Neurodynamics: is tension contentious?

ABSTRACT

Tensioning techniqueswere the first neurodynamic techniques used therapeutically in the management of people with neuropathies. This article aims to provide a balanced evidence-informed view on the effects of optimal tensile loading on peripheral nerves and the use of tensioning techniques. Whilst the early use of neurodynamics was centered within a mechanical paradigm, research into the working mechanisms of tensioning techniques revealed neuroimmune, neurophysiological, and neurochemical effects. In-vitro and ex-vivo research confirms that tensile loading is required for mechanical adaptation of healthy and healing neurons and nerves. Moreover, elimination of tensile load can have detrimental effects on the nervous system. Beneficial effects of tensile loading and tensioning techniques, contributing to restored homeostasis at the entrapment site, dorsal root ganglia and spinal cord, include neuronal cell differentiation, neurite outgrowth and orientation, increased endogenous opioid receptors, reduced fibrosis and intraneural scar formation, improved nerve regeneration and remyelination, increased muscle power and locomotion, less mechanical and thermal hyperalgesia and allodynia, and improved conditioned pain modulation. However, animal and cellular models also show that ‘excessive’ tensile forces have negative effects on the nervous system. Although robust and designed to withstand mechanical load, the nervous system is equally a delicate system. Mechanical loads that can be easily handled by a healthy nervous system, may be sufficient to aggravate clinical symptoms in patients. This paper aims to contribute to a more balanced view regarding the use of neurodynamics and more specifically tensioning techniques.

KEYWORDS:

• Neurodynamics
• tensioning techniques
• neuropathic pain
• mononeuropathy
• polyneuropathy
• radiculopathy
• carpal tunnel syndrome

Acknowledgments

Our thanks to Lilah Ellis for the provision of illustrations for Figure 1.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Richard Ellis

Richard is an Associate Professor in the Department of Physiotherapy at Auckland University of Technology (AUT) in New Zealand. He teaches on both the undergraduate and postgraduate programmes in the fields of musculoskeletal physiotherapy, manual and manipulative therapy, ultrasound imaging and research. Richard is also a Co-Director of the Health and Rehabilitation Research Institute (HRRI) at AUT, leading the Active Living and Rehabilitation: Aotearoa New Zealand (ALARA, https://hrri.aut.ac.nz/research-activities/active-living-and-rehabilitation) research group within HRRI. External to AUT, Richard is the Treasurer and an Executive Committee member of the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT). Richard is a Senior Tutor with the New Zealand Manipulative Physiotherapists Association (NZMPA). He is also an Associate Editor for the New Zealand Journal of Physiotherapy.

Giacomo Carta

Ricardo is a Griffith University Postdoctoral Research Fellow at Menzies Health Institute Queensland and a member of Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE) in Australia. Ricardo’s personal research interests are in understanding the integrated contributions of structure and biomechanics of peripheral nerves to neural function, dysfunction, and regeneration. His research expertise spans neuromusculoskeletal biomechanics, advanced neuroimaging methods, and clinical neurophysiology. Ricardo’s current research focuses on understanding the mechanisms underlying nerve damage in various peripheral neuropathies, with a particular focus on chemotherapy-induced peripheral neuropathy, and seeks to enhance the early diagnosis and management of peripheral neuropathies and chronic neuropathic pain.

Ricardo J. Andrade

Giacomo is a final-year Ph.D. student in Experimental Medicine and Therapy at the Stefano Geuna & Stefania Raimondo lab (Human Anatomy Department) at the University of Turin and Cavalieri Ottolenghi Neuroscience Institute, Italy (https://bit.ly/3kn81iD). Giacomo’s research interests are in understanding the pro-regenerative and pain modulation mechanisms of manual therapy and in particular neurodynamic treatment of somatic and autonomic nerves. His research expertise spans neuronal culture (in vivo and ex vivo), in vivo animal experiments with behavioral, histochemical, and molecular analyses, and neuropathic pain patient assessment. Giacomo’s current research focuses on understanding markers in the peripheral nerves responsible for pain modulation and nerve regeneration that are shared between humans and other mammals and seeks to implement clinical treatments for pain and neurodegenerative diseases. He also teaches in both the undergraduate and postgraduate programs in the fields of general neuroscience and neuropathic patient management.

Michel W. Coppieters

Michel is Menzies Foundation Professor of Health Research at Griffith University in Brisbane (Australia), where he directs the Musculoskeletal Health and Persistent Pain Research Group (https://mskhealthlab.com.au). The Group’s state-of-the-art research facility has quickly become one of the best pain labs in Australia and beyond. Although the focus has traditionally been on common musculoskeletal conditions, such as back pain and neck pain, we also research important conditions and side-effects that affect the musculoskeletal system, such as diabetic neuropathy, spinal cord injury and chemotherapy-induced peripheral neuropathy. We conduct lab-based research, as well as clinical research in the community, primary care, and hospital settings. Our research aims to (1) better understand the pathobiology of musculoskeletal and neurological conditions, (2) improve diagnostic procedures, (3) develop and evaluate biologically plausible interventions and (4) assess whether success of these interventions can be explained by reversal of the original pathobiological processes. Michel has successfully supervised many national and international PhD students. He has an excellent track record in mentoring early and mid-career researchers and clinicians, and is well-respected nationally and internationally.