At Northwest Physiotherapy Group, we use neurodynamic testing as the baseline assessment for all our clients, no matter what symptoms they present with. This crucial step ensures that nerves move freely throughout the body, which is essential for pain-free movement and long-lasting treatment results. When nerves don’t glide properly, we observe increased muscle guarding, and the improvements clients make during treatment simply don’t last.
Table of Contents
- 1 The Three Critical Zones of Neural Movement Assessment
- 2 Upper Limb Nerve Testing
- 3 Upper Cervical Spine Nerve Testing
- 4 Lower Limb Nerve Testing: Side-Lying Assessment
- 5 The Clinical Significance of Comprehensive Neural Movement Testing
- 6 Bilateral Assessment: The Complete Clinical Picture
- 7 Integrating Nerve Movement Testing Findings into Treatment Planning
- 8 Conclusion: The Foundation of Effective Physiotherapy
The Three Critical Zones of Neural Movement Assessment
Our comprehensive nerve movement testing protocol examines three key areas of the body where nerve tension commonly manifests:
- Upper limb neural pathways
- Upper cervical spine
- Lower limb neural pathways
Let’s explore each testing zone in detail.
Upper Limb Nerve Testing
Testing Procedure:
The upper limb assessment evaluates the neural pathways running through the shoulder, arm, and hand. This test is particularly valuable for clients presenting with:
- Shoulder pain
- Neck tension
- Tingling or numbness in the arms or hands
- Reduced grip strength
- Limited range of motion in the upper extremities
Clinical Significance:
During this assessment, we are specifically looking for:
- Sudden increase in tissue tension
- Involuntary muscle guarding
- Client’s subjective reporting of discomfort
A positive test reveals itself through increased resistance when tension is applied to the nerve. This is often seen as reduced elbow extension range of movement. Importantly, when the neural tension is released, we should observe a return to free movement and full elbow extension. This comparison provides critical diagnostic information about upper limb neural mobility.
Upper Cervical Spine Nerve Testing
The upper cervical region contains critical neural structures, making proper assessment essential for clients with:
- Headaches
- Neck pain
- Dizziness
- Upper back tension
- Referred pain patterns
Differential Assessment:
When performing the test it is important to evaluate:
- Quality of cervical movement
- Presence of protective muscle guarding
- Changes in movement patterns when neural structures are tensioned
- Bilateral differences in response
A clear test shows equivalent movement quality in passive cervical flexion movement regardless of whether neural tension is applied. This indicates healthy neural mobility in the upper cervical region.
Lower Limb Nerve Testing: Side-Lying Assessment
The lower limb assessment evaluates sciatic and other lower limb nerve movement and is especially important for clients experiencing:
- Low back pain
- Sciatica symptoms
- Hamstring tightness
- Hip mobility restrictions
- Radiating leg pain
Clinical Interpretation:
During lower limb testing, I’m evaluating:
- The angle of knee extension at which resistance first appears
- Quality of the resistance (abrupt vs. gradual) and guarding
- Changes in available range after neural release
- Symmetry between sides
A positive test typically presents as early resistance during leg straightening that improves when neural tension is released. This pattern indicates neural mobility restrictions rather than simple muscle tightness.
The Clinical Significance of Comprehensive Neural Movement Testing
Why Clearing Neural Tension Takes Priority
At Northwest Physiotherapy Group, we’ve observed that attempting treatment without first addressing neural tension yields suboptimal results. When nerves don’t move freely, several clinical consequences emerge:
- Persistent muscle guarding limits the effectiveness of manual therapy
- Exercise prescription may exacerbate symptoms if neural tension remains
- Treatment gains diminish rapidly as protective patterns reassert themselves
- Client discomfort persists despite addressing other structural issues
Treatment Sequencing Based on Nerve Testing Findings
Our treatment protocols follow a specific sequence informed by nerve movement test results:
Phase 1: Neural Mobilization
- Gentle neural gliding techniques
- Graded desensitization of irritable neural structures
- Controlled breathing to reduce protective muscle tone
Phase 2: Tissue-Specific Interventions
- Only after clearing neural tension do we address:
- Joint mobility restrictions
- Specific muscle imbalances
- Movement pattern corrections
Phase 3: Functional Integration
- Restoring normal movement patterns
- Building capacity with neural structures now moving freely
- Activity-specific rehabilitation
Bilateral Assessment: The Complete Clinical Picture
While our demonstration focused on single-side testing, we always perform comprehensive nerve movement assessment on both sides. This bilateral comparison provides crucial information about:
- Asymmetries in neural tension
- Potential nerve root involvement
- Functional compensation patterns
- Treatment prioritization
By methodically assessing both sides, we can identify the primary areas requiring intervention versus secondary compensatory patterns.
Integrating Nerve Movement Testing Findings into Treatment Planning
Patient Education Components
An essential aspect of our approach at Northwest Physiotherapy Group involves explaining nerve testing findings to clients. This educational component:
- Helps clients understand the source of their symptoms
- Improves compliance with neural mobilization home exercises
- Reduces fear-avoidance behaviors
- Establishes realistic expectations for recovery progression
- Helps clients understand important concepts about pain science and how the brain creates pain as a protective response
Home Program Design
Based on nerve testing results, we develop tailored home programs for clients that:
- Respect current neural sensitivity
- Gradually increase neural mobility
- Integrate with other treatment components
- Progress at an appropriate pace for tissue healing
Conclusion: The Foundation of Effective Physiotherapy
Nerve movement testing forms the cornerstone of our assessment process at Northwest Physiotherapy Group. By ensuring nerves move freely throughout the body, we establish the conditions necessary for successful treatment across all other interventions.
The systematic assessment of upper limb, cervical spine, and lower limb neural pathways provides a comprehensive understanding of how neural tension may be contributing to a client’s presentation. By addressing these issues first, we consistently achieve better outcomes and more durable results for our clients.
Remember: Clear the nerves first—it’s the essential first step toward lasting recovery. If you’re experiencing persistent pain or limited mobility, contact Northwest Physiotherapy Group to schedule your comprehensive nerve movement assessment today.
If the above content has resonated with you and you’d like to learn more about testing and clearing neural tension to get long term results with your condition, you can access our FREE 3 PART Video series here.
