Clinical Notes in Physiotherapy

- The Lumbar Plexus Glide (L2-L4)

- The General Brachial Plexus Glide

- The Ulnar Nerve Glide

- The Radial Nerve Glide

- The General Median Nerve Glide

The patient must understand that he or she needs to accept good pain and avoid bad pain with regard to neural glides. Good pain is muscle, ligament, or skin stretch. Bad pain is neural pain or reproduction of the presenting symptoms. The movement should be quite slow. Typical guidelines initially consist of pausing for 1 to 2 seconds at the onset of symptoms, with gradual progression to holding the provocative position for 10 seconds or longer. Ten repetitions four times per day are prescribed as a starting point. Pain lasting more than 1 hour indicates significant acuity, and the number of repetitions and frequency should be reduced. The position that marks the begining of neurological symptoms is considered to be provocative position, and should be held for seconds depending on the symptoms. After holding, it is important for the patient to return to the starting position before performing the next repetition.

All articular movements produces some degree of nerve gliding to accomodate nerve length changes induced by angular rotation. Several factors may limit the ability of a nerve to glide. A peripheral nerve may demonstrate limitations in normal mobility that results from restrictions in either the extraneural tissues (connective tissue structures around the nerve or between the nerve and surrounding tissues) or restrictions in the intraneural tissues (nerve tissue that composes the nerve itself). Neural mobilization, or neurodynamic, techniques are used in both acute or chronic conditions to develop or remodel extraneural and intraneural scarring into an alignment that facilitates normal physiologic nerve gliding.

✅ Neural Mobilization

✅ Extensor Tendon-Gliding Exercises Diffrential gliding of the extensor digitorum communis tendons to each of the fingers can be achieved by the following progression. - Teach the patient to passively flex the MCP and IP joints of one finger with the opposite hand while actively maintaining the other fingers in extension. - If the patient has difficulty doing this, begin with the involved hand resting on a table with the palm up. Stabilize three of the four fingers against the table while passively flexing one of the digits. Then instruct the patient to attempt to actively keep the fingers against the table while one of the digits is passively flexed. - Progress by having the patient actively maintain the fingers in extension with the fingers spread out and then actively flex each finger in turn while the other fingers remain extended. - Have the patient flex the middle and ring fingers while maintaining extension of the index and little fingers (long horn sign). This promotes isolated control of the extensor indicis and extensor digiti minimi tendons and promotes their gliding on the extensor digitorum communis tendons.

- Initiate the exercises with the wrist in neutral position. - Once full range of the finger motions is achieved, progress to doing the exercises with the wrist in flexion and in extension to establish combined finger and wrist mobility. - Full excursion and tendon-gliding of all the extrinsic muscles are accomplished by starting with the wrist and fingers in full extension, then moving to full wrist and finger flexion, and then reversing the motion.

✅ Flexor Tendon-Gliding Exercises Flexor tendon-gliding exercises are designed to maintain or develop free gliding between the FDP and FDS tendons and between the tendons and bones in the wrist, hand, and fingers. There are five positions in which the fingers move during tendon-gliding exercises. The following progression is suggested.