Donald Mull is a chiropractic candidate at University of Southern California Health and Sciences. He recently presented at the ACA Rehab conference in Las Vegas, NV. His research synopsis is featured below.
There has been interest in how movement of neural structures influence physiology dating into the mid 1950’s as orthopedic tests such as single leg raise and Laségue were developed. “Neural mobilization is defined as a physiotherapeutic tool which is used to directly influence peripheral nerve mechanics where neurodynamics refers to the integrated biomechanical and neurophysiological interaction of the nervous system.” (Ellis, 2011) Essentially, how nerves move through both surrounding tissues and its own connective tissues can have an effect on neural physiology, blood flow and the perception of pain in the CNS.
The peripheral nerves provide vital information both to the brain as well as back to the muscles to accomplish complex movement patterns. With any slight alteration of neurodynamics, there is risk for decrease in neural blood supply, axoplasmic flow as well as tissue dispensability. This project is aimed to identify how using neurodynamics as a therapeutic tool can aid in the functional treatment of hamstring strains. Hamstring strains are one the most common injuries among sports which require its athletes to spend a large portion of the contest in a full sprint. The hamstring is most commonly injured in the late swing phase of the sprint cycle where it must act to slow down knee extension while in hip flexion. This puts not only the hamstring muscle in a lengthened position, but also the rest of the tissues in the posterior chain, including the sciatic nerve. In a systematic review in 2012, H Liu et all found that neural tension has been associated with athletes with past history of hamstring strains.
The use of neurodynamics in the treatment of hamstring injuries can increase blood flow to neural structures, decrease perceived pain, decrease neural tone of muscles as well as increase the axoplasmic flow to allow for a clear message to the brain and/or desired tissues. In the presence of adverse neural tension, neurodynamics can be utilized as an efficient tool to open the window for the use of active care, carrying over to strength and conditioning training. Once the tissues are extensible and pain has diminished, the use of exercises under eccentric load can then be used to bridge the gap from disability to performance. These exercises include closed chain hip dominant movements (Deadlift, single leg RDL, KB swing etc) as well as open chain, knee dominant movements (Nordic hamstring exercise, TRX curl, standing band curl). Once a foundation of strength and movement quality exists, sports specific movements, which require greater intensity and sports specific cognition can be implemented. At the end of the day, the most efficient and long-lasting message to the brain only aids in reducing the risk of and recovery from injury.
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