Michael Shacklock

DipPT, MAppSc (MSK), FACP. Founder, author best seller, Clinical Neurodynamics, NDS Neurodynamic Solutions.

[Michael Shacklock @Neurodynamics]

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: https://t.co/RcF92mJAb1

[Michael Shacklock @Neurodynamics]

See this Instagram photo by @drmichaelmaxwell https://t.co/srPcm4q9KP

[Michael Shacklock @Neurodynamics]

@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.

[Michael Shacklock @Neurodynamics]

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.

[Michael Shacklock @Neurodynamics]

@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.

[Michael Shacklock @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.

[Michael Shacklock @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 I recommend finding someone who:
- has broad experience
- balances science and clinical reasoning
- caters for people’s uniqueness.

[Michael Shacklock @Neurodynamics]

@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.

[Michael Shacklock @Neurodynamics]

@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.

[Michael Shacklock @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?

[Michael Shacklock @Neurodynamics]

@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!

[Michael Shacklock @Neurodynamics]

@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.

[Michael Shacklock @Neurodynamics]

@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.

[Michael Shacklock @Neurodynamics]

@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.

[Michael Shacklock @Neurodynamics]

@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.

[Michael Shacklock @Neurodynamics]

@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.

[Michael Shacklock @Neurodynamics]

@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!

[Michael Shacklock @Neurodynamics]

@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

[Michael Shacklock @Neurodynamics]

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

[Michael Shacklock @Neurodynamics]

@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.