2.  Be familiar with the anatomy and function of the neural structures.  Be familiar with the aim of neural dynamic tests.  Be familiar with the neural dynamic evaluation tests.  Be familiar with the clinical presentation of a patient with neural symptoms.  Be familiar with the general principles of treatment of neural symptoms.  Be familiar with the contra-indications of neural mobilisations.

3.  Neural pain sensitive structures should always be kept in mind  Especially in patients who were subjected to trauma  The possibility exists that the resultant inflammatory process could also affect the nerve-root and nerve-root sheaths

4.  This could lead to abnormalities in terms of mobility  Meningeal nerve-root sheaths have a well developed pain receptor system which is responsible for the strange pain distribution  Adhesions are generally prevalent as a result of the weak lymphatic drainage in the area

5.  The nerve-root which is an extension of the dura mater, can therefore also be responsible for symptoms in another area – continuity of the system  The most common cause is reduced mobility of the neural structures

6.  During the normal flexion and extension movements, the spinal cord moves approximately 7 – 10 cm and therefore the surrounding neural structures must be relatively mobile  Mechanical stimuli of a non-injured nerve is pain free, but excessive lengthening or pressure stimulates the nervi nervorum which results in a pain response and ischemia  Ischemia leads to pins and needles, pain and muscle spasm

7.  Rare patterns of referred pain  Strips of pain  Pain at pressure points  Block of pain around a joint  Burning sensation or swelling  Symptoms mostly set in after assuming certain positions or carrying out actions which could cause stretching

8.  A neurodynamic test evaluate/tests the pain sensitivity/ provocation of the mechano-sensitive neural structures and the reaction of the protective muscles to lengthen around the neural tissue

9.  Passive neck flexion (PNF)  Straight leg raise (SLR)  Mid-slump test  Slump test  Upper limb tension test (ULTT)

10.  Explain to the patient what you are going to do and what they must do  Do one component of the test at a time  Take into account barriers to movement (onset of resistance, pain or other symptoms)  Note the quality of movement

11.  Consider irritability  Be consistent with starting position (e.g. pillows)  Note pain response (area and nature)  Do not necessarily reproduce the pain  Watch for and correct antalgic posture/movement

12.  Test for symmetry – compare both sides  Sensitising and desensitising components can be added  Handle well or don’t bother

13.  The test is considered positive if:  the patient’s symptoms are elicited  pain is reproduced  if there is more muscle reaction than on the other side  if there is any limitation in the mobility  if it is different from the normal

14.  Both non-neural and neural structures must be treated  Soft tissue must be prepared before the neural structures are mobilised  First mobilises non-neural structures, soft tissue and then neural structures  Be aware of signs and symptoms in respect to irritability and intensity

15.  Always start distal e.g. DF  Gr II short of pain and resistance, slow  Dull, constant pain must be avoided during treatment  Joint or muscle must be in mid-range since the separation level is more open in this position

16.  Work in 20 sec or 20 movements and increase the treatment by 20 each time  Re-evaluation signs and symptoms  Neurological evaluation is very important  Home exercises may be given after the second day of treatment  Neural structures must not be rested in stretched positions

17. Less movement and more adhesions  Pins and needles may be experienced during treatment – should disappear immediately after treatment  Place nerve in stretched position and then add the other components  Through range of movement Grade III and IV  All components must be evaluated

18.  Treat in close proximity of the origin of the symptoms  Can also perform an AP on the radius while the arm is placed in the ULTT  Get full tension before strong techniques are carried out e.g. SLR with rotation  Ensure at all times that the joints are able to withstand strong neural techniques  Patients react well to treatment, but can flare-up easily – be very careful!

19.  Acute nerve-root pressure  Worsening of neurological symptoms  Pathological conditions that affect the structures e.g. diabetes  Cord and cauda equina  Malignancies  Acute inflammation

20.  The slump test must not be carried out during a possible disc herniation or instability  Take care with irritable conditions  Always test neurological signs before and after neural mobilisations  Adhesive spinal cord