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"Adverse Neural Tension" Testing Techniques (ANT)

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  • Michael

    Re adhesive capsulitis / frozen shoulder - I find this to be something of a misnomer, and I see quite a few patients with limited ROM, particularly abduction, ER and scapulohumeral dysrythmia, who have been told it will all go away in two years. In the early stages of acute pain and restricted movement without the dead end feel of the capsulitis phase (in the first three months or so) these folk seem to respond very well just with neurodynamic movements. I find the whole condition a peculiar one - especially when the histology is comparable with Dupuytren's contracture.

    I would have thought ULNTTs were standard for every shoulder with pain and inhibited movement; is this not the case? The standard exercises seem only to aggravate the condition, and I dropped them some years ago.

    I'm interested in more of your comments on and around the nuances of the 'frozen shoulder' syndrome....

    Nari

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    • Hi Micheal :

      Thank you for your views , regarding nerve overuse problems and evidences , very good explanation .


      By the way , I liked very much the idea that of the invlovement of neural factor in joints restrication , of course this is true .


      Regards

      Emad
      :rose:

      Comment


      • Yes Nari, I agree that neurodynamics should be routine for all shoulder problems. But those who do the educating have often say that NDTs are only indicated when there are symptoms that suggest neural involvement such as pins and needles, numbess, weakness, symptoms distal to the shoulder and dermatomal symptoms etc.

        We should look at neurodynamics because they have the potential to contribute to any musculoskeletal problem.

        I also haven't found much success with the standard exercises but, having spoken to an upper limb surgeon friend of mine who has operated on some of them, he said that the only histopathology they find is a severe synovitis related to the capsule. They have also done extensive work on the causes of capsulitis and still can't pin it down to anything specific or singular.

        Regards,
        Michael

        Comment


        • Hi Nari & Michael :

          At least , when we ,as practationers, think of the nervous system in cases of joint restrication ( stiffness ) , we avoid its adverse effects and more detrioration , putting the nervous system aside in those cases is more better , however it will be more advanced if we could use the nervous system postively in those cases .But how ?? i do not know !

          Just ideas :idea:

          Regards

          Emad
          :rose:

          Comment


          • Thanks, Michael.

            Interesting that so many PTs think neurodynamics is only for neuro exams in the presence of neuro 'signs' - I have found that almost universal, and trying to change that perspective is quite difficult....


            Nari

            Comment


            • Yes Nari, it 's very difficult but nevertheless things are improving I feel. Rome wasn't built in a day, neither was clinical neurodynamics!

              Emad, many neurodynamic solutions exist for these patients. ND exercises, interface release techniques, ND off-loaders, tensioners. sliders - it all depends on what the patient presents with and how to progress the patient. I use a system that does the following:

              1. classifies the patient's neurodynamic and musculoskeletal changes
              2. when appropriate, treats each component in an integrated way
              3. starts the patient at the correct progression to a. avoid provocation of symptoms and b. offer them solutions for their level of problem
              4. progresses them through the levels from low to high. It's all outlined in my book. But if you have any questions, feel free to ask.

              I hope this helps.

              Regards,
              Michael

              Comment


              • Hi Michael ;

                Of course , this is helpful. Thank you very much .


                you are so kind .

                Regards

                Emad
                :rose:

                Comment


                • Rolf
                  I wonder if atmospheric pressure changes might be making things worse for your patients. I have CRPS. In the areas where I have arthritic changes I'm affected by pressure changes, including ascending and descending in a plane.
                  When it's cold I need to artificially make myself warm (eg hot bath, heater, heat pack) and then wear suitable clothing to retain the warmth. If I fail to get warm then I am in more pain.

                  I can be in the snow but warm and no added pain, or in a cool breeze in summer and have blue extremities.
                  jeisea
                  blog crps-rsd-a-better-life

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