Training – Neurological and Dural testing of the Neck and Lumbar spine.
In this week’s workshop we explore the appropriate testing for neurological issues of the cervical and lumbar spine, usually following injuries in the area such as a disc bulge. With both the cervical and lumbar spine, if there are distal distribution of symptoms (e.g. arm pain with cervical issues or leg pain with back issues), you want to assess the neurological status of the upper or lower limb.
What you are looking for:
- If there is reduced or altered sensation in a dermatome – This may indicate irritation of the nerve root. You would still treat the primary pathology, such as the disc bulge, however, monitor symptoms which should improve as the primary pathology improves
- If there is absent sensation or (most importantly) reduced strength in the myotome – This may indicate nerve root compression – This requires a referral to a specialist (such as a sports doctor or neurosurgeon) for further testing and potential intervention. This does not automatically mean decompression surgery, but an opinion is needed
- Reduced reflexes may be consistent with nerve compression, however, as reflexes can be affected by the testing and whether the patient is actively contracting, use this information together with other neurological testing
- If there is increased reflexes and muscle tone is HYPERTONIC – This may indicate an upper motor neuron issue and must be referred for further testing
Dural tension:
- This is due to scar tissue from a previous healing injury such as a disc bulge
- You will NOT get an acute scar tissue issue; it arises after you have in the healing stages of a back injury
- See the slide on how to assess the dural of the different peripheral nerves
- You can start to mobilise these structures AFTER the disc bulge has settled and is no longer irritable.
- Monitor symptoms and if they worsen, it might be just too early to mobilise these structures
Download the workshop notes
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