BUTLER MOBILIZATION

(A BRIEF INTRODUCTION)

Application of movement testing of nervous system requires on understanding of the relationship of Neural Mechanics & Neural Physiology.

These two factors constitute normal function of nervous system.

     Over all function of nervous system is to provide communication while adapting to movements. Communication composed of 2 components Electrical & Chemical Mechanism. Collectively these components of communication are referred to as the Physiology or Function of Nervous system. Common form of communication of Nervous system is by Action potential. Second component of communication is identified as a chemical process which involves axoplasmic transport. This chemical communication provides nutrition & receives inflammation from the target tissues through axoplasmic flow.

This flow is Bidirectional & is identified by the terms antegrade & retrograde transport. There are two main Biomechanical concepts related to the nervous system.

1.  Mechanical interface and it s effect
2.  Neruo biomechanics

     The Mechanical interface may be defined as the tissues or material adjacent to the nervous system that can move independently to the system.

E.g. Supinator muscle for Radial nerve.

       Carpal tunnel syndrome for Median nerve.

 INTERFACES:

Pure Mechanical interfaces:

1. Fascial sheet
2. Blood vessels
3.  Muscle or ligament

Pathological Interfaces:

1.  Osteophytes
2.  Ligamentous swelling
3. Fascial scarring
4. Odema
5. Blood around nervous system
6.  A tight plaster or Bandage.

Interfacing tissues may be regarded as extradural or extra neural.

Neuraxial & Meningeal adaptive mechanisms:

During flexion the length of spinal cord increased 5—9 cm larger than the normal. During this the neuraxias and meninges elongate and more anteriorly in the spinal cord. During extension they more posteriorly allow relaxation of the neuraxis and create transverse folds in the duramater and tip of theca moves caudally. With lateral flexion movements the nervous system on the convex side elongates whereas concave side shortens.

In rotation nerve root gets stretched on the same side.

 TENSION POINTS:

     Tension points are those where no movement of nervous system takes place in relation to the interface

In spine: C6, T6, L4

Lower limbs: Posterior aspect of Knee & Hip

Upper limbs: Anterior aspect of Elbow.

Anatomy of Tension points:

Nervous system depends on adequate blood supply. In general extra neural vessels enter the nervous system in areas of little movement in relation to interface. These areas are tension points.

NEURODYNAMICS

            The normal function of the nervous system can be defined as Neurodynamics.

Neurodynamics is the relationship of normal physiology & normal mechanics.  Pathomechanics identifies as an abnormal component of physiology (pathophysiology) or an abnormal component of mechanics (pathomechanics) or combination Two. Explained in the figure 1. 

 

      Evaluation of the musculoskeletal system includes an appreciation of the interconnection between the physiology and mechanics of the neural elements.

Physiology of nerves are find out by conduction system of nerves. Neruodynamics testing also addresses the physical capabilities of the nervous system through manual positioning and loading. This type of examination identifies the load characteristic of the neural elements. There are multiple techniques that use positioning and movement to focus tensile load through the neural elements or unload the neural structures. This technique identifies the mechanics of the nerve or the nerve’s ability to move, including the ability to slide, angulate, glide, strain or compress.

The nerve bed can increase in length from 12—20 percent during limb. The nervous system has the ability to move, and this capacity to move has been described in tension tests.

BASE TESTS:

There are many test used to find out nervous system mechanics

These tests includes

1. Passive neck flexion (PNF)
2.  Straight leg raise (SLR)
3. Slump test
4. Prone knee bending (PKB)
5. Upper limb neurodynamic test (ULTT)

      These tests are designed to Bias the neural elements to a greater degree than the surrounding interface. These tests attempt to load specific nerve roots, nerve trunks, and localized regions of the central canal or even component of sympathetic nervous system.

INDICATIONS:

1.  A clinical reasoning hypothesis of movement dysfunction supporting neurogenic pain.
2.  An Aggravation of the pain pattern by a functional position or an ADL position that resembles a base test position.
3.  Positive conduction tests suggesting the neural involvement.
4.  To examine, normalize or improve the normal neruodynamic of the nervous system.

CONTRA INDICATIONS:

1. A tethered spinal cord or conditions with spinal cord adherence to the meninges or the spinal canal.
2. Increasing neurologic signs or neurologic injury when a load is likely to cause a rapid neurologic deficit.
3. Inflammatory, infectious, or viral conditions such as an Abscess, GBS.
4. Red flags found with a neurologic examination, such as extra segmental or multilevel loss of sensory or motor function, a positive babinski response.
5. Severe injury or abnormality of the interfacing tissue of the nervous system found with spinal instability, osteoporosis, and transient quadriplegia.
6. Severe pain as a result of any examination technique.

 SLUMP TEST

 

 SLR and its Modification

Prone knee Bending Test & its Modification

Upper Limb Tension Test.

Bibliography:

1) David Magee 

2) Butlers Neural tissue mobilization.