Evidence of neurodynamics

[marcelk]

The Evidence of Neurodynamics

Where is actualy the evidence of neurodynamics?

A query on pubmed and cochrane lib. does not come up with
Review's or Rct's.


But still the question remains : where's the evidence?

Through clinical reasoning yes the nervous system seems
to be the logical place for treatment and explanations.

[EricM]

You could start with both of David Butler's books, as well as Michael Shacklock's - both packed full of evidence for neurodynamics. Marcel, this whole site in fact does nothing but present and discuss the evidence for neurodynamics, you may need to reconsider what sort of evidence you're looking for?

[Luke Rickards]

Here's a few that come up without trying too hard-

Cleland JA, Childs JD, Palmer JA, Eberhart S.
Slump stretching in the management of non-radicular low back pain: a pilot clinical trial.
Man Ther. 2006 Nov;11(4):279-86. Epub 2005 Dec 27.

George SZ.
Characteristics of patients with lower extremity symptoms treated with slump stretching: a case series.
J Orthop Sports Phys Ther. 2002 Aug;32(8):391-8.

Majlesi J, Togay H, Unalan H, Toprak S.
The sensitivity and specificity of the Slump and the Straight Leg Raising tests in patients with lumbar disc herniation.
J Clin Rheumatol. 2008 Apr;14(2):87-91.

Fernández-de-Las-Peñas C, Coppieters MW, Cuadrado ML, Pareja JA.
Patients with chronic tension-type headache demonstrate increased
mechano-sensitivity of the supra-orbital nerve.
Headache. 2008 Apr;48(4):570-7.

Alshami AM, Babri AS, Souvlis T, Coppieters MW.
Biomechanical evaluation of two clinical tests for plantar heel pain: the
dorsiflexion-eversion test for tarsal tunnel syndrome and the windlass test for
plantar fasciitis.
Foot Ankle Int. 2007 Apr;28(4):499-505.

Coppieters MW, Alshami AM.
Longitudinal excursion and strain in the median nerve during novel nerve gliding
exercises for carpal tunnel syndrome.
J Orthop Res. 2007 Jul;25(7):972-80.

Alshami AM, Souvlis T, Coppieters MW.
A review of plantar heel pain of neural origin: differential diagnosis and
management.
Man Ther. 2008 May;13(2):103-11. Epub 2007 Mar 30. Review.

Coppieters MW, Butler DS.
Do 'sliders' slide and 'tensioners' tension? An analysis of neurodynamic
techniques and considerations regarding their application.
Man Ther. 2008 Jun;13(3):213-21. Epub 2007 Mar 30.

Butler DS, Coppieters MW.
Neurodynamics in a broader perspective.
Man Ther. 2007 Feb;12(1):e7-8.

Coppieters MW, Alshami AM, Hodges PW.
An experimental pain model to investigate the specificity of the neurodynamic
test for the median nerve in the differential diagnosis of hand symptoms.
Arch Phys Med Rehabil. 2006 Oct;87(10):1412-7.

Babbage CS, Coppieters MW, McGowan CM.
Strain and excursion of the sciatic nerve in the dog: biomechanical
considerations in the development of a clinical test for increased neural
mechanosensitivity.
Vet J. 2007 Sep;174(2):330-6. Epub 2006 Aug 17.

Coppieters MW, Alshami AM, Babri AS, Souvlis T, Kippers V, Hodges PW.
Strain and excursion of the sciatic, tibial, and plantar nerves during a modified
straight leg raising test.
J Orthop Res. 2006 Sep;24(9):1883-9.

Coppieters MW.
Shoulder restraints as a potential cause for stretch neuropathies: biomechanical
support for the impact of shoulder girdle depression and arm abduction on nerve
strain.
Anesthesiology. 2006 Jun;104(6):1351-2. No abstract available.

Coppieters MW, Kurz K, Mortensen TE, Richards NL, Skaret IA, McLaughlin LM,
Hodges PW.
The impact of neurodynamic testing on the perception of experimentally induced
muscle pain.
Man Ther. 2005 Feb;10(1):52-60.

Coppieters MW, Bartholomeeusen KE, Stappaerts KH.
Incorporating nerve-gliding techniques in the conservative treatment of cubital
tunnel syndrome.
J Manipulative Physiol Ther. 2004 Nov-Dec;27(9):560-8.

Coppieters MW, Stappaerts KH, Wouters LL, Janssens K.
The immediate effects of a cervical lateral glide treatment technique in patients
with neurogenic cervicobrachial pain.
J Orthop Sports Phys Ther. 2003 Jul;33(7):369-78.

Coppieters MW, Stappaerts KH, Wouters LL, Janssens K.
Aberrant protective force generation during neural provocation testing and the
effect of treatment in patients with neurogenic cervicobrachial pain.
J Manipulative Physiol Ther. 2003 Feb;26(2):99-106.

Coppieters M, Stappaerts K, Janssens K, Jull G.
Reliability of detecting 'onset of pain' and 'submaximal pain' during neural
provocation testing of the upper quadrant.
Physiother Res Int. 2002;7(3):146-56. Erratum in: Physiother Res Int.
2002;7(4):following 250.

Coppieters MW, Butler DS.
In defense of neural mobilization: Part two.
J Orthop Sports Phys Ther. 2002 Mar;32(3):125-6. No abstract available.

Coppieters MW, Van de Velde M, Stappaerts KH.
Positioning in anesthesiology: toward a better understanding of stretch-induced
perioperative neuropathies.
Anesthesiology. 2002 Jul;97(1):75-81.

Coppieters MW, Butler DS.
In defense of neural mobilization.
J Orthop Sports Phys Ther. 2001 Sep;31(9):520-1; author reply 522. No abstract
available.

Coppieters MW, Stappaerts KH, Staes FF, Everaert DG.
Shoulder girdle elevation during neurodynamic testing: an assessable sign?
Man Ther. 2001 May;6(2):88-96.

Coppieters MW, Stappaerts KH, Everaert DG, Staes FF.
Addition of test components during neurodynamic testing: effect on range of
motion and sensory responses.
J Orthop Sports Phys Ther. 2001 May;31(5):226-35; discussion 236-7.

Coppieters MW, Stappaerts KH, Everaert DG, Staes FF.
A qualitative assessment of shoulder girdle elevation during the upper limb
tension test 1.
Man Ther. 1999 Feb;4(1):33-8.

[kongen]

Wow.. lot's of nice articles there, any chance of full text in Sound of Silence? Maybe doing a thread with evidence for neurodynamics?

[Diane]

That is probably doable. I bet Luke already has all the articles. ;)

[marcelk]

You could start with both of David Butler's books, as well as Michael Shacklock's - both packed full of evidence for neurodynamics. Marcel, this whole site in fact does nothing but present and discuss the evidence for neurodynamics, you may need to reconsider what sort of evidence you're looking for?

Cheers Eric,

I did read Butler"s books and know shacklocks work.

Actualy I am wondering about real evidence.

Thanks Luke, but which of those article's is a Randomised Clinical Trial?

[Barrett Dorko]

Sorry Marcel. Here we only deal in fake evidence.

[Luke Rickards]

Good call, Barrett.

One of the things that I find interesting about the bulk of current research on neurodynamics is that it tends to centre around the question, "Do we actually have a real phenomenon here, and how can we understand it in the context of current knowledge of physiology?". This is a sensible way to avoid what Harriet calls 'Tooth Fairy Science'. No doubt more attention will be given to outcomes evidence at some point.


Marcel,
From the list above there are two RCTs.

Coppieters MW, Stappaerts KH, Wouters LL, Janssens K.
The immediate effects of a cervical lateral glide treatment technique in patients
with neurogenic cervicobrachial pain.
J Orthop Sports Phys Ther. 2003 Jul;33(7):369-78.

Cleland JA, Childs JD, Palmer JA, Eberhart S.
Slump stretching in the management of non-radicular low back pain: a pilot clinical trial.
Man Ther. 2006 Nov;11(4):279-86. Epub 2005 Dec 27.

I'm sure you can track down others.

[marcelk]

Sorry Marcel. Here we only deal in fake evidence.

Good point,
how many of the published RCT's would make a chance to being included in a (Cochrane) systematic review?
How many of the articles Luke came up with would be good enough for such a review?

Maybe except this one:
http://jrm.medicaljournals.se/article/pdf/10.2340/16501977-0015

One RCT in the list above,... and a pilot clinical trial.

For posting this I "stepped out of my shoes as PT" and wonder what evidence there is?

In general some (many) Rct's are not useable in systematic reviews , for example : simply because they were not performed correctly. Therefore findings ie conclusions of these studies are not totaly legitimate.



(sorry, english is not my native language)

[Jason Silvernail]

Marcel-
If you only consider RCTs to be evidence, then you'll be disappointed at almost everything we do in physical therapy specifically and medicine in general.
If you "step outside of your shoes" and look in, you'll hopefully be glad as a patient we have the scientific reasoning process and intelligent theory that guides in the absence of such RCTs. If not, very little care would happen at all.

I've grown disillusioned with systematic reviews - especially in the area of spinal manipulation for lumbar pain and the quality RCTs that exist. I'm much more comfortable with intelligent theory, the neuroscience of pain, and one or two quality RCTs.

But by all means, if you judge a treatment construct to be without evidence in the absence of RCTs fit for systematic review, then go for it. However, one wonders how many patients you'll be able to treat....

[Luke Rickards]

Hi Marcel,

RCTs are excluded from SRs because they don't fit the study question, not because of poor internal validity. Assessment of the internal validity of relevant RCTs happens as part of a review.

Why don't you do an internal validity assessment of these two RCTs and let us know what you think?

[bernard]

Michel W. Coppieters (http://www.somasimple.com/forums/showthread.php?t=1051)

[marcelk]

Hi Marcel,

RCTs are excluded from SRs because they don't fit the study question, not because of poor internal validity. Assessment of the internal validity of relevant RCTs happens as part of a review.

Why don't you do an internal validity assessment of these two RCTs and let us know what you think?

Hi Luke,

Your right "Assessment of the internal validity of relevant RCTs happens as part of a review."

Clearly this post is a bit "touchy".

I posted this merely in a form as a question of the "devils advocate". Hope that makes sense. (a bit)

Bernard : Thanks a lot.

[Luke Rickards]

I posted this merely in a form as a question of the "devils advocate".Fine.

One RCT in the list above,... and a pilot clinical trial.I suspect you are unaware that a pilot clinical trial is not necessarily any less valid than a 'standard' clinical trial. I have just had a careful look at the methodological quality of the Cleland et al. 2006 study, and as would be expected from this research group it is of high quality.

[John W]

I don't want to get too far afield here, but based on the heated debate we're having over at EIM about McKenzie's approach and this thread looking for "evidence" for neurodynamics, I wonder if this might not be the thread to start talking about the value and applicability of qualitative research. Is anyone familiar with Lincoln and Guba's Naturalistic Inquiry? Do any of the assumptions that they propose including relativism and the lack of one true objective reality apply to treating patients in pain? Is there any purely qualitative research that has been done with persistent pain patients?

I have heard Barrett refer to the individual nature of being, and ideomotion would seem to fall in line with this subjective form of reality- each individual possessing their own intrinsic ability to move their way out of pain. How does this subjective reality reconcile with quantitative analysis of neurodynamics and neuromatrix theory? Are these two sides of the same coin? Are they complementary or mutually exclusive? Is it like Newtonian physics to quantum mechanics- an evolution?

Just a few simple questions:confused:.

[Luke Rickards]

Hi John,

I've posted some reading relevant to these questions here (http://www.somasimple.com/forums/showthread.php?p=53202#post53202).

How does this subjective reality reconcile with quantitative analysis of neurodynamics and neuromatrix theory?I think that Butler himself has attempted to answer, or at least acknowledge, this issue. I would suggest reading- Butler DS, Coppieters MW. Neurodynamics in a broader perspective. Man Ther. 2007 Feb;12(1):e7-8
Inflamed, adhered and mechanically challenged peripheral nerves undoubtedly exist. However there is surely a large group of patients where findings of altered neurodynamic tests are broadly a manifestation of a person’s inability to cope. That is, the nervous system has become peripherally and centrally unregulated due to non-mechanical inputs with resultant perturbations and contributions from the endocrine, autonomic, motor, and immune systems.][This means that responses to structural differentiation may have little to do with mechanical alterations in neural tissue, for example, ankle dorsiflexion increasing SLR evoked pain may be just the addition of normal, albeit threatening input to a pain neuromatrix.][In central sensitivity, there is still a place for neural mobilisation, as a sliding technique should allow mechanically non-aggressive large range novel movements which could be therapeutic for central mechanisms on the basis of threat reduction.** The notion that education enhancing the patient’s understanding of pain may reduce the sensitivity of neurones (Moseley et al., 2004) and allow better movement has been missed, yet surely this is a part of modern neurodynamics.
**Sound like ideomotion, anyone?

[Barrett Dorko]

I think that this is undoubtedly a description of ideomotion and that the effect of its amplified expression in the presence of Simple Contact is its natural consequence.

I am also reminded of the myriad motions used by Feldenkrais during the course of his many lessons. They teach, they don't mobilize and they are never to hurt. The ultimate effect is exactly what any therapist would want. I always add these to my care.

[marcelk]

www.feldenkrais-ausbildung.de/files/Literatur/MotorischesLernenEnglisch.pdf -

[Javier Gonzalez]

I think that Butler himself has attempted to answer, or at least acknowledge, this issue. I would suggest reading- Butler DS, Coppieters MW. Neurodynamics in a broader perspective. Man Ther. 2007 Feb;12(1):e7-8

Perhaps it is interesting for the people to have access to this paper.

[marcelk]

I suspect you are unaware that a pilot clinical trial is not necessarily any less valid than a 'standard' clinical trial. I have just had a careful look at the methodological quality of the Cleland et al. 2006 study, and as would be expected from this research group it is of high quality.

Hi Luke,

Thanks a lot for the "papers,.....".


"Slump stretching in the management of non-radicular
low back pain: A pilot clinical trial"

",......However, limited evidence exists to
support the effectiveness of using the slump test as a
treatment approach and has only been presented in the
form of case reports or case studies (Cleland et al., 2004;
Cleland and McRae, 2002; George, 2000, 2002),......
page 280
Although the slump test is used clinically to investigate
the presence of altered neurodynamics there is
currently a lack of evidence suggesting that any
particular neurodynamic treatment technique results in
changes of the mechanical or physiological function of
nerve tissues.,....."
page 285

The study by Cleland et al is of high quality.

And he says it a lot better then my attempt.

[Luke Rickards]

Hi Marcel,

Are you still playing devil's advocate? Quote mining is certainly an effective method.

You asked above about real evidence in the form of outcome studies, yet the second quote you chose is a challenge for more basic science evidence. If you read the rest of the paragraph you will see that this was not an acknowledgment of total ignorance.

Complete understanding of the therapeutic mechanisms behind physical treatments is notoriously challenging. In fact, we don't fully understand the reasons why any of the things we do to patients in pain might 'work', whether there is solid evidence that they do work or not.

[Javier Gonzalez]

Perhaps it is interesting for the people to have access to this paper.
Here is the response from Shacklock to Butler's article: