Wednesday, October 17, 2007

Reflections on the Upper Limb Neurodynamic Test (ULNT)

It is worth reflecting on a test now widely used in clinical diagnosis and therapy within physical therapy, yet still with little attention outside the world of physical therapy.

Taken from Figs 12.2D, 12.2E, 12.2F, 12.2G From Butler DS 2000 The Sensitive Nervous System, Noigroup, Adelaide

The Perth based physiotherapist, Bob Elvey, via research and teaching was instrumental in getting the test integrated into manual therapy management in the late 1970s and 80s. Bob always had an emphasis on skilled handling, and perhaps a reason for slow integration outside physiotherapy is that it can be difficult for unpracticed hands. I always liked a description of the test as the “straight leg raise of the arm” (Kenneally et al., 1988) and hoped that this would enhance clinical integration.

In early writings (Butler, 1991), a fairly peripheral and mechanistic approach to the test was taken; the neuroscience revolution in knowledge was yet to unfold. These days we realize that the responses to the test (and also the performance of the test) will be dictated by the underlying pathobiological mechanisms. Simply said, if a person has peripheral neurogenic mechanisms related to scarring, pinching, blood around a nerve, or ” mechanosensitive hot spots” etc in the peripheral nervous system, then the test is very likely to reproduce these problems and identify a neural tissue health issue. However in other pain states where central mechanisms are dominating (eg fibromyalgia), the test needs to be seen as a test of movement rather than a test of damaged tissues.

In summary, the ULNT is a test of all tissues in the upper limb with a preferential focus on the median nerve and its associated plexus and roots. It is also a test of the neural representational stability of the ULNT movement and the meaning of the movement to that person.

For optimal test performance and analysis see “The Sensitive Nervous System” or the neurodynamics DVD. For up to date research on aspects of the test and neurodynamics, Pubmed Coppieters MW.

Butler, D. S. (1991). Mobilisation of the nervous system. Melbourne: Churchill Livingstone.

Kenneally, M., Rubenach, H., & Elvey, R. (1988). The upper limb tension test: The slr of the arm. In R. Grant (Ed.), Physical therapy of the cervical and thoracic spine. New York: Churchill Livingstone.