Peripheral Nerve Sliders & Tensioners | Upper Limb Neurodynamics

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The peripheral nerves (median, ulnar, and radial nerve) can easily be visualized using a theratube or similar rubber band. Sliders and tensioners are commonly used in the treatment of nerve related issues after radicular syndrome for example.
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📚 ARTICLES:
- Ellis et al. (2008): pubmed.ncbi.nl...
- McKeon et al. (2008): pubmed.ncbi.nl...
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This is not medical advice! The content is intended to be educational only for health professionals and students. If you are a patient, seek care of a health care professional.

[@hillsongirl1]

he got a hair cut after the median nerve slider lol

[@Garahan]

1:43 median nerve 2:30 ulnar nerve 3:38 radial nerve

[@slevin39kelevra]

Obrigado amigo, você é um amigo! :)

[@michaelminugh5357]

Oh man, I would've loved having this for the exam half a year ago, amazing idea to use the tube to visualize it all.

[@devilshxxter]

Gosh! I'm doing a presentation on this topic. You guys definitely saved my life!

[@Physiotutors]

Good luck with the presentation 👍🏼

[@highthrivinghealth4158]

Yes it was a fabulous tutorial

[@nehahardas4837]

Guys u r doing grt work...🙌 thanks a lot physiotutors😘😎

[@Physiotutors]

Thanks neha!

[@mdkooter]

Thanks, however a little comment : Your instructions are a bit confusing, because visually you indicate the head position opposite in the static examples than in the dynamic movements following. The static examples indicate the head is tilted one way with a certain hand position, while the dynamic examples you show the inverted. I'm sure I'm misunderstanding this, but even after watching it several times I still get confused by it..perhaps in your speech you clarify this but I'm very focused on the visuals and probably don't comprehend it well.

[@Esraa-Hossam]

Thank you guys I will never forget this 😊❤️❤️❤️❤️❤️

[@Physiotutors]

That was our goal. Works wonders if you explain this to patients with a tube!

[@Esraa-Hossam]

@@Physiotutors thanks a lot 😍😍

[@طارقونوس-ذ1خ]

Thanks very mutch you are very creative man, iam from syria and we have here war ans a very much patients So we benfiting from the informations

[@Physiotutors]

Haha, the idea comes from David Butler so we were not that creative!;) Glad you like it though!

[@tonyblom5564]

Great and simply demonstrated to make me see and feel really easy the effect that comes right away. Thank you!

[@juliuschowdhury7033]

BROTHER GRT INFO.. I RE ALLY APPRICIATE . BT CN U GUIDE ME ABOUT OSTEOPATH..

[@Physiotutors]

Good to hear, appreciate it Julias! We're physios and doing our masters in manual therapy, so can't tell you anything about osteopathy.

[@CNu-l6x]

Hello Physiotutors. My question, please, is how to choose to use the tensioner or the slider ? Thank you

[@satyaekhihai4653]

Explained in a very effective way, very easy to understand, thanks a lot.

[@vinista256]

This guy has a Schwarzenegger vibe.

[@robertmclean1714]

Thank you for this very nicely demonstrated video.

[@Physiotutors]

Glad you like it 👍🏼

[@Lv_Av]

Thank you so much! My patient needs both of Ulnar and Radian. It was so clear and easy to remember!

[@nicklas956]

Hi, first I want to say that you are doing a great job. My question is, where can I find the nerve slides in the app?

[@Physiotutors]

Thanks! The app only includes assessment. No interventions, therefore it’s not in the app

[@amyreuban]

Great video. Hypothetically speaking, for someone in late subacute/ or chronic stage what dosage would you reccomend ( reps sets etc) Im a RMT student from Canada and I have lots of info on assesment ( magee text specifically) im looking for more advanced treatment / technique application resources, as the neuro side of rehab wasn't covered all that much in detail. thanks.

[@Physiotutors]

Hey amy Would not specifically aim for a certain set rep scheme. Rather dose as symptoms allow. They shouldn’t increase symptoms

[@newts-fv8kl]

As your one of the few You tubers who replies can you please answer a question for me. I have been told that the tightness in my right shoulder blade is caused by my neck....physio advice is median glide and levator scap strecth, is this correct?

[@Jzinho89]

Great job guys!! Awesome content, it helps me a lot 🙏

[@Physiotutors]

Thanks Joao 👍🏼

[@michellehamilton4075]

This is great information. Where can I get one of those rubber hoses and what are they called? Thank you!

[@SOYANAPIEDRAHITA]

me encanta, me fascina, tanta teoria explicada en menos de 5 min, thanks , Kai. your videos are great guys.

[@aryandev6780]

Sir can u pls tell me , after doing bicep workout why am feeling pain in my left side of bicep to front shoulder and I feel little numbness in corner of thumb and and tingling when I sit on both the legs it's been a month , I m feeling good after doing ur exercises, pls reply me sir

[@davidsychan]

Fantastic! Thank you so much!

[@Physiotutors]

Happy to hear that you like our video David! Thanks for following us!

[@sontakkerohit]

Do you have any resources that would help with intervention and also for outcome assessment? It would be great if you take a moment to direct me .

[@mannrawatofficial6991]

can u suggest me better exercise for weak hip abduction end range knee extension n fr over supination and there is flexion posture of upper body. while walking n standing in stroke case. these are problems i am getting to make the patient walk.

[@sheryvalsan2405]

What is the difference between sliders and tensioners..

[@Physiotutors]

Gliding techniques, or ‘sliders’, are neurodynamic maneuvers that attempt to produce a sliding movement between neural structures and adjacent nonneural tissues, and they are executed in a non-provocative fashion. As the name implies, the purpose of neurodynamic tensile loading techniques is to restore the physical capabilities of neural tissues to tolerate movements that lengthen the corresponding nerve bed. It is important to emphasize that tensile loading techniques are not stretches; these neurodynamic maneuvers are performed in an oscillatory fashion so as to gently engage resistance to movement that is usually associated with protective muscle activity (Butler, 2000; Shacklock, 2005). The vigor of technique may be adjusted to elicit gentle stretching sensations or to evoke mild symptoms in rhythm with each oscillation (Butler, 2000). Tensile loading techniques are more aggressive than neurodynamic ‘sliders’ (Butler, 2000; Shacklock, 2005), and they are not indicated in patients with clinical evidence of impairments in impulse conduction.

[@ranadiaa6335]

Thanks I really can understand it clearly now 😍😘

[@Physiotutors]

Glad you do!

[@johnm8261]

This video is top!! Thank so much for sharing 😊

[@mjclaudianava5397]

Hi thank you for the video. Should we bend the head towards or away from the hand for ulnar nerve when the hand is in extension?

[@mazbrighton8056]

Great video, thanks. It threw me off that you got a haircut half way haha.

[@Physiotutors]

Haha, had a hair dresser on the set!;p Just kidding, sometimes we have do to retakes a week later or so.

[@ginavanulzen6681]

I was told one of these tests is a shoulder impingement test and I got a positive sign, im a rock climber so my arms are often overhead in internal rotation which increases the risk for shoulder impingement. I don’t present with any shoulder pain but I have been having occipital headaches and I’ve also had finger injurys on the same side. Should I be doing these glides?

[@thealchemylab007]

Good work But music is irritating

[@Physiotutors]

Heard that one before, but it kind of became our tune!;)

[@hassanbeddaa1435]

Nice work tutors! Although my English is bad I will try to ask you my question. How to know if our patient has extra neural lesion or intra neural lesion? And if we must juste use sliders in extra neural and tensioners in intra lesion or both

[@hassanbeddaa1435]

And thank you very much

[@Physiotutors]

Don't think we are able to distinguish that. We first treat the interface (place where a peripheral nerve gets entrapped), then perform sliders (less provocation, should be pain free) and progress to tensioners. This build up has nothing to do with intra- or extraneural lesions, but more with progression.

[@hassanbeddaa1435]

Thank you Physiotutors. So, there is no assessment able to distinguish between the 2 lesions.

[@Physiotutors]

Not that we know of

[@---wb5ql]

Great video!! Thank you! I have scalene tightness and brachial plexus entrapment due to probably the first rib? (Chiropractor first rib adjustment helps a lot). What do you think I should do? I have been suffering for 7 months

[@altaykosova5910]

theacher s should watch this video great job!

[@Physiotutors]

Feel free to recommend the video to your teachers - maybe they implement it in their teachings?;)

[@sangeetahazarika-ge3if]

How to get the thera tube

[@dmzabo3914]

This is where my Caucasian shows up...I have absolutely zero rhythm to do this in one take. Thank goodness for pause and rewind. lol. Hope all who need this help find it

[@Physiotutors]

You got this. 1 and 2 and 3 and 4 and

[@ganirintiniano]

It feels like when i was trying to lear how to do "popping" in breakdance 💪

[@sowrabadhikary8706]

Great video.... Thank you sir❤️

[@kristab6862]

Excellent video! Thank you!

[@okashakhan8433]

Amazing and informative videos! thank you so much sir❤

[@vigneshrider6850]

Guys r u have any Physiotherapy college

[@Physiotutors]

Haha, no we are still part-time Master students ourselves. Maybe in a couple of years - who knows?;)

[@vigneshrider6850]

Physiotutors I'm going to finish my UG how can I join Masters in ur institution

[@Physiotutors]

Our Master's is in Dutch, so you'd have to learn the language first.

[@hassanbeddaa1435]

Hi tutors I have a question please. In the case of CTS, we must began with wrist dorsal flexion first or let it as a final step in treatment?

[@Physiotutors]

Check out this blog post discussing neurodynamics in CTS: www.physiotutors.com/reblog-carpal-tunnel-syndrome/

[@missinesse]

Hi, I have a question if you dont mind. How can correct a pelvic position for a patient with chronic low back pain ? Sorry I know it has nothing to do with this vidéo

[@missinesse]

I mean procedure. What exercice can we give to do at home? And which questions should we ask first ?

[@TheHeartofStillness]

Did body work for years,why was I never tight this? YOU ROCK!

[@Physiotutors]

Gotta eat big to get big 😉

[@eyal297]

Great! Thank you!

[@bepe999]

Does it have the same effect without the Theratube?

[@Physiotutors]

The tube is only for illustration purposes to show what the nerve is doing

[@basantsheta8818]

The best

[@MrUsername0426]

Hi, could you direct me to the research you were citing at the beginning of the video? Thanks :)

[@Physiotutors]

Check the links in the description

[@akselkerim5704]

Hi! You made a great job!! I'd like to ask why you haven't performed all the gliding techniques with contralateral neck flexion?

[@Physiotutors]

Because Contrapateral neck flexion is used in tensioners

[@mohammedalmosawe7672]

is there any test for traps and rhomboid tear also rotator cuff and shoulder blade position thank u

[@Physiotutors]

Never heard of a trap or rhomboid tear - basically never happens. Use the search function on our channel to learn more about "scapular dyskinesis" and "shoulder impingement"

[@azharta3850]

This one is great!!!

[@Physiotutors]

Thanks a lot 😊 we’ve also made one for the lower extremity

[@azharta3850]

Thank you for that too!!

[@oscargadorjr.4238]

how does ulnar gliding influence pain relief?

[@Physiotutors]

There are a couple of theories such as improved gliding of the nerve within the epineurium, and blood flow/oxygen to the nerve, but to our knowledge noone really knows yet. Pain is complex.

[@Fatima-jf8tg]

great!!!! thaaanks

[@killjoythree-five3916]

Great video

[@sagarikasharma4108]

Hello sir.. Where can I get this band?

[@Physiotutors]

This one is from physiosupplies

[@sagarikasharma4108]

@@Physiotutors okay thanks

[@devinnazareno7107]

omg thank youuuuuuuuuuuuu huhuhu

[@walidmakki]

Can you have more than one nerve injury together

[@Physiotutors]

Of course

[@nurk5230]

perfect! thank you

[@manuelapressenda1017]

AMAZING!!!! THANK YOU!!!

[@Physiotutors]

You're Welcome! 😀

[@jessicasmith7666]

Are these two ended slider exercises?

[@Physiotutors]

A two ended slider is a tensioner

[@rahimaallauddin954]

Conceptual....

[@babymarcus123]

Excellent

[@pr6613]

Nice work! I would like to ask if shoulder depression is a important component during sliders? Thanks

[@Physiotutors]

It can be used, but it doesn't matter too much how you build it up plus it's hardly possible for a patient to add shoulder depression themselves. We like to teach sliders and tensioners to our patients as a home exercise.

[@eyal297]

For those who dont know how to depress the shoulder actively, you may find it helpful to instruct them to do so while the scapula is put against a wall with some weight shift to it while depressing it prior to the exercise. I'd suggest adding that when the patient is advanced in sliders and doesnt get mildly provoked without this depression.

[@benishbhatti6624]

Can u come in Pakistan???

[@Physiotutors]

Do you mean for holidays or for a lecture?

[@mindigoodman7217]

you guys are the best! thank you!!

[@Physiotutors]

Appreciate it Mindi, thanks for following!

[@alifjamal2221]

can I know the recommended dosages for sliders and tensioners? like how many reps? how long do I hold?

[@Physiotutors]

There are no recommended dosages to our knowledge. We recommend our patients a couple of repetitions throughout the day, for example 3 times a day and 10 reps. The idea is to start with sliders (less provocative) and progress into tensioners (with slight provocation). There is no end-range holding time or whatsoever

[@alifjamal2221]

thank you for the reply!

[@ranjitm07]

Neural mobilisations should be medium to large amplitude and u should not hold end range position more than second according to shacklock

[@aminajappie3415]

Awesome!! Thanks 👏

[@Physiotutors]

Happy you like it Amina!

[@areebasid2259]

Thankyou for making this video. It will help us. But please make a vdo on how to assess a patient for back pain

[@Physiotutors]

Ur welcome Areeba! That's too much for one simple video. Our backpain guideline video series can give you ideas what to do!

[@highthrivinghealth4158]

Great explanation!

[@Physiotutors]

Happy you like it!

[@blimplock]

Thanks for all your tutoring, much appreciated! Any thoughts on number of repetetions, sets, frequence when doing nerveglides?

[@Physiotutors]

You're welcome! Not sure if there are any studies showing that a certain volume is better than another. We advise our patients do them several times a day and then around 10-20 reps.

[@blimplock]

Physiotutors Thank you so much. Another question: some therapists claim that tensioning of a nerve (as in home exercise) may cause ischemia and therefore not should be done. Only gliding techniques. Any comments?

[@Physiotutors]

Neural tissue mobilization techniques are passive or active movements that focus on restoring the ability of the nervous system to tolerate the normal compressive, friction, and tensile forces associated with daily and sport activities. It is hypothesized that these therapeutic movements can have a positive impact on symptoms by improving intraneural circulation, axoplasmic flow, neural connective tissue viscoelasticity, and by reducing sensitivity of AIGS (Butler 2000, Shacklock 2005) So you are trying to improve blood circulation through movement. We are usually starting with the interface (is there anything the entraps the nerve?), followed by sliders (less provocative) and progress towards tensioners as you want to increase tissue tolerance to stretch, which does occur in activities of daily living as well! Be careful that your patients don't exercise with too much discomfort and overdo it!

[@blimplock]

Physiotutors Thank you again; I always work on interfaces if present, and progressing to gliding movements. But have been somewhat unsure and sceptical when it comes to clean stretching of the nerve, because of what i.e Chris Dukarski says. Guess one should try out gentle stretching and see the effect.

[@VS-id2yn]

*me watching this* wow this is so cool I will probably NEVER forget this!! Also me trying to do this with my theraband: That escalated quickly... xD so let`s watch this again ;)