EditorialImproving application of neurodynamic (neural tension) testing and treatments: A message to researchers and clinicians
Introduction
Compared with other approaches in the treatment of neuromusculoskeletal disorders, neurodynamic or neural tensions tests are relatively new, only entering manual therapy with significance from the 1970s onwards (Grieve, 1970; Elvey, 1979; Maitland, 1979; Kenneally et al., 1988; Butler, 1991, Butler, 2000; Shacklock, 1995a, Shacklock, 1995b, Shacklock, 2005). As a reflection, investigation of this growing area is also relatively new. In its youth, neural research contains problems that should be brought to the attention of the clinician and anyone who intends to conduct research into this subject. Hence, the aim of this editorial is to highlight some key issues that can be improved upon in the future.
Much criticism has been directed at the neural approach, some of it being quite fair and well-founded. Nevertheless, we must accept that neural techniques are probably here to stay and it is better to have the subject researched rigorously, showing its strengths, weakness and limitations so that the field can grow into a more mature, well balanced and well founded aspect of manual therapy.
With that, several key issues related to neurodynamics research that need elucidation are as follows: nomenclature, review of the literature, ethics, scientific rigor, standardization and safety with performance of neurodynamic techniques.
Section snippets
Nomenclature
Nomenclature of any specialized field reflects how we think about, and apply, our knowledge of the area. A key problem with discussions of neural testing and treatment has been use of the words ‘tension’ and ‘stretch’. During the early proliferation of the neural approach, the diagnosis of ‘adverse neural tension’ became enormously popular, in fact ubiquitous, particularly in the 1990s. Whether the diagnosis has any validity is not the subject of this editorial. However, the consequences of
Review of the literature
A problem with the literature quoted in submissions on research into neurodynamic testing and treatments is that it is often second generation. This means that it is taken from books that summarize and hypothesize and does not originate from, or describe, the original scientific papers whence the neural approach arose. A detailed history of the origins of the approach is not necessary. However, it is important that readers of such research reports are reassured that the literature is reviewed
Ethical and safety issues
Many peer-reviewed journals prefer that submitted research is approved by an institutional ethics committee. What is apparent in some research is that persons on ethics committees that scrutinize submissions for neurodynamics research may not be savvy to the potential negative effects of some neural techniques, to the point that it is surprising that some research is ever approved. Some negative effects consist of pain and other symptoms and the possibility of lasting neurological consequences
Structural differentiation
Another key issue with procedures involving neurodynamic testing is whether any evidence is provided that the tests used are actually focused specifically on the nervous system as opposed to musculoskeletal structures. Structural differentiation is a manoeuvre that emphasizes the neural tissues as opposed to musculoskeletal tissues. For instance, in cases of neck investigation, release of wrist extension at the end of the median neurodynamic test 1 would be used to produce changes in neck
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