletic Training & Sports Health Care 10, no. 4 (2018), 149-153. doi:10.3928/19425864-20180612-01.

3. Butler, David S. The Sensitive Nervous System. Noigroup Publications, 2000.

4. Butler, David S. The Neurodynamic Techniques: A Definitive Guide from the Noigroup Team. 2005.

5. Coppieters, Michel W., and David S. Butler. "Do ‘sliders’ slide and ‘tensioners’ tension? An analysis of neurodynamic techniques and considerations regarding their application." Manual Therapy 13, no. 3 (2008), 213-221. doi:10.1016/j.math.2006.12.008.

6. Ellis, Richard F., and Wayne A. Hing. "Neural Mobilization: A Systematic Review of Randomized Controlled Trials with an Analysis of Therapeutic Efficacy." Journal of Manual & Manipulative Therapy 16, no. 1 (2008), 8-22. doi:10.1179/106698108790818594.

7. Henrique, Herman, Silva Santana, Iasmin Adelia, Victor Fernandes De Oliveira, Êmyle Martins Lima, Alena Ribeiro, Alena Peixoto Medrado, Katia Nunes Sá, Ana Maria Blanco, and Abrahão Fontes Baptista. "Neurodynamic Mobilization and Peripheral Nerve Regeneration: A Narrative Review." International Journal of Neurorehabilitation 02, no. 02 (2015). doi:10.4172/2376-0281.1000163.

8. López López, Laura, Janet R. Torres, Araceli O. Rubio, Irene Torres Sánchez, Irene Cabrera Martos, and Marie C. Valenza. "Effects of neurodynamic treatment on hamstrings flexibility: A systematic review and meta-analysis." Physical Therapy in Sport 40 (2019), 244-250. doi:10.1016/j.ptsp.2019.10.005.

9. Nee, Robert J., and David Butler. "Management of peripheral neuropathic pain: Integrating neurobiology, neurodynamics, and clinical evidence." Physical Therapy in Sport 7, no. 1 (2006), 36-49. doi:10.1016/j.ptsp.2005.10.002.

10. Shacklock, Michael. "Neurodynamics." Physiotherapy 81, no. 1 (1995), 9-16. doi:10.1016/s0031-9406(05)67024-1.

11. Shacklock, Michael. Clinical Neurodynamics: A New System of Musculoskeletal Treatment. St. Louis: Elsevier Health Sciences, 2005.