Tensioners and Sliders

Prepared by

Dr.Aparna Kulkarni(PT)

Dr.Meena Nair(PT)

Neural Mobilization

• Mobilization of nervous system is an approach to physical treatment of pain.
• This technique propose to reduce Mechano-sensitivity by improving the ability of neural tissue to tolerate mechanical force during movement (NEE et al 2011)
• Neural mobilization techniques are used to decrease adverse mechanical tension on the nerve
• This technique frees up the nerves which so that it can slide in it’s sheath.

Physiological effects of Neural Mobilization

• Restore the dynamic balance between the relative movement of neural tissues and surrounding mechanical interfaces
• Facilitation of nerve gliding
• Reduction of nerve adherence (viscoelastic properties),
• Dispersion of noxious fluids,
• Increased neural vascularity (intraneural bloodflow), and
• Improvement of axoplasmic flow

Two types of techniques are commonly used treating patient with nerve related pain

1. Tensioners.
It’s a neurodynamic test that produces tension in the neural structure
2. Sliders.
Neurodynamic manoeuvre to produce sliding movement of neural structure relative to their adjacent tissues.

Effects of Tensioner

• Involve elongation of nerve bed.
• Beneficial effects by pumping action of nerve.
• Reduce intraneural pressure and improve circulation. (Coppieters et al 2008)
• Produces tension in neural structure but does not surpass the elastic limit.
• Activate viscoelastic, movement related and physiological function in nervous system.

Effects of Sliders

• Involve combination movement at different joint.
• Elongation of one nerve bed is balanced by reduction in length of nerve bed at another joint.
• Less aggressive technique.
• Appropriate for acute conditions and post-operative management.
• Reduction in nerve tension limit the possibility of causing nerve irritation and inflammation. (Coppieters et al 2008)

Indication

• Used in non irritable condition ( Neuropathic/ Neurogenic)
• For patho-mechanical causes.
• Fibrosis
• Connective tissue adhesion.
• Restriction of normal tissue mobility.

Contraindication

• Malignancies of the nervous system or vertebral column
• Acute inflammatory infections.
• Areas of instability.
• Spinal cord injuries.
• Suspected disc lesions.
• Cauda equina lesions.
• Dizziness related to VBI.
• Any central nervous system disorder( Spina bifida, MS)