Review of Erson Religioso’s Clinical Neurodynamics Webinar Series

I’d like to do a review of a webinar that I have seen and studied through MedBridge. I am a paid customer of MedBridge for continuing education for physical therapy.

I was approached by MedBridge to be part of their affiliate program, whereas the code that we can provide “WeingroffPT” can provide significant discounts for MedBridge.

However, my review of the different webinars is completely as a paid customer, meaning I can say whatever I want and people can look for themselves. If they are interested, they can take advantage of “WeingroffPT” and get some very significant discounts for what MedBridge has to offer, which includes some telehealth options, the webinars that we’re reviewing, and even some home exercise program models that can be provided to your patients.

I looked at my friend Erson Religioso’s Neurodynamics series of two webinars, so you’re going to get your continuing education x 2 based on if your state has this available.

Neurodynamics is a model of treating peripheral pain. While I’m going to talk a little bit about how I interpret those things, but ultimately the peripheral nerves that are off the brachial plexus and the sacral plexus can cause pain in particular referral areas. If there is an approach and angle on the part of the therapist that the pain is being tracked back to one of these nerves that is not functioning ideally, in this case, the nerve itself is not sliding or gliding within its neural sheath, it can elicit a threatening sensation and can be perceived as pain.

So, there’s going to be different techniques that will track to different nerves which would track to different referral patterns. So that being said, it is adding another layer to the sub-evaluation. We have already determined if joints can get into the right positions to absorb and adapt to stress.

In this case they cannot because some movements are being reported with a perception of pain.

So now we’re going to have to determine an angle because there’s many, many different angles, some of which don’t ever make a whole lot of sense of how we can modulate pain. Pain is a perception and Erson goes through a significant amount of time describing his present position and his interpretation of pain science. Now that being said, in my mind, there’s lots of different angles, lots of different thought processes that can be used to change pain and that doesn’t mean another isn’t going to work.

For instance, if we use these neurodynamic techniques to treat and train something and there is a positive response, meaning less pain, I am not personally of the thought process that that would be the only way. Well, we thought we did our tests and there’s certainly other ways such as ultrasound and dissection that can actually add higher layers of confidence that yes, this nerve wasn’t flossing within its sheath, it wasn’t moving and in this sliding fashion. And that was exactly where we felt that the pain was tracked.
That in my mind isn’t still the only way. That’s really where I think we can go a little bit deeper from what Erson was trying to show us and take some assumptions that while we can prove what we tried to do, there’s still no way to prove that that’s exactly what happened.

There’s a lot of things in touch. Erson shows us some of the other things that he would use in conjunction with neurodynamics in terms of some restriction, a band restriction, types of techniques and some of his edge tool instrument assisted. I don’t think it has to be the edge tool. I think that’s a very valuable and versatile tool, but it doesn’t have to be the edge tool. There’s lots of other instruments that could do what he’s showing you to do in conjunction with a diagnosis that this was a neurodynamics issue.

But I want to take things even another step further where if we’re going to suggest that perceived pain could be from this sliding issue. Well, you could also have a sliding issue and not have pain. That sliding issue may show up as a lack of motion and that lack of motion would be part of your keen evaluation.

So, can joints get into the right positions to absorb and adapt to stress. No. So now we have a mobility issue where now perhaps it’s consistent across all different positions and we might require some angle to determine if that mobility is second to a lack of sliding in the sciatic nerve, for instance, or different forms of stiffness through the myofascial components of the hamstrings. Now why is that important? Not because you are treating pain, but because the adaptation of a nerve sliding is very different than relaxation or change in histology of the myofascial components of a contractile element such as the hamstring. Those are two totally separate pieces of anatomy that have two totally separate needs and demands for inputs to change, except they both look exactly the same. There’s lots of folks out there that will suggest that people don’t have tight hamstrings and they rock out a slump test or some kind of neural flossing technique that was also be part very possible to treat pain. But in this case, they find out, look, you can’t stretch a hamstring after 10 repetitions of this active moment.

That’s absolutely correct, but I do think that there’s another layer of testing that we need to look at where that if we do have a mobility issue:

1) Is it at the joint?
2) Is it at the myofascial component?
3) Is it at a neural component?

Because all three of those segments may look very, very similar in a global movement. But again, they’re going to have very, very different requirements for inputs to change. So, I think we can get after a lot of those here with these webinars, even though Erson is primarily talking about his interpretations of pain science as well as the peripheral techniques and how he has adjuncts taking advantage of, of more interpretations of how the body changes.

And while you can always prove what you try to do, you can always prove what was in your head and you can always prove that there is a desirable change at the end.

I’m not sure you can always prove what actually happened because there was probably a number of things that happened.

Changing pain is very multimodal and there’s probably lots of things. It probably also suggests that it’s a silly thing to even be worried about why a person got better. And I don’t think anybody should ever have to apologize for getting somebody to a better place functionally where then they could train. Now, if you’re not going to train, then you’re probably missing the boat in the first place as to why that person had a neurodynamics issue or why they had pain in the first place. Lots of folks like to call these techniques, “tricks.”

But there are sometimes you see some significant changes and I think neurodynamics can be one of those techniques that can lead to those significant changes.

But we need to train.

Once you’ve knocked out pain and you’re knocked out mobility, you’re probably left with motor control and you’re certainly left with fitness.

And those are two qualities that are definitely required to sustain those changes.

They’re not quite adaptations yet because the body hasn’t completely changed. We’re not going to call that an adaptation. Maybe we’ll call it an adjustment. Obviously, that’s going to be confused with some manual techniques, but neurodynamics is something that then has to lead to something else.

I think we’re going to get a lot of that very positive out of Erson Religioso’s neurodynamics webinars.

if you’d like to check out the stuff that we’re reviewing here on MedBridge, visit this link, which has webinars that do have continuing education credits for some states.

If you use “WeingroffPT” you’ll have a significant discount for the different options that they have.

Hopefully, you’ll check it out.

-CW

  • May 11, 2020

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