Introducing Neurodynamic Technique into Clinical Practice

by Walt Fritz, PT on January 19, 2018

I’ve recently begun including a newer paper into my body of evidence to support my Foundations in Myofascial Release Seminar for Neck, Voice, and Swallowing Disorders titled, “Integration of a neurodynamic approach into the treatment of dysarthria with idiopathic Parkinson’s disease: A pilot study”. I’ve been a proponent of using the concepts of neurodynamic technique (NdT, not to be confused with NDT: neurodevelopmental technique) in explaining some of the potential ways in which manual therapy may be impactful for changes in pain, function, and movement and was slightly disappointed to read that its addition to traditional intervention was inconclusive. The writers compared typical dysarthria treatment with the same treatment with the addition of a neurodynamic approach. They do a really nice job of simplifying the explanation of the foundations of neurodynamic technique and provide some pretty juicy links via the bibliography for a science nerd like me to absorb. They also lay out the basic concepts used to explain neurodynamics and its influence on movement and dysfunciton.

Maybe I should be disappointed by the lack of conclusive proof that NdT, combined with typical intervention strategies for dysarthria, were less than impressive, but the mere inclusion of NdT as a potential treatment strategy or explanatory narrative into the world of manual therapy for the SLP is pretty exciting. When we touch it often has positive effects, and all avenues of effect need to be explored, deconstructed, and formed into better models. The conclusions of this study mirror many introductory papers: “Due to the small sample size, the effectiveness of the integration of neurodynamics into speech therapy cannot be definitively concluded for now. In order to be able to have generalized applicability, future studies with larger numbers of participants are required.“ Nothing substantive, but movement in directions of plausibility.

One frustration I find with many papers is the authors fail to adequately describe the intervention strategies in detail, leaving the reader to wonder and speculate as to exactly how intervention was accomplished. In many manual therapy papers, reference is typically made to identifying the intervention, myofascial release, for instance, but a student of this modality realizes there are multiple different methods of intervention all calling themselves myofascial release. Without full descriptions of the methods, actions, handholds, hold times, pressures used, etc., little good comes except to validate (or invalidate) a general class of therapy. In this paper, the authors list in table format the speech motor skills assessed along with the corresponding innervation(s) and actions. They then describe the NdT manuuever along with the general positioning of the cervical spine to ensure proper methodology. A few photos are provided showing the NdT maneuver performed. This documentation is excellent.

Examining Table 2, I see the tremendous overlap between a myofascial release style of engagement, as taught in my workshops, and NdT interventions. For instance, following column one down to “Articulation: tongue” and reading across, we see that innervation comes via the hypoglossal nerve and that the neurodynamic maneuvers are: palpation, active/passive tongue protrusion/lateral protrusion, (and) hyoid mobilization. The work taught in my workshop moves through these exact sequences. While I stop short of saying myofascial release and NdT are the same thing, as I know better, there are remarkable similarities in how they are accomplished.

Since I first encountered the concept of NdT nearly 10 years ago I’ve seen parallels in its methods with the maneuvers involved in myofascial release and other manual therapies. NdT would take the known path of a nerve and assess it for tension. If tension was noted or reported, treatment was performed in specific and often pre-defined manner. The overlap with myofascial release/manual therapy would be that we (MFR therapists) may take the skin and underlying tissue under lines of tension in remarkably similar patterns with (hopefully) similar outcomes. Manual therapies may more accidentally stumble upon neural tension patterns, though each brand of manual therapy has a recipe that may parallel NdT. Rabbit holes. We all exist within them and see only what our rabbit hole feeds us. When we stick our heads out of our hole and look around at others, it is only then that we can see how similar we all are. Seeing papers such as this informs me that we are on the correct path. Build bridge between modalities, pulling from the strengths of each while not overstating effects.

The full text paper can be read as reference #413 on my Research page.

 
Cheers,

Walt Fritz, PT

Foundations in Myofascial Release Seminars.

I am a proud member of the Medbridge Massage team of educators. I have 8 online trainings, all presented from my updated, science-informed model of myofascial release. Take advantage of some pretty great discounts with a 12 month package of viewing, learning and CEUs with unlimited viewing of not only my (pretty great) courses, but also over a dozen of the top educators in the massage profession. Approved for CEUs for all US MTs. Use the discount code FRITZmassage for the $49/year price by using this link: Medbridge Massage.

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