Journal of Orthopaedic & Sports Physical Therapy

2001;31(5):224-225

Neural Mobilization: The Impossible

Richard F! Di Fabio, PhD, PT
Editor-in-Chief

cringe every time I hear a physical therapist claim that they use "neural mobilization"
to treat a patient who complains of pain or limited joint motion.

The basis of mechanical assessment is formed by understanding the relationships be-

tween limb movement and changes in the patient's symptoms. When symptoms a p
pear or worsen with joint stress and then lessen or disappear with a reduction of joint ten-
sion, these patterns give us clues about pathology. Too often, however, we assume that hints
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about a disease process provide absolute verification of a pathological condition. The error
of our assumption is compounded when we develop treatments for structures that may not
be the source of the patient's problem.

A prime example of the leap from mechanical assessment to the identification (or misidenti-
Copyright © 2001 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.

fication) of structural pathology is when we claim that "adverse mechanical tension in the
nervous system" is the cause of the patient's complaint. The dialogue between Coppieters et
al and David Butler, MAppSc, PT in this issue of the Journal provides the readers with a fasci-
nating look at the complexities clinicians face when attempting to interpret neural tension
tests.

No one doubts that nerves move when we move, but localizing the problem to nerves that
are supposedly unable to slide in the neural sheath is done clinically (and by necessity) with-
out direct measurement of the mobility of nervous tissue. Motion of the limbs for "tension
Journal of Orthopaedic & Sports Physical Therapy®

testing" does not allow anyone to specifically identify the structures that create patient symp
toms. Performing the slump test%r the upper limb tension test,'-2for example, can stretch
limb muscles, joint capsules, and other soft tissues, just as sure as it can stretch the peripher-
al nerves and the spinal d u n . The use of "sensitizing maneuvers" (ie, the use of ankle dorsi
flexion or passive neck flexion to increase mechanical tension on neural tissue) does not
help us localize the tissues at fault because other structures are moving with the nerves dur-
ing these procedures.

Butler and Giffordl have emphasized that "a positive tension test does not necessarily indi-
cate that there is a mechanical disorder of the nervous ~ystem."p"~~but this cautionary note
falls on deaf ears for those who have accepted the jargon of "neural tension testing" and
advocate the treatment of limited neural mobility.

There is no plausible evidence that we can mobilize neural tissue independently of other an-
atomic structures in living people or that "neural mobilization" is effective in the treatment
of musculoskeleltal dysfunction. In addition, there is no evidence that neural tension tests
are sensitive and specific indicators of impairments caused by abnormal neural mobility. If a
patient has a positive upper limb tension test, for example, there could be a multitude of
problems unrelated to "neural tension" that create a painful response to this test.

Using theory to build support for assessments and treatments is a necessary first step in de-
veloping testable hypotheses about the mechanisms that underlie physical therapy interven-
 tions. We have assumed too much, however, when it comes to neural tension tests and the
treatments associated with these a~sessrnents.'.~

When we arrive at the cross road between theory and practice, we often forget to insist on
the validation of assessment tools. In the case of neural tension testing, too many of us have
simply accepted the speculation about what these clinical assessments really test and measure.

REFERENCES
1. Butler DS, Gifford LS. The concept of adverse mechanical tension in the nervous system. Part 1: Testing
for 'dural tension.' Physiotherapy. 1989;75:622-629.
2. Butler DS, GiffordLS. The concept of adverse mechanical tension in the nervous system. Part 2: Exami-
nation and treatment. Physiotherapy. 1989;75:629-636.
3. Johnson EK, Chiarello CM. The slump test: the effects of head and lower extremity position on knee
extension. ] Orthop Sports Phys Ther. 1997;26:310-317.
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Copyright © 2001 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
Journal of Orthopaedic & Sports Physical Therapy®

J Orthop Sports Phys Ther-Volume 31 .Number 5.May 2001 225

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