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CHOICES: Perspectives on the Future of PT In this forum you will read interviews conducted in depth with various figures who are making an impact on the profession. NOTE: The forum is fully moderated. All posts need a moderator approval before becoming visible.

 
 
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Old 27-07-2006, 03:37 AM   #1
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Default Michael Shacklock Interview

MICHAEL SHACKLOCK INTERVIEW

Michael Shacklock has developed a method of treatment and written a book entitled Clinical Neurodynamics describing this method. In the text, the reader is introduced to new diagnostic and treatment techniques using neurodynamic testing and movements. The system provides a means by which to evaluate the contributions of the mechanical interface, the innervated tissue, as well as the neural tissue in order to create a scheme of treatment. Additionally, he has created a method of staging the sensitivity of the condition based on physical examination findings. A progression of treatment is described in a systematic manner.

SomaSimple: Thank you Michael Shacklock for joining us in this program on Somasimple. We are very pleased and fortunate to have you as our first guest.

In your text, the definition of Clinical Neurodynamics is listed as the following:

clinical application of the mechanics and physiology of the nervous system as they relate to each other and are integrated with musculoskeletal function.

How did this concept come to be defined?


Michael:
Firstly, I'm very honoured to be the first interviewee on Somasimple. I'd like all your visitors to know that I really appreciate your web site and am so pleased that it fosters discussion, dissemination and development of this fantastic area.

There are really two parts to the answer to this question.

1. The concept of neurodynamics came to me when I became familiar with the neural tension approach with David Butler and Helen Slater in the late 1980s and early 1990s when we were in practice together in Adelaide (acknowledgements to Bob Elvey and Dr Alf Breig for their earlier pioneering contributions to the area). This was an extremely stimulating, exciting and formative time for me because the concept of 'neural tension' was new and growing rapidly with huge interest in regions such as Australia, the UK, Europe, USA and Canada, to mention only a few. We were developing it with such pace and intensity that I can only look back on that time with amazement and fond affection.

Anyway, in using the approach on certain conditions, I found that some patients did not respond well and were sometimes made worse - the acute lumbar nerve root for instance. I felt that the neural tension approach did not answer a large number of questions that, if were answered, could really help the approach. So I started reading a subject that I hated at PT graduate school - physiology. That is when
I started reading the basic sciences on subjects like neurogenic inflammation, neuronal sensitivity (mechanosensitivity), neuropathy, neuroplasticity, central nervous system mechanisms and finally that four letter word - PAIN.

So by the end of the 1990s, I had read thousands of scientific and clinical peer-reviewed papers (I don't read many PT books because I like to get into the detail) and spoken with authorities in the area such as Professors Patrick Wall, Issy Pilowsky, Ronald Melzack , Marshall Devor, Marcelo Costa and so forth. Such was the pace and enthusiasm in our professional environment in Adelaide that, by the mid- 90s, we had held an international multidisciplinary conference on the subject and produced a book that has sold almost 10 times the number of copies that was anticipated (Moving in on Pain, Butterworth Heinemann, 1995). In my inquiries, I learned that mechanics and physiology of the nervous system are often dynamically interdependent and felt that we should integrate these aspects in our clinical practice. In 1995, I wrote two papers on linking the two (Shacklock 1995a, 1995b). That is when I coined the term 'neurodynamics' for physical therapy. It was of course not the first time the term had been used. It is used ubiquitously in the neurosciences, psychiatry, neuropharmacology and a wide range of other neural disciplines. But the idea was to encourage therapists to use many aspects of neural function in their clinical practice in addition to tension, but only those that were relevant. Neurodynamics became an 'applied science', so to speak. This naturally meant sliding and compression of nerves, axonal transport, intraneural blood flow, inflammatory mechanisms and sensitivity of neural tissues.

Fortunately, much of the physical therapy world has adopted the term but more change is necessary. Still many therapists really only consider the nervous system as a tension based/mechanical organ with little concern for its movements or physiology. In fact, the most common search words that land visitors on our web site (www.neurodynamicsolutions.com) are still 'neural tension'. So there remains much work to be done for the approach to mature into a fully integrated one.

2. For many therapists, the application of neurodynamics as opposed to neural tension was a quantum leap. But by the time 2000 had come, I still felt that we needed to make another jump which was to integrate the nervous system with musculoskeletal function. This was because still we were mobilising nerves in isolation. Once again, this doesn't always help, particularly since the mobilisations applied at that time still applied tension to the nervous system.

The entrance of the neurosciences into manual and physical therapy was changing the face of clinical practice. We had gone so far into the neurosciences as a fundamental subject that therapist were getting bogged down on the complexities and not really coming away with practical clinical neurodynamic solutions. The subject of pain had entered the fray, which I believe was a fantastic development of course, but we had moved so far from the physical that there was a gap in our clinical practice - the Do-It-Yourself for hands-on neurodynamics.

So I wrote a book and called it 'Clinical Neurodynamics' (Elsevier).

This was to give the clinical therapist a number of things; practical hands-on solutions, a clinical resource and to take the next step which was test and treat neurodynamics in a way that the nervous system really moves which is integrated with the musculoskeletal system. This dealt with the issue of applying tension to the nervous system in isolation by providing a system for categorising patient problems which needed the compression and tension to be taken OFF the nervous system as opposed to ON. It also dealt with the problem of confusing sliding dysfunctions of the nerves with tension dysfunctions by giving diagnostic criteria and systematic treatment progressions from the painful to the athletic level. Lastly the clinical neurodynamics system now includes techniques on how to REDUCE tension in the nervous system. Hence, the integration of musculoskeletal and nervous systems with the term 'Clinical Neurodynamics'.

REFERENCES
Shacklock M 1995a Neurodynamics. Physiotherapy 81: 9-16
Shacklock M 1995b Clinical application of neurodynamics. In: Shacklock
M (ed.) Moving in on Pain. Butterworth-Heinemann, Sydney: 123-131
Attached Images
File Type: jpg Shacklock Portrait-1.jpg (32.1 KB, 23 views)

Last edited by BB; 10-08-2006 at 06:40 AM.
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