Neuro Anatomy

Lumbar Spine

Neuro Anatomy

• Important for neurological assessment• Helps with tension testing and neurodynamic

treatments• Knowing anatomy will help identify potential

causes of radicular pain or radiculopathy• E.G paraesthesia in the hand- is this in a

dermatome pattern or a peripheral nerve pattern

Spinal Nerves

Spinal Nerves

Lumbar Plexus

Lumbar Plexus

Femoral Nerve

Obturator Nerve

Lumbosacral Plexus

Lumbosacral Plexus

Sciatic Nerve

Peroneal Nerve

Tibial Nerve

Sural Nerve

Dermatomes and Myotomes Vs Peripheral Nerve

• Remember the cutaneous and motor distribution of a peripheral nerve IS NOT the same as dermatome and myotome patterns

• Nerve roots will progress into multiple peripheral nerves

• E.g C8 nerve root is present in ulnar, median and radial peripheral nerves

Neurodynamics

Lumbar Spine

The Neurodynamic System

• Interaction of 3 components– Mechanical Interface– Neural Structures– Innervated Tissues

Abnormal Neurodynamic System

• Can be the result of one or a combination of:– Dysfunctional Tension– Dysfunctional Sliding– Dysfunctional Compression

Tension

Sliding

Compression

Movement of the Neural System

• The nervous system will generally slide towards the moving joint distally and proximally to increase the available slack

Femoral Nerve Testing

Sciatic Nerve Testing

Peroneal Nerve Testing

Tibial Nerve Testing

Sural Nerve Testing

Slump Testing Upper Lumber Nerve Roots

Look for…..

• Pain• ROM• Paraesthesia or Numbness

Structural Differentiation

• Perform the test• Make a change 2 joints away from the symptoms• Does it increase or decrease symptoms?• Does it make no change?

Dermatomes

Dermatomes

Dermatomes

Myotomes

L2 L3

Myotomes

L4 L5

Myotomes

S1 S1

Myotomes

S1 - 2

Management

• Soft tissue release• Joint mobilisations– Sliders and Tensioners

Sliders

Tensioners

Manual TherapyCorkskrew

Home Exercise ProgrammeLeg Swings

Home Exercise ProgrammeHeel To Sky

Home Exercise ProgrammeFemoral Nerve

Home Exercise ProgrammeCranio Cervical Flexion Straight Leg Raise

Home Exercise ProgrammeSeated Slump Part 1

Home Exercise ProgrammeSeated Slump Part 2

Home Exercise ProgrammeSeated Slump Part 3

Home Exercise ProgrammeSeated Slump Part 4

Neurodynamic Treatments

• Be inventive• Decide on what aspect of the nerve you need to

target• Decide whether you need to perform a slider or a

tensioner• Decide if you want to tension the entire spinal

cord and dura mater• HEP or Manual Therapy? Eg MTrP release in neural

load, Hip distraction mobilisations in neural load