Michael Shacklock

ATTN: PTs and Chiros! NEW FREE WEBINAR! Case-based Approach to Understanding Neurodynamic Testing and Treatment. Michael Shacklock, DipPT, FACP); Drs Michael Maxwell DC & Dr Joseph Gravino DPT. Day - Sun Jan 19 Time: PST 2:00 pm, EST 5:00 pm Register here: us02web.zoom.us/webinar/regist…

See this Instagram photo by @drmichaelmaxwell instagram.com/p/DEOUjr4SXyL/…

@AnninaBSchmid Well done Annina!! Very much deserved, and on the right day!! Keep up your excellent work. I’m sure there is plenty more to come! Best wishes from Australia.

So excited to be awarded Professorship in Oxford, as a physiotherapist and on the day of physiotherapy no more. Massive thank you to all my team and collaborators past and present, would not have been possible without you!!!🍹🎊🎉!

Hello Everyone, NDS has a NEW INSTAGRAM ACCOUNT instagram@neurodynamicsolutions We'll be doing our updates there for lots of good info. Please go there for the latest in research, techniques and clinical pearls.

@Logan_Nordquist Excellent afternoon @Logan_Nordquist. Theory done and a big practical day tomorrow. Hybrid model is up and humming. Thanks for the opportunity Gestalt Education and @ChicagoCubsHQ.

First con ed of 2023 with @Neurodynamics

@Steven_AK @MoversMentors @PeteOSullivanPT @kieranosull @leehphysio @BethDarnall @ProfJillCook @JoanneLKemp @knowpainmike @JeremyLewisPT @davidopar @marklaslett_NZ @NicoleStoutPT @MichaelRathleff @CGMMaher @JoNijsBE @RonHruska @JoshClelandPT @PhysicalTherapy @timothywflynn @Stephania_ESPN If you want someone who is specialised, hopefully they would have done original work or contributed to forwarding knowledge in their area.

@Steven_AK @MoversMentors @PeteOSullivanPT @kieranosull @leehphysio @BethDarnall @ProfJillCook @JoanneLKemp @knowpainmike @JeremyLewisPT @davidopar @marklaslett_NZ @NicoleStoutPT @MichaelRathleff @CGMMaher @JoNijsBE @RonHruska @JoshClelandPT @PhysicalTherapy @timothywflynn @Stephania_ESPN I recommend finding someone who: - has broad experience - balances science and clinical reasoning - caters for people’s uniqueness.

🚨📖 Movers & Mentors is now available on Amazon in paperback and eBook! Visit the link in our bio to order your copy today! @PeteOSullivanPT @kieranosull @leehphysio @BethDarnall @ProfJillCook @JoanneLKemp @knowpainmike @JeremyLewisPT @davidopar @marklaslett_NZ

@pttimyyc @joegdpt Maybe a proximal sliding one but these are rare. Maybe it’s producing some sliding that relieves the pain with not much shoulder abduction to avoid too much tension.

@Neurodynamics @joegdpt Yeah I remember from your book some of the different dysfunctions (ex: closing dysfunction of the facet joint). Is there a dysfunction that would lead to symptomatic relief with long arm traction ?

Has anyone found that some neuro arm symptoms feel better with long arm traction and others worse? If anyone has any guidance or possible explanation for this lmk! *just curious*

@joegdpt @pttimyyc Yes and it’s important that we consider dysfunctions that lead us to treatment types because general sliders or tensioners may not attack the right mechanisms.

@pttimyyc I see this often. Many times I find this to be due to either the sliding mechanism or convergence of neural tissue. Often you will find some mechanical sensitivity to either a proximal or distal directed neural slide. Anything to add to this @Neurodynamics ?

@AnninaBSchmid Good work! Nerve scarring occurs in CTS and one wonders if impaired fibrinolytic activity is also linked, and if the CTS is from compression by synovial sheaths or intrinsically neural. Is the nerve part of the chicken or merely the egg?

The gene DIRC3 seems to modify risk for both conditions. An increased IGF-1 signalling in fibroblasts may have a role in the pathology of both conditions. 3/4

For those who (like us) clinically often observe co-existence of carpal tunnel syndrome and trigger finger 1/4: sciencedirect.com/science/articl…

@Retlouping @marklaslett_NZ Neurodynamic tests are functional (not medical) tests and should not be used directly for diagnosis of pathology or disease. They are better for detection of pain-related nerve movement than diagnosis of ‘why’. That’s done in the rest of the evaluation. BOOM!

@Retlouping @marklaslett_NZ Yes and n. root deficit is key to diagnosis of radiculopathy, but this still does not distinguish the cause: - radiculitis without compression - compression (disc, tumour, cyst, stenosis). As always, nothing’s perfect and diagnosis comes from a combination of tests.

The reference standard (MRI) is very weak here. MRI findings of disc herniation are themselves sensitive but not strongly specific (except extrusion). Specificity matters nor in diagnostics, hi sensitivity is more important with screening

@marklaslett_NZ @joegdpt Neurally, we can base the choice of progression on the ipsi/bilateral comparison SLR. But we also have to be careful about the X SLR because the X-over nerve root mechanism can disrupted, may not be appropriate.

@marklaslett_NZ @joegdpt Interesting. If we’re thinking of added neural techniques, flexion in standing compresses the spine but can be a lower progression for the ipsilateral nerve root than seated slump with only the ipsilateral knee extended. It’s about spinal cord movement.

Update on the post 2 level adherent dura mater case from a wekk ago. He has been challenging standing flexion for a week and the X SLR test has become negative, but otherwise unchanged. Reviewed him, taught him more & will see him in 2-3 weeks. Good start on 3-6 month journey

@TaiwanOzPhysio @MovementPainPT Common difficulty with clinical trials is lack of diagnosis - difficult to know if treatment is directed at the cause. With neural aspect to sciatica, we need: - radiology/electrophysiology - exclusion of other causes - relate neural symptoms to movement.

@MovementPainPT @Neurodynamics Still some need "doing nothing"😇 (From the abstract, I boldly guess some would only have somatic referral symptoms...)

More is not always better. sciencedirect.com/science/articl…

@MarkCroucher2 Yes, we found adding hip internal rotation and ankle dorsiflexion to the #straightlegraise improved diagnostic efficacy. Often the regular SLR is not enough to exclude #lumbarradiculopathy How we do neurodynamic tests can be important, also for treatment.

Extending the straight leg raise test for improved clinical evaluation of sciatica: reliability of hip internal rotation or ankle dorsiflexion - PubMed pubmed.ncbi.nlm.nih.gov/33761924/

@AnninaBSchmid Well done to the team. Begs the questions: 1. Does the Inventory lack sensitivity? 2. Does the inventory lack specificity? I've seen people with signs of CS but they do NOT have pain. 3. Does CS always relate to pain. My opinion - no, not always. More research needed!

The plot is thickening...well done Luis for this work demonstrating that the CSI is not associated with signs indicative of central sensitisation in patients with focal nerve injuries.

@Carlthephysio @thomas_jesson @adamdobson123 @PalingClaire @CombatSportPhys Yes, compared to nerve root, concerns can be: - progressive - widespread neurol. problem (large pathology) - continence & sexual function are v. important - lack of recovery - many causes (not differentiable with physical tests) - don’t provoke > needs medical invest. & Rx

Can anyone tell me whether the cauda equina is more vulnerable to permanent damage vs a nerve root and why? Is the urgency to decompress vs nerve root due to the wider implications of the Sx or the permanence of them? @thomas_jesson @adamdobson123 @PalingClaire @CombatSportPhys

@Henktempelman1 @marklaslett_NZ @DerekGriffin86 It’s influenced by signs, symptoms and response to unloading the nerve root.

@Henktempelman1 @marklaslett_NZ @DerekGriffin86 Actually, for the nerve root, it’s often not necessary to do repeated movements because it’s return of blood flow responds temporally, so static can be better than dynamic.

An excellent illustration challenging the common notion that flexion increases a posterior disc bulge. The image clearly shows a reduction in the disc bulge in flexion. Thanks to @Neurodynamics for the reference. journals.sagepub.com/doi/10.1177/19…