Neurodynamics: is tension contentious?

JOURNAL OF MANUAL & MANIPULATIVE THERAPY, 2022 · DOI: https://doi.org/10.1080/10669817.2021.2001736 · Published: January 2, 2022

Neurology Pain Management Rehabilitation

Simple Explanation

Neurodynamic techniques, including tensioning, are used to assess and treat the nervous system. Tensioning techniques increase nerve strain, while sliding techniques mobilize the nerve without substantial strain increase. Traditionally, neural mobilization was viewed through a mechanical lens, but current understanding acknowledges neurophysiological, neurochemical, and neuroimmune effects. Tensile loading is crucial for nerve health, promoting cell differentiation, neurite outgrowth, and pain modulation. However, excessive tension can negatively impact the nervous system.

Study Duration

Not specified

Participants

Animal models and human trials

Evidence Level

Not specified

Key Findings

1
Tensile loading can promote neuronal cell differentiation, neurite outgrowth and orientation, increased endogenous opioid receptors, reduced fibrosis and intraneural scar formation, improved nerve regeneration and remyelination.
2
Tensioning techniques in animal models have shown to alleviate mechanical hypersensitivity and decrease pro-inflammatory cytokines.
3
Human trials indicate that nerve stiffness adapts to tensile mechanical stimuli, and tensioning techniques can enhance conditioned pain modulation.

Research Summary

This article provides an evidence-informed view on the effects of optimal tensile loading on peripheral nerves and the use of tensioning techniques, highlighting neuroimmune, neurophysiological, and neurochemical effects. The review of in-vitro, ex-vivo, animal, and human studies demonstrates that tensile loading is essential for the mechanical adaptation of healthy and healing neurons, with benefits including improved nerve regeneration and pain modulation. While tensile loading offers numerous benefits, the authors emphasize the importance of caution and sound clinical reasoning in applying tensioning techniques to avoid exacerbating symptoms in patients with neuropathies.

Practical Implications

Clinical Application

Clinicians should carefully consider the use of tensioning techniques, balancing the potential benefits with the risk of symptom aggravation.

Dosage Considerations

Optimal nerve tension dosage should be individualized, considering the patient's clinical presentation, symptom nature, and stage of healing.

Further Research

Future research should focus on quantifying nerve strain in humans and investigating the effects of excessive tensile forces on neuroimmune responses.

Study Limitations

1
Difficulty in isolating the effects of tensioning techniques in larger human clinical trials.
2
Animal models used in studies may not accurately represent the neuropathies seen in physiotherapy patients.
3
Challenges in directly determining nerve strain from human research.

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