When presented with a painful movement pattern, the DTM student first considers the neurology servicing that area. Those considerations include the spinal nerve roots, the downstream peripheral nerves, and the superficial neurology. We then apply an empirical “clinical audit process” (CAP) to explore the potential involement at each level of neurology.
A patient presents with pain in the plantar foot that has become chronic and has responded poorly to local interventions targeting the plantar fascia itself. Our investigation might first consider the health of the spinal nerve roots servicing that area. Using a McKenzie-oriented assessment (review the books of Robin McKenzie or the courses from MDT for detailed information), repetitive endrange extension might be applied, followed by a re-assessment of the painful movement to see if the movement is less painful. The peripheral neurology servicing the plantar foot might be screened using neural tension testing (see the work of David Butler and Michael Shacklock for excellent books, DVDs and courses) to attempt to reproduce the familiar pain. Neurodynamics may follow, if indicated, to address the mechanical interface of the peripheral nerves. Locally, the superficial nerves and their course through the painful area are addressed with a goal of “creating space” and improving bloodflow to the involved neurology. With a similar neurodynamics mindset, we lift the tissues around the involved neurology while the painful movement is performed to see if the symptoms improve. If these assessments greatly reduce or resolve the painful movement, then teach the patient to “create space” for the involved neurology and then move in ways to improve the mechanical interface of the neurology.