The Sensitive Nervous System

The Sensitive Nervous System

• Is accessibly written from a clinician's point of view
• Gives clinicians a framework to engage modern neurobiological advances of 'the decade of the brain'
• Presents novel techniques which are instantly applicable
• Will help you to listen to patients' stories and understand them better
• Offers links to modern Bio-Psycho-Social constructs
• Presents some guidelines for the future of movement therapies.

The decade since the publication of David Butler’s Mobilisation of the Nervous System has seen the rapid growth and influence of the powerful and linked forces of the neurobiological revolution, the evidence based movements, restless patients and clinicians. The Sensitive Nervous System calls for skilled combined physical and educational contributions to the management of acute and chronic pain states. It offers a “big picture” approach using best evidence from basic sciences and outcomes data, with plenty of space for individual clinical expertise and wisdom.

Chapter Summaries

• 1. Introduction – painting on a bigger canvas: A perspective on the history and future of manual therapy, including neurodynamics
• 2. A birds eye view of the nervous system: It’s time for manual therapy to go above the atlanto-occipital joint. Neurodynamic tests are also represented in the various homonculi in the central nervous system. Includes clinically relevant discussions about how the brain may work, plasticity, the action potential and how “use it or lose it” is as relevant for the nervous system as it is for muscles and joints.
• 3. Pain mechanisms and central sensitivity: Here is also a description of peripheral pain mechanisms and how they present clinically. Lots of drawings and clinical thoughts.
• 4. Central sensitivity, response and homeostatic systems: A challenging issue for manual therapists is secondary hyperalgesia – sensitive tissues due to CNS changes. The mechanisms of CNS changes and the relevance to manual examination are described in this chapter. There is also information on the immune, endocrine and sympathetic systems.
• 5. Neurodynamics: This is an update and a review of the neurodynamics chapter in “Mobilisation of the Nervous System”. There are many suggestions for clinical integration.
• 6. Clinicians and their decisions: Clinical reasoning is seen as evidence based medicine at its best. Reasoning models are expanded to embrace modern neurobiology.
• 7. Assessment with a place for the nervous system: This pivotal chapter links physical evaluation with the bio-psycho-social approach. Its also about talking to patients about pain, collecting information in the reasoning categories and an introduction to “yellow flags”.
• 8. Palpation and Orientation of the Nervous System: Unique to a manual therapy text, the skill of palpation of the peripheral nervous system is described. The descriptions are supported by numerous anatomical and technical drawings.
• 9. Manual examination of nerve conduction: Clear descriptions and illustrations of the handling and analysis of the examination of conduction reflect the author’s belief in the importance of this part of physical evaluation.
• 10. Neurodynamic tests in the clinic: With practice, the tests can be easily performed. The next step of analysis of findings is described in this chapter.
• 11. Neurodynamic testing for the spine and lower limb: Clear and concise descriptions of the SLR and derivatives, slump test, long sitting slump tests and prone knee bend and variations are described. Plenty of drawings.
• 12. The upper limb neurodynamic tests: Clear descriptions of tests biased to ulnar, median, and radial and musculocutaneous nerves, including reversals of movement. Plenty of drawings.
• 13. Research and Neurodynamics: Unique to a manual therapy textbook, the efficacy of tests is explored by guest contributer, Jim Matheson. There are guidelines to reading the literature and for future researchers here.
• 14. Management strategies – integration of neurodynamics: This chapter is about the use of neurodynamic tests for pain explanations, and passive and active movement therapy. However it must all be under big picture evidence based guidelines.
• 15. Clinical aspects of neurodynamics: Aspects of neurodynamics are described in relation to carpal tunnel syndrome, nerve root irritation, thoracic problems and neurogenic foot problems. Its all about concepts that you can apply to any part of the body.