butler technique study

7/26/2019 butler technique study

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NEURAL MOBILIZATION


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OBJECTIVES

Nerve anatomy and physioo!y

Cini"a #iome"hani"s o$ nerve

%athome"hani"s&pathophysioo!i"a andpathome"hani"a'

%rin"ipes o$ ne(ra mo#ii)ation

*emo Eviden"e on a NTT


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Introd("tion

Con"ept o$ "ontin(o(s tiss(e tra"t

1. Both CNS and %NS need to #e "onsidered as one sin"e they $orm a "ontin(o(s tiss(e tra"t

2. This system is "ontin(o(s in three +ays. The "onne"tive tiss(e is "ontin(o(s atho(!h di$$e

rent in $ormat &epine(ri(m , d(ramater'- A sin!e a.on is asso"iated +ith n(m#er o$ "onne"tive tiss(

es-. Ne(rones are inter"onne"ted #oth ee"tri"ay and

"hemi"ay-


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Introd("tion "ont

The Nervo(s system

In"(des a the ne(ra tiss(e in the #ody

Ne(ra tiss(e Ne(rons

// "es that send and re"eive si!nas

Ne(ro!ia &!ia "es' // "es that s(pport and prote"t ne(rons


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Centra Nervo(s System

Nerve roots are "onsidered to #e more a part o$ "entra than periphera nervo(s system +hi"h in"(demenin!es , a"0 s"h+ann "es 1 re"eive n(trition $r

om CS2- The "onne"tive tiss(e o$ the nerve tr(n0s are very d

i$$ $rom those o$ the roots even tho(!h the same a.on is present in the ventra roots-

Many a(thors have dra+n attention to the $a"t thatthe "onne"tive tiss(e "overin!s in nerve roots arem("h +ea0er, or not present at a&M(rphy 3455'-


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CNS "ont-

6am#e&3478' "ond("ted an ee"tron mi"ros"opy st(dy 1 $o(nd the "onne"tive tiss(e o$ the nerve roots +ere more i0e eptomenin!es&ara"hnoid 1%iamat

ter' than that o$ periphera tr(n0- 9atana#e &34:;' (sin! an ee"tron mi"ros"ope $o(

nd that ea"h rootet has a pia ayer and it resem#ed a +ispy sheet o$ !a(!e-

There are a no- $eat(res at the nerve root eve $or transmission


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CNS "ont--

The $o(rth, $i$th, si.th "ervi"a spina nerves has a stron! atta"hment to the !(tter o$ respe"tive transverse pro"ess-

At se!menta eve d(ra 1 epid(ra tiss(es $orm a"onne"tive tiss(e sheath +hi"h in"(de epid(ra sheath&*ommisse 1


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CNS "ont>

The epid(ra tiss(es and the d(ra "om#ine to $orm epine(ri(ma and the o(ter ayer o$ perine(ri(m+here as the endone(ri(m is the "ontin(ation o$ th

e pia&S(nderand 3458,


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The Ne(ra.is

The ne(ra.is &spina "ord ' is the "ontin(ation o$ med(a o#an!ata and e.tends app to L? verte#ra eve and it tapers to $orm "on(s med(aris-

Brei!&345:' notes t+o methods o$ ne(ra.ia adaptation to stret"h

Un$odin! and (nt+istin! as a.ons strai!hten

Movements in reation to nei!h#o(rin! verte#ra se

!ments-


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The Menin!es

o %ia 1 Ara"hnoid mater @

These are very dei"ate mem#ranes $ar more than d(ramater- A mesh or atti"e o$ "oa!en $i#res ma0e

(p the pia and ara"hnoid maters- This ao+s stret"h 1 some "ompression +itho(t 0i

n0in! &Brei! 345:' and they prote"t the ne(ra eements and ao+in! the movements at the same time-

o CS2, S(# ara"hnoid 1S(#d(ra spa"es @

The s(#ara"hnoid spa"e "ontain CS2 -


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It a"ts as a hydra(i" "(shion s(rro(ndin! the "ordand nerve roots-

o *(ra mater

O(termost ayer menin!ea ayer 1 #y $ar the to(!hest and the stron!est +hi"h "ontains "oa!en and some eastin $i#res arran!ed on!it(dinay &Tint(ri'-

This !ives the d(ra the"a !reater a.ia stren!th &


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Ne(rodynami"s

*e$inition @ Cini"a ne(rodynami"s is essentiay the "ini"a appi"ation o$ me"hani"s and physioo!y o$ the nervo(s system as they reate to ea"h other a

nd are inte!rated +ith m(s"(os0eeta system- 6enera ayo(t o$ the system @

Me"hani"a inter$a"e @ It is de$ined as that tiss(e ormateria ada"ent to the nervo(s system that "an m

ove independenty to the system-


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Ne(ra str("t(res

Innervated tiss(es

The $irst is that they provide the #asis $or some "

a(sa me"hanisms that therapists sho(d pay parti"(ar attention-

The se"ond reason is $or ma0in! spe"i$i" re$eren"e to the innervated tiss(es is that they provide th

e therapists +ith the opport(nity to move nerves- The third reason is $or the treatment #asis&La#a

n et a 34:4'-


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Me"hani"a $(n"tions

Tension @

The $irst primary me"hani"a events in the nervo(s system is !eneration o$ tension-

Sin"e the nervo(s system is atta"hed to ea"h endo$ the ne(ra "ontainer the nerves are en!thened #y eon!ation-

%erine(ri(m @ This is the primary !(ardian a!ainst e."essive tension and is e$$e"tivey "a#in! in the periphera nerve&S(nderand 3443'-


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*ense pa"0ed "onne"tive tiss(e and $ormin! ea"h $as"i"e this possess "onsidera#e on!it(dina and easti"ity-

It ao+s periphera nerve to +ithstand appro.- 3:/?? strain #e$ore $ai(re&S(nderand 3443'-

Sidin! o$ nerves @ The se"ond event is movement o$ nervo(s system reative to their ada"ent tiss(es-This

is "aed e."(rsion or sidin!&9i!is 1M(rphy 34:7'-It is o$ on!it(dina and transverse -


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Lon!it(dina sidin! @The sidin! o$ nerves do+n thetension !radient ena#es them to end their tiss(e to+ard the part at +hi"h eon!ation is initiated-

This +ay tension is distri#(ted aon! the nervo(s system-

2or e!- Median nerve at e#o+


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Transverse sidin!@ It o""(rs in t+o +ays

The $irst is to ena#e the nerve to ta0e the shortest "o(rse #et+een t+o points +hen tension is a

ppied- The se"ond means #y side +ay press(re #y

nei!h#o(rin! str("t(res s("h as m(s"e and tendons-

Sidin! o$ periphera nerve in the nerve #edis provided #y mesone(ri(m and interna sidin! o$the $as"i"es-


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Compression @ Ne(ra str("t(res "an "han!e their shape +hen press(re is e.erted on them-

A "ini"a e.ampe (nar nerve in e#o+ $e.ion -

The epine(ri(m is the paddin! o$ the nerve and it prote"ts the a.ons $rom e."essive "ompression-

It "ontains $iner and ess densey pa"0ed "onne"tive +hi"h !ives them spon!y =(aities and ena#es th

e nerve to sprin! #a"0 +hen press(re is removed-


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Nerve #endin!@ The #endin! o$ the ner(ra str("t(re aro

(nd the inter$a"e is a !ood e.ampe o$ the "om#ini

n! o$ $(ndamenta events to prod("e a more "ompe. a"tion-

E.@ Unar nerve at e#o+


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Movement o$ innervated tiss(es@ In addition to on!it(dina $or"es #ein! appie

d to the nervo(s system $rom the ada"ent to the n

erve, the innervated tiss(es "an #e (sed to prod("es("h events-

2or instan"e *orsi$e.ion o$ $oot and toes (sed to appy tension on s"iati" nerve-


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Movement o$ inter$a"e


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Nervo(s system responses to movement-


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%hysioo!i"a evenets

Intrane(ra #ood $o+@ Bood $o+ o$ the periphera nerves is a

"t(ay maintained #y nerves&nervi vasa nervor(m'

&Bove1Li!ht 344;'- No"io"eptors and sympatheti" $i#res ar

e reevant #e"a(se in addition to potentiay "a(sin! pain they reease s(#stan"e % and "a"i(m !ene r

eated peptide $rom their terminas into the +as o$the #ood vesses&Zo"hodne 1


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Maintanen"e o$ #ood $o+ d(rin! movement@

*(rin! norma movement, nerve #o

od $o+ is preserved thro(!h an intri"ate system o$vesses that distort the nerve-

At rest, vesses are "oied and d(rin!movement they #e"ome (n"oied rather than stret"

hed&S(nderand 1 L(nd#or! 344:'-


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Ne(rodynami" siders


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Ne(rodynami" tensioners


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Spine

Me"hani"a inter$a"e

Ne(ra

Innervated tiss(e


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2e.ion and e.tension

Me"hani"a inter$a"e/ Spina "ana 2e.ion o$ the +hoe spine "a(ses eon!ation o$ th

e spina ne(ra str("t(res #e"a(se they, and their "ana areo"ated #ehind the a.is o$ rotation o$ the spina se!ments-

Ne(ra tiss(es

Tension and strain are the t+o responses $or $e.ion- The amo(nt o$ tension is not "eary 0no+n #(t strain $rom (m#ar e.tension to $e.ion in (m#ar d(ra "an rea"h D

, sa"ra nerve roots 37&Adams1Lo!(eF G(an et a 34::'-


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Sidin! and "onver!en"e Sidin! o$ ne(ra str("t(res is "ompe. in

spine and spe"i$i" se=(en"es o$ movements their o

+n sidin!- $or e!- Ne"0 $e.ion prod("es "ephaad s

idin! o$ ne(ra str("t(res in (m#ar re!ion&Brei! 345:'-


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Latera $e.ion and atera !ide

Me"hani"a inter$a"e

The 0ey event +ith atera $e.ion in reation to me"hani"a inter$a"e is that the interverte#ra $

oraminae "ose do+n ipsiatera side and open on the "ontraatera side&2(i+ara et a ?3'-

Ne(ra e$$e"ts

Latera $e.ion prod("es in"reased tensio

n in the ne(ra str("t(res on the "onve. side o$ thespine and red("e tension on the "on"ave side&Sevaratnam et a 34::'-


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In"rease in tension o""(rs in t+o +ays @

The $irst is that atera $e.ion itse$ prod("es eon!ation o$ the inter$a"e and ne(ra tiss(es

on the "onve. side- The se"ond is #y "a(sin! an in"rease in

distan"e #et+een the spine and the periphery #y side+ay transation o$ the verte#rae&Lo(is 34:3'-

Uses @1. Str("t(ra di$$erentiation-

2. Sensiti)ation-


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Others

Contraatera ne(rodynami"s-

Biatera ne(rodynami" te"hni=(es-


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6enera Ne(ropathodynami"s

Mechanical interface dysfunctions


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Me"hani"a inter$a"e dys$(n"tions

Closing dysfunctions

Pathoanatomical


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Cosin! dys$(n"tions

Red("ed "osin!Symptoms @

Hey #ehavio(ra aspe"t is symptoms in"rease +ith "osin!movements-

%hysi"a $indin!s@

3- %ost(re @

In a"(te and severe dys$(n"tions a prote"tive de$ormity is $re=(enty apparent- This de$ormity is a+ays in the openin

! dire"tion so as to red("e press(re on the ada"ent ne(ra str("t(re


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E."essive "osin!Symptoms @

%rovo0ed #y "osin! me"hanism-


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Openin! dys$(n"tions

Red("ed openin!Symptoms @

Us(ay a"hes and pains in the o"ai)ed area +ith or +itho(t re$erred pain-

Openin! movements provo0e pain and are (s(ay restri"ted-


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%hysi"a $indin!s@ The red("ed openin! dys$(n"tion prod("e a prote"tive

de$ormity on the ipsiatera side (ni0e "osin! type has on "ontraatera side-

This de$ormity is spe"iay desi!ned to red("e tension in the inter$a"in! and ne(ra tiss(es-

%apation @

Tenderness, m(s"e ti!htness and thi"0enin!-

E!- L8/S3 se!ments may #e a""ompanied #y tenderness and ti!htness o$ ipsiatera ere"tor spinae as they imit "ontraatera $e.ion-


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E."essive openin!Symptoms @

A"hes and pains and "an prod("e re$erred pain-

%ins and needes ,n(m#ness "an o""(r in this dys$("tion- Symptoms are intermittent and they are prod("es +hen prov

o0in! movements are done -

%hysi"a $indin!s

No de$ormity o""(rs in this type-

Openin! movements are in"reased and that eads to this disorder-

E.- Cervi"a re!ion "ontraatera $e.ion and rotation-


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%apation @

Tenderness over spe"i$i" sites is o$ten present-


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Ne(ra dys$(n"tions


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Ne(rodynamis tests

9hat to o#serve "han!es in movement, movement dia!ram-

%annin! the e.amination-

Leves-


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Leve ne(rodynami" testin! "ontraindi"ated-

Any "ontraindi"ation $or man(a therapy !eneray e.ists $or ne(rodynami" testin!-

Leve 3 imited e.amination

Indi"ations @3-9hen symptoms are easiy provo0ed and ta0es on! time to s

ette a$ter movement-

?- In "ases o$ severe pain-

D- %resen"e o$ any ne(roo!i"a de$i"it-8-9hen pro#ems sho+s a pro!ressive +orsenin! a$ter physi"a

e.aminantion


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Leve ?/ Standard e.amination

Indi"ations and "ontraindi"ations@

The pro#em is not espe"iay easiy provo0ed and symptomsare not severe-

Ne(roo!i"a symptoms are a#sent- 9hen pain is not severe at the time o$ e.amination-

It is "ontraindi"ated +hen pro#em is (nsta#e, hypersensitive, irrita#e or +hen pathoo!y is present


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6enera points on te"hni=(e@ E.panation to patient

Biatera "omparison

Test the (na$$e"ted side $irst Maintain ea"h movement pre"isey

Be !ente and donot h(rry

Evo0e vers(s %rovo0e

Short d(ration o$ testin!-


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Standard ne(rodynami" testin!

S(mp test

Strai!ht e! raise

%rone 0nee #end


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S(mp test

Introd("tion@ This is (sed to eva(ate the dynami"s o$ ne(ra s

tr("t(res o$ the "entra and periphera nervo(s system $romthe head, aon! the spina "ord, s"iati" nerve tra"t and its e.t

ensions-Indi"ations @


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Steps in s(mp


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Leve Da&ne(rodynami"ay sensiti)ed' The eve Da position o$ the s(mp test in"orporate

s additiona sensiti)in! manoe(vres o$ media rotation and add("tion o$ hip, dorsi$e.ion o$ an0e and "ontraatera $e.io

n o$ spine-


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SLR

Introd("tion@

The SLR is (sed to test the movement and me"hani"asensitivity o$ the (m#osa"ra ne(ra str("t(res and their dista e.tensions-

Indi"ations@ It is !eneray appied in "ases o$ pain and other sympt

oms in the posterior and atera aspe"t o$ the o+er =(arter #(t its (se "an #e +arranted in e.amination o$ the thora"i" spine-

%reparation @

%t in s(pine yin! +ith the #ody ai!ned symmetri"ay-In it p(rest $orm the test is per$ormed +itho(t a pio+-


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Method

Str("t(ra di$$erentiation

pro.ima symptoms @ (se dorsi$e.ion

*ista symptoms@ hip $e.ion prod("es dista symptoms so $(rther di$$erentiation is re=(ired-

A"tive "ervi"a $e.ion @ not re=(ired


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Norma response@

The norma response to the SLR is p(in! and stret"hin! in the posterior thi!h that spreads into the posterior 0nee and sometimes (pper third o$ "a$&Le+1 Sater 34::'-


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Leve 3 @

Te"hni=(e@ %t is in s(pine yin! +ith strai!ht 0nee i$possi#e -%assive dorsi$e.ion is per$ormed and theim# is raised so+y to the $irst onset o$ symptoms-

Leve Da

Te"hni=(e @ the strai!ht e! is raised to the $irst point o$ symptoms, then interna rotation and add("ti

on are per$ormed and dorsi$e.ion is added at the end-


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Treatment !i(deines

Me"hani"a inter$a"e

Not to provo0e symptoms-

Initiay per$ormed as atrai $or D/7 se"onds-

Ne(ra "omponents

siders @ One ended

T+o ended


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Tensioners @ One ended

t+o ended


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Stati" openers


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butler technique study

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