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Old 04-05-2005, 01:28 PM   #1
ricardo123
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Default "Adverse Neural Tension" Testing Techniques (ANT)

Hi,

Can anyone tell me what ANT Testing Techniques are please? Are they related to manual therapy? :?

Many thanks
Rich
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Old 04-05-2005, 01:52 PM   #2
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Hi Rich,

Where did you listened this abbreviation => ANT?

The only definition I think is Active Neural Test?
In Neurodynamics tests, a test may be done actively or passively.

(It exists also the term ART that is Active Release Technique)
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Old 04-05-2005, 02:43 PM   #3
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Hi Bernard,

Yes, it has been mentioned in conjunction with some Maitland manipulation treatment. I think it is Active Neural Test.

Would you happen to know what it is and where I can read more about it please?

Many thanks
Rich
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Old 04-05-2005, 05:31 PM   #4
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Hello,

Try with that one

http://www.somasimple.com/forums/showthread.php?t=817

And read the topic READ ME FIRST on The Sound Of Silence Forum.
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Everything should be made as simple as possible, but not a bit simpler.
If you can't explain it simply, you don't understand it well enough. Albert Einstein
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Old 05-05-2005, 10:28 AM   #5
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That's great Bernard,

Many thanks again!

Kind regards,
Rich
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Old 07-05-2005, 04:17 PM   #6
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Default ANT tests

Hi Ricardo et al. First-timer here. I've been peeking at the discussions and noticed that you asked about ANT. I've been intimatelyinvolved in the area for the last 20 years and my experience is that the term originated from 'Adverse Neural Tension'. It all started from Alf Breig's book 'Adverse mechanical tension in the central nervous system' in 1978 (currently out of print). He is a 95 year-old Swedish retired neurosurgeon who did seminal research on biomechanics of the nervous system both in '78 and 1960 . His first book was called "Biomechanics of the central nervous system'. In both books he presented amazing photos of his research on the nervous systems of fresh cadavers in different body positions to illustrate how the nervous system moves with body movements and how pathologies can affect nervous system movement biomechanics and dysfunction. Enter Grieve, Maitland, Elvey, Butler and Shacklock (2005) who took this approach into manual therapy more extensively than before. Butler put forward the concept of Adverse Neural Tension in the late 1980s and 1990s which at the time was innovative to say the least. However, things have really moved from neural tension to neurodynamics, taking into account movement and physiology of the nervous system as a means of diagnosis and treatment of musculoskeletal and sporting pain problems. I hope you don't mind me mentioning my new book. If you would like to see something about it feel free to visit www.neurodynamicsolutions.com . For others, I'm happy to help with any questions or such like on the subject if anyone needs.

Shacklock M 2005 Clinical neurodynamics: a new system of musculoskeletal treatment. Elsevier, Oxford

Humbly yours,
Michael Shacklock
Musculoskeletal Physiotherapist

Last edited by bernard; 19-01-2007 at 08:14 AM. Reason: asked by M Shacklock
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Old 07-05-2005, 05:03 PM   #7
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Hi :

Michael Shacklock.

Welcome to the forum.

By the way you gave does not work , i think there is over DOT.It s
http://www.neurodynamicsolutions.com

Thanks for the history and knowledge .

Regards

Emad

Last edited by bernard; 19-01-2007 at 08:14 AM. Reason: asked by M Shacklock
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Old 07-05-2005, 06:29 PM   #8
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Welcome to SomaSimple Michael, 8)

I feel honored that you joined our humble young board!
Two years ago, I was totally unaware about neuromobs but I took a look on the NOI site and was disturbed by the fresh knowledge that was told there.

Our board is totally free and you're allowed to tell more about your book! You may post also in the training section if you want.

So Ricardo, it wasn't Active but Adverse. I forgot it. :?

ps: I deleted the dot in the cited link. :wink:
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Old 07-05-2005, 07:53 PM   #9
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HI Bernard:

:lol: :lol:
Me , could NOT delet the overdot , thanks for your helping hand :idea:


Regards

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Old 08-05-2005, 02:39 AM   #10
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Welcome to the board, Michael, and all it offers.

I am the puma sitting in the Persistent Pain Patients forum - it is much better looking than I am.

I have been a neuronut (Bernard will attest to that) for about 15 years, and look forward to your posts and any comments.



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Old 08-05-2005, 03:06 AM   #11
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Hi Michael,
Welcome. Just want to say that I've got both your books now, and very much appreciate that you wrote down all your ideas and synthesized all that information. Thank you! (Too bad that Brieg book is out of print.)

I hope you will stay awhile and allow people to ask you all sorts of possibly time-consuming questions..
,
Diane
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Old 08-05-2005, 03:58 AM   #12
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Thanks All for the welcome to Somasimple. Yep, if I can be of any help do let me know. And it has been a pleasure to finally release my book on Clinical Neurodynamics. We've been redoing the Neurodynamic Solutions web site and it might not be functioning as well as it should. This should only be temporary and thanks for your patience. About the Breig books, something is in the pipeline and if you would like any more information on this (it's a little early to be specific, I'm sorry), we can e-mail you with more info when things happen. Just log on to our web site and register for free information and we will gladly supply you with news updates, conference announcements, new research, clinical solutions and case histories. We don't spam junk around the place. We just let people know what's going on and try to be helpful in Clinical Neurodynamics.
Nari and Diane, I came across your contributions at other web locations which you will be aware of and am really pleased to see your discussions. My particular interest is to make Neurodynamics as clinically useful as possible and part of this is demystifying it and offering a system of diagnosis and treatment that is derived from the causal mechanisms within an evidence based framework, but not in a way that makes the evidence stifle creative thinking and application. What a sentence, sorry! The reason I add the evidence comments is that there is a lot of good evidence for the effectiveness of neurodynamic techniques (particularly in diagnosis and some stuff is coming out soon on therapeutic efficacy) but most therapists haven't read it. I mention some of it in my book but a problem with some research is that it doesn't leave the therapist with much in terms of clinical reasoning and it often doesn't measure the phenomena that we encounter clinically. I can be more specific about evidence in support of the clinical neurodynamics approach if anyone would like.

Regards to you all,
Michael
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Old 08-05-2005, 05:46 AM   #13
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Michael

We would definitely like, in answer to your last offer.

And I will spend the time soon having a cruise (less energetic than surf) around your website - looking forward to it.

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Old 08-05-2005, 01:05 PM   #14
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Michael,
Quote:
About the Breig books, something is in the pipeline and if you would like any more information on this (it's a little early to be specific, I'm sorry), we can e-mail you with more info
Yes, thanks; I'd definitely like to know more about it.
Quote:
am really pleased to see your discussions
I'm sure we'll be more than pleased to see more of yours.
Quote:
My particular interest is to make Neurodynamics as clinically useful as possible and part of this is demystifying it and offering a system of diagnosis and treatment that is derived from the causal mechanisms within an evidence based framework, but not in a way that makes the evidence stifle creative thinking and application.
I like the sounds of that!
Quote:
I can be more specific about evidence in support of the clinical neurodynamics approach if anyone would like.
Wonderful! I'm sure there will be more questions popping up.

Again, welcome.
Diane
PS: Looking forward to meeting you and learning your stuff in November.
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Old 08-05-2005, 03:12 PM   #15
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Yes, Diane, I'm looking forward to it too. I presume you mean that you are coming to my course in Vancouver in November that Deena Scoretz is organising. I have been to Vanc. several times before and it is a wonderful place. We should have a meal and a chat. For me, discussion is the food of life.

EVIDENCE:
There are many forms of evidence, as you will all know but the key issues for neurodynamics as I see them are 1. mechanisms validity (face validity in the EBM field), 2. diagnostic efficacy (sensitivity and specificity) and 3. therapeutic efficacy. Number 1. asks the question: do the tests actually do what we think they do on a mechanisms level and do they mechanically test or move the nerves, do they evoke impulses from different parts of the nervous system at the exact time of testing. Well, the answers to these questions are as follows:
1. Nerves can certainly be moved in a highly specific way with specific neurodynamic sequencing techniques. There are cadaver and real-time imaging studies to prove this. Our group did some recent work on imaging nerves in real time to see if we could move the nerves a. specifically with specific movements and b. whether these movements could be accurate in producing neural movement in relative isolation ie. WITHOUT moving the neighbouring musculoskeletal tissues (see Shacklock 2005 CD ROM, Clinical Neurodynamics, Elsevier,Oxford). Diane you should have this if you have my book. On the CD we show the median nerve at the wrist moving in perfect isolation longitudinally ie. without producing movement in the neighboring fascia and muscles. These observations had been made in cadaver studies in the 1970s (McLellan and Swash 1976 - it's referenced in my book). However, we are not entirely sure that this differentiated movement ability exists all over the body. My impression is that some areas of the body can be differentiated well and we might not be so fortunate in other areas of the body.
The question of whether the nerves produce impulses at the exact same time as testing and whether these can be differentiated in normals versus abnormals has also been answered (Nordin et al 1984). They got patients with neural disorders and, with microelectrodes placed into axons of the affected nerves, measured the nerves' responses to mechanical testing and showed that the abnormal nerves were hyperactive when tested mechanically, producing increased amounts of afferent input into the CNS compared with normal. The tissues investigated were: median and ulnar nerves, spinal cord, among others. So this question is well and truly answered.

The next question (2.) relates to diagnostic efficacy in patients ie. sensitivity and specificity - how effective are the tests in diagnosis? I'll get back to you after this. Past my bed time.

Hope this is interesting. Best wishes to you all.

By the way, whoever got this web site going really knew what they were doing. Great job! Was that you Bernard?
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Old 08-05-2005, 03:45 PM   #16
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It was indeed Bernard, our technically brilliant PT.


Michael, I can't get the CD to work. (I'm not technically brilliant.)
I have an Imac, 9.1 OS. The screen comes up but stays black. It's a frustration. I'm keeping the CD though, for some day when I have a better computer. Your cadaver studies sound brilliant.

Yes, would love to visit when you come by Vancouver.
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Old 08-05-2005, 03:55 PM   #17
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Diane, I didn't go to bed after all. The wine and jazz (on the stereo) that I'm partaking of are keeping me going. For technical support for the CD contact the Elsevier people. Their job is to help you. The details are at the back of the book. I too had trouble on my iMac during the development of the book but we sorted it out. DO contact Elsevier. I'm really keen that everyone sees the CD because it brings the nerves to life and it is really a "Seeing-is-believing" experience. Also, there are some instructions at the back of the book for those who are having technical problems. I hope this helps. Anyway:

technical.support@elsevier.com

or phone: Canada 1800 692 9010

Best
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Old 08-05-2005, 05:22 PM   #18
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THANK you Michael. I'll get on that.
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Old 08-05-2005, 05:32 PM   #19
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Diane,

Just look the required specifications for the CD to work?
If it stay black perhaps you have a too old plug-in or it is not macintosh compatible? :?
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If you can't explain it simply, you don't understand it well enough. Albert Einstein
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Old 08-05-2005, 07:48 PM   #20
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My system MIGHT not be quite new enough for it. In the book, it says it will work on 9.1+ OS. I've got only 9.1. So, I will try again as per Michael's suggestions, and with a more careful look, but think I might have to upgrade or else get a new computer, soon... There's a lot this one can't do out there in the web, or even in its own innards.
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Old 09-05-2005, 12:14 AM   #21
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Diane, it should work on OS 9.1. It did on my iMac which uses this operating system. I also have OS X at work and it works on this. So if it doesn't, Elsevier Technical Support should be able to help you. You will need to make sure that cookies are activated, java script also (these are under the Preferences section (security), and you might need to clear the cache. Maybe you will need to upgrade your web browser, presumably it is Internet Explorer. If you upgrade the computer, I recommend the new iMac G5. It is a gem with OS X Tiger or any other up-to-date PC will do it I'm sure. Good luck.
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Old 09-05-2005, 03:10 AM   #22
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Hi Michael, thanks for the tech support. I use Netscape 7, not internet explorer. I found the cookies and enabled them, enabled the javascript, loaded up the quicktime player, I don't have a clue how to "clear a cache." When I clicked on start, an explorer window came up, and I found a 'go' icon.. It acted like it was loading but the screen was still black.

Next step, take the CD to the computer store and get them to show me what to do. I'll do that next weekend, this one's gone. Thanks again.
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Old 09-05-2005, 06:45 AM   #23
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Diane,

Netscape and IE have huge differences while running.
Some pages are properly loaded on IE while they don't on Netscape or Firefox. Some products are only designed to work with IE!
IE may work as Michael said it?

Yes Michael, I did the job but it was simple. I must confess that programming is my "second" language but HTML or PHP are still foreign ones for me. (I was trained with OOP (object oriented programming)).

I'm thinking about enhancements with the board??
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If you can't explain it simply, you don't understand it well enough. Albert Einstein
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Old 09-05-2005, 08:25 AM   #24
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http://www.ncbi.nlm.nih.gov/entrez/q...t_uids=6096790

Pain. 1984 Nov;20(3):231-45. Related Articles, Links

Ectopic sensory discharges and paresthesiae in patients with disorders of peripheral nerves, dorsal roots and dorsal columns.

Nordin M, Nystrom B, Wallin U, Hagbarth KE.

Ectopically generated and antidromically conducted nerve impulses were recorded in 5 patients with tungsten microelectrodes inserted into skin nerve fascicles. All patients had mainly positive sensory symptoms and reported paresthesiae which could be provoked by different maneuvers which suggested increased mechanosensitivity of the primary sensory neurons at different anatomic levels. Ectopic multiunit nerve activity correlating in intensity and time course to the positive sensory symptoms was recorded: when Tinel's sign was elicited in a patient with entrapment of the ulnar nerve at the elbow, when paresthesiae were provoked by elevation of the arm in a patient with symptoms consistent with a thoracic outlet syndrome, when paresthesiae were evoked by straining during chin-chest maneuver in a patient with an S1 syndrome due to a herniated lumbar disc, when a painful Lasegue's sign occurred during the straight-leg raising test in a patient with an S1 syndrome due to root fibrosis, and when Lhermitte's sign was elicited by neck flexion in a patient with multiple sclerosis. The sites for the ectopic impulse generation in these cases are suggested to be peripheral nerve, brachial plexus, dorsal root or dorsal root ganglion and dorsal columns. The paresthesiae were non-painful except in the patient with Lasegue's sign and the ectopic impulses were probably recorded from large myelinated afferent fibers.

Publication Types:

* Case Reports

PMID: 6096790 [PubMed - indexed for MEDLINE]
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Old 09-05-2005, 08:28 AM   #25
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Hi All,
I posted this one a long time ago.
I think that it brings some "fuel" to this thread?

http://www.somasimple.com/forums/showthread.php?t=420

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Everything should be made as simple as possible, but not a bit simpler.
If you can't explain it simply, you don't understand it well enough. Albert Einstein
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Old 09-05-2005, 10:47 AM   #26
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I was at a pain study weekend - physio/anaethetist / psych/ pain managment with 'chi kung exercises' the other week .
The anaethetist did a tour around pharmacology . Some of these inflammatory mediated pains need appropriately taken drugs .
Many people are aganist taking medication altogether . I encourge many people esp with oa type pain states to take their meds appropriately as I am sure this is a big issue in why people don't control their pain states properly ?
I like the ideas around neral mobilisation but admit that when I was taught it I probably did more harm than good ! Mobilising at end range in centralised pain states or with people with severe avoidance psych/social issues doesn't work too well!
Nerves need to put in the context of head/society (brain and environment ) Maybe social neurobiology is a good way to look at things .
Incidientally I find that tai chi 'warm up' sequences address most issues with ischeamic(lifestle induced) neurogenic type pain syndromes as they work spirally and unwind 'tight' nerve beds and trunks . The concept of a whole body response to movement sensation also fits with the sensitisation concept.
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Old 09-05-2005, 11:21 AM   #27
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I have dedicated the last year removing the Theraband program off dozens of patients with pain states. Amazing how they improved when they stopped flogging away with the stuff.

Loading is certainly an aggravation, as is repetition.

My loaded question is: (no pun intended)

How many repetitions are too many?

My number is no more than 5, but that is a figure plucked out of empirical working with PPPs.

Can anyone give a ball park figure?


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Old 09-05-2005, 11:41 AM   #28
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Hi Ian :

You are right , sometimes , i feel neural mobils did harm , however i belive anytype of therapy when applied appropariely ,it may work well.

what is that 'chi kung exercises' ?

regards

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Old 09-05-2005, 11:59 AM   #29
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Quote:
Originally Posted by emad
Hi Ian :

You are right , sometimes , i feel neural mobils did harm , however i belive anytype of therapy when applied appropariely ,it may work well.

what is that 'chi kung exercises' ?

regards

Emad
hmmm
chi kung (氣功) is so popular in taiwan and china.
All chinese people like this and they believe it could cue disease and promote health.

Here is the web site

http://www.chikung.org.tw/english.htm
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Old 09-05-2005, 03:56 PM   #30
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Thanks for placing the Nordin article up Bernard. This is one of the best studies on mechanosensitivity in patients with neurodynamic disorders.

Also, Ian. I agree that neurodynamic tests were not always the best thing for some of our patients, particularly the ones whose symptoms were easily provoked. But we should eventually be able to have a good idea of who will and won't respond and make judgements, ie. appropriate treatment selection, with improved specificity as time passes. I've developed a system of technique selection for peripheral neurodynamic which I hope helps.

Yours, Michael
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Old 09-05-2005, 08:13 PM   #31
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Hi fapt :

Thank you for the link .


Cheeeeers

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Old 10-05-2005, 07:19 AM   #32
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Here is a link to the PDF file of the referenced file =>

Ectopic sensory discharges and paresthesiae in patients with disorders of peripheral nerves, dorsal roots and dorsal columns.
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Old 10-05-2005, 07:47 AM   #33
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Here is the other cited one =>

Inflammation Induces Ectopic Mechanical Sensitivity in Axons of Nociceptors Innervating Deep Tissues
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Old 10-05-2005, 12:43 PM   #34
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Thanks Bernard, I met Geoff Bove in Denmark in the late 1990s when he was assistant professor at Odense University. I did a lecture to their department and we exchanged some great ideas. Soon after that, he went to Harvard. I like the work he does, neurophysiology that is.
When we had our discussions he was very interested in nerves being a source of pain without producing changes in conduction velocity.

The paper you posted - I've not read it before and, having printed it out, I'm really keen to get my teeth into it. Thanks a lot for doing this. I'll comment on it soon.
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Old 11-05-2005, 07:42 AM   #35
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http://www.ncbi.nlm.nih.gov/entrez/q..._uids=11585565

Neurosci Lett. 2001 Sep 21;311(1):49-52.
Inflammation with no axonal damage of the rat saphenous nerve trunk induces ectopic discharge and mechanosensitivity in myelinated axons.

Eliav E, Benoliel R, Tal M.

Department of Oral Diagnosis, Oral Medicine and Oral Radiology, The Hebrew University, Hadassah School of Dental Medicine, P.O. Box 12272, Jerusalem, Israel. eeliav@netvision.net.il

Inflammation along a nerve trunk with no frank axonal nerve damage produced by complete Freund's adjuvant (CFA) or Carrageenan is known to induce a painful peripheral neuropathy. In the present study, we examined the electrophysiological properties of myelinated axons (spontaneous discharge and mechanical sensitivity) at the inflamed nerve site. The rat saphenous nerves were exposed at mid-thigh level and wrapped in 2 mm wide bands of haemostatic oxidized cellulose (Oxycel) that were saturated with undiluted CFA. In the control rats the Oxycel) was saturated with saline. At postoperative days (PODs) 2-5 and 6-10, fine axon bundles were teased from the nerve, and electrophysiological recordings performed. At both time points spontaneous activity at the site of the application in CFA rats (PODs 2-5=9.9+/-2.5%: PODs 6-10=6.1+/-1.4%) was significantly higher than in the control animals (PODs 2-5=2.9+/-1.1%: PODs 6-10=1.6+/-1.4%: P=0.03, P=0.02, respectively). Mechanical sensitivity at both time points was significantly higher in CFA rats (PODs 2-5=12.6+/-3.1%: PODs 6-10=10.3+/-3.1%) than in saline rats (PODs 2-5=3.4+/-2.91%: PODs 6-10=0.8+/-1.0%: P=0.03, P=0.04, respectively). This study clearly shows that perineural inflammation with no axonal nerve damage induced by CFA application around the nerve trunk elevates spontaneous activity and induces mechanosensitivity in myelinated axons.

PMID: 11585565 [PubMed - indexed for MEDLINE]
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Old 11-05-2005, 07:45 AM   #36
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http://www.ncbi.nlm.nih.gov/entrez/q..._uids=10611131

Brain. 2000 Jan;123 ( Pt 1):171-84.
Effects of 4-aminopyridine on demyelinated axons, synapses and muscle tension.

Smith KJ, Felts PA, John GR.

Neuroinflammation Research Group, Department of Neuroimmunology, Guy's, King's and St Thomas' School of Medicine, Guy's Campus, London SE1 9RT, UK. kenneth.smith@kcl.ac.uk

Several clinical trials have demonstrated that 4-amino-pyridine (4-AP), a potassium channel-blocking agent, improves symptoms in some patients with multiple sclerosis. The beneficial effects have typically been attributed to the restoration of conduction to demyelinated axons, since this effect was previously demonstrated experimentally. However, the clinical dose is approximately 250-1000 times lower than that used experimentally, potentially making extrapolation of the experimental findings unreliable. To examine the action(s) of 4-AP in demyelinating disorders, the drug was administered at clinical doses, both in vivo and in vitro, to rat dorsal column axons which had been experimentally demyelinated by the intraspinal injection of ethidium bromide. 4-AP had no consistent effect in restoring conduction to demyelinated axons, even to axons which were held just on the verge of conducting by adjusting the lesion temperature. However, 4-AP had prominent effects that did not involve demyelinated axons, including the potentiation of synaptic transmission and an increase in skeletal muscle twitch tension. We propose that these latter effects may be largely responsible for the beneficial action of 4-AP in multiple sclerosis patients. If so, the dominant effects of 4-AP in multiple sclerosis patients are independent of demyelination, and it follows that 4-AP may be beneficial in other neurological disorders in which function is diminished.

PMID: 10611131 [PubMed - indexed for MEDLINE]
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Old 12-05-2005, 01:48 PM   #37
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Bernard, thanks for putting on such an important study. I was aware of this one but sometimes things get buried in the back of my mind. As you will already know, the reason this study is important is that it shows that nerve pain and abnormality of function may result from inflammatory changes in the connective tissues of nerves without slowing conduction. The problem with diagnosis is that reduced conduction has been the gold standard for diagnosis of neuropathy. The inflammatory neuritis model that Eliav et al use produces the kind of neuropathy that neurodynamic tests might well pick up whereas nerve conduction tests may not detect this problem. This is consistent with the idea that mechanical tests contain something different from physiological tests because each examines for different things. We now have to accept the idea that there may be diifferent kinds of neuropathy which will be detectable with different tests.

The whole question of whether mechanical tests are effective relates to mechanosensitivity. Two positions in the literature have been discussed: 1. nerves are never mechanosensitive so they could never hurt. This is incorrect. 2. Normal nerves are not mechanosensitive and abnormal ones can be. This is also incorrect. The correct position is that all normal nerves are mechanosensitive when they are stimulated by a sufficiently strong mechanical stimulus. This has been shown in basic science studies (I quote these in my book, pages 63-65). Pull or push hard enough on a nerve and it will become active and may hurt. You only have to press, bang or stretch your ulnar nerve to find this out! So we have to consider physical testing of the nervous system in relation to two aspects, the state of the neural tissues and the forces to which they are subjected.

1. Normal nerves subjected to normal forces are less likely to produce symptoms.
2. Normal nerves under abnormal mechanical forces are more likely to produce symptoms.
3. Sensitised nerves subjected to normal forces can produce symptoms.
4. Sensitised nerves that are subjected to abnormal forces are likely to produce symptoms.

The other thing that the Eliav group has shown I think is that the perineuritis model produces central sensitisation!

Interesting thoughts I hope.

Best.

Michael
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Old 12-05-2005, 03:35 PM   #38
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Thank you Michael,
That is the most succinct post I've ever read about sensitivity of nerves. I hope you don't mind if I quote you by copying this post whenever/wherever this topic pops up!
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Old 12-05-2005, 09:03 PM   #39
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:idea: Yes , so much interesting /amazing thoughts Micheal

I have to raise Hat showing respect and admiration .



Cheeeeeeeeers

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Old 13-05-2005, 03:03 AM   #40
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Thanks for the positive feedback. Feel free to quote it. It's presented in detail in my book and I'd love to develop on this further because it is a key issue with all neurodynamic testing and treatment. It also feeds into clinical application in which the four categories can be applied to diagnosis and clinical decision making. To lead into patient representations of each category:

Category 1: no symptoms: normal ADL
Category 2: minor neural symptoms with extended use of body or abnormal or extensive repeated postures or movements that apply force to nerves. The symptoms relieve quickly and neurodynamic testing reveals very little because the nerves are not provoked at the time of examination.
Category 3: more persistent neural symptoms that don't go away as easily. Patient doesn't subject nerves to abnormal forces, ie. ADL is relatively normal but something is clearly wrong with the nerves. Neurodynamic testing is abnormal.
Catetory 4: Patient is subjecting their nerves to inappropriate forces and they are abnormal. Persistent pain in spite of being very active or having bad biomechanics and subjecting the nerves to excessive or inappropriate forces. Neurodynamic testing is quite abnormal.

This all leads into treatment which I can discuss later - patient coming!

Michael
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Old 13-05-2005, 04:03 AM   #41
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Michael

A good categorisation.

I believe many of us (Physios) sit in category 2.

A big majority of my health centre clientele fall between 3 and 4.

My favourite patients are those in category 4, but theydrift back and forth into 3.

Looking foward+++ to your next post on Rx!



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Old 17-05-2005, 04:09 AM   #42
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OK, here is the next edition of how to work clinically with mechanosensitivity.

Category 1 - If it ain't broke, don't fix it.
Category 2 - These are usually biomechanical problems in the interface which places abnormal or undesirable forces on the nervous system and the nervous system's response is likely to be reasonably normal and will settle down quickly when the interfacing structures start behaving themselves. This is where the neurodynamic tests results are variable because the mechanical irritation/compression may not be in action at the time of examination and their result will be dependent on recent or current provocation. The main dysfunction is in the interface (musculoskeletal tissues) so biomechanical, manual and manipulative and exercise therapies are good for these to improve motor control and physical behaviour of the tissue under consideration. This normalises or optimises the forces on the nervous system and gives the nervous system a chance to recover. It even helps protect the nervous system when done well. This approach effectively optimises the environment in which the normal nervous system is located, reducing provocation.
Category 3 - there is a definite problem in the nervous system which is sensitive to movement and, in this situation, is treated mechanically as an entity in its own right. Depending on the level of treatment (1, 2, 3a, 3b, 3c or 3d), the spectrum of techniques for neural mobilization range from neural off-loaders, sliders and tensioners. Decisions on this are based on which neurodynamic dysfunction exists: proximal or distal sliding, cephalad or caudad, neural tension dysfunction etc., see below.
Category 4 - both the nervous system and musculoskeletal system (interface) are a problem. Treatment to each is given but selection of techniques is made with care and is based on system of progression that I outlined in my book - level 1, 2, 3a, 3b, 3c, 3d and so on. This is when, at higher levels of dysfunction, treatment can be applied to the interface and neural structures simultaneously. The reason for this is that, at higher levels of function, separate tests for the musculoskeletal and systems can be normal. But when tests and treatment for both at the same time are performed, the problem will often emerge much more obviously. Selection of treatment techniques is derived from the mechanical dysfunction in the interface (adjacent musculoskeletal structures), the specific neural dysfunction and the level of the clinical problem (ie. 1, 2, 3a, 3b, 3c or 3d, each has its own set on inclusion and exclusion criteria). This system addresses the issues of a. not knowning how to select assessment and treatment techniques for specific patient problems and b. preventing provocation with 'neural tension testing'. Instead these tests are performed neurodynamically with emphasis on dynamics (mechanics and physiology) rather than just mechanical tension, hence the term 'neurodynamic tests' and my book being called 'Clinical Neurodynamics".

Selection of techniques for the category 4 mechanosensitivity goes a bit like this and is in relation to the neural component of the dysfunction:

Neural dysfunction from level 1 to 3
position away-move away
position toward- move away
position away-move toward
position toward-move away

This relates to where the nervous system is positioned before it is moved and whether it is moved in the direction of the dysfunction or away. This is influenced by how easily the symptoms are provoked, among other things. Sliders are generally better for irritable problems and usually tensioners (not neural stretches! - they are performed quite differently) are performed at higher progressions. However, at the lowest levels, neural off-loaders are performed to reduce sensitivity in the neural tissues.

Interface dysfunction from level 1 to 3 - to be covered later. Got a meeting, must go.

Hope this is interesting
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Old 17-05-2005, 06:33 AM   #43
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Very interesting! Thank you. I've got your book on the way and excited to dive into it!

The last of the selection of techniques...position toward-move away....is that meant to be position toward-move toward?

Cory
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Old 17-05-2005, 06:56 AM   #44
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Michael, Thanks for posting here.
I have slowly started to read your book (its safer that way, less likely to trip over any words). On page 11 you present a figure modelled on Maitland's work, but no legend to decipher the lables! I wasn't trained in that approach and don't have access to any of his books. I'm sure its obvious but could you (or anyone else) please decipher it for me?!
Thanks
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Old 17-05-2005, 07:27 AM   #45
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Hi Eric, from Vancouver Island? If so, Deena Scoretz at UBC is organizing my course in Vancouver for November. Glad to see someone's reading my book.

ABCD are just the corners of the diagram.
L - limit of movement
P1 - first onset of Pain
P2 - maximum Pain
R1 - first onset of Resistance
R´(R prime) - level of resistance at the end of range (L) when P2 was what produced the restriction.

Hope this helps and thanks for asking.

Best wishes,
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Old 17-05-2005, 03:31 PM   #46
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Michael,

Quote:
Glad to see someone's reading my book.
I think that many readers of the site are interested about it. I can't tell about it for the moment but I ordered it last week!
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Old 17-05-2005, 03:48 PM   #47
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Michael, your book is creating a stir. I think everyone is getting it and reading it.

I found a Mac tech who is coming over tomorrow evening to help me get the CD /computer interface to work. Can't wait.

Diane
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Old 18-05-2005, 12:45 AM   #48
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Thanks for the positive feedback everyone. I'm pinching myself because it is selling like hot cakes and basically the first sx month's supply has been ordered in the first two months! As I said, my main aim was to clarify and develop neurodynamics into a clinically applicable system that links to the causal mechanisms, particularly the mechanical and physiological ones in the tissues at fault. Other issues, eg. central and psychosocial, also exist in many patients but this book focuses on the tissues based stuff. The CD enhances the book because it brings the nerves to life with real-time images of the nerves moving, including a patient with carpal tunnel syndrome compared with a normal nerve at the tunnel.

Incidentally, we followed up the carpal tunnel syndrome patient who on the CD last Friday (4 years down the track) and huge changes in nerve anatomy and biomechanics could be seen. This correlated very closely with her neurodynamic tests. More on this later.

By the way, at the moment, the preferred web site to buy the book is www.elsevier.com.

Any questions and I'll be glad to answer.
Best,
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Old 18-05-2005, 03:54 AM   #49
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Sorrry the URL for purchase of the book (Clinical Neurodyamics) if you are outside Australia is www.elsevierhealth.com, although I have a small number of books myself and can sell you one or two at a discount. Postage is added. Just fax Neurodynamic Solutions with your name, order, credit card details, postal address and email address (+61 8 8212 8028).

Happy reading!
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Old 18-05-2005, 04:24 AM   #50
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Kia Ora Michael. Thanks for the clarification. Yes I am on the Island and am making plans to be at your course during November in Vancouver. I was surprised to discover we have the same physio alma mater, although it has recently changed names to become AUT. And no, I'm not a Kiwi.

Eric
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