Neurodynamic Exercises in College Athletes With Musculoskeletal Pain: A Critically Appraised Topic.

CLINICAL SCENARIO: Pain is a common complaint following an orthopedic injury; however, the exact cause of nociception can be complex. Multiple tissues can generate a patient's complaint of pain, such as the skin, muscle, ligaments, tendon, nerves, and bones. Regarding the somatosensory system, inflammation around the nerve can create pain and alter movement coordination; this information has resulted in increased awareness of neurodynamic assessments and exercises. Neurodynamic assessments and exercises provide a unique paradigm to effectively assess and treat neural tissue, which may not commonly be considered within the traditional orthopedic examination. CLINICAL QUESTION: In college athletes with musculoskeletal pain and activity impairments, does the use of neurodynamic exercises improve pain or function? SUMMARY OF KEY FINDINGS: Of the 5 studies, all consisted of chronic injuries with 3 involving upper-extremity pathologies and 2 focusing on lower-extremity pathologies. All 5 studies noted short- and long-term improvement following the incorporation of neurodynamic sliders or tensioners into the treatment plan. Four of the studies had follow-up periods greater than 30 days with sustained improvement on patient outcomes. Only 2 studies described a progression of neurodynamic exercises through sliders and tensioners. Three studies utilized a set/repetition format for exercise prescription, whereas a fourth used a time-based format, and a fifth article utilized both. Finally, 4 studies utilized neurodynamic assessments to identify whether there was a neural component to the patient's presentation (eg, peripheral nerve mechanosensitivity). CLINICAL BOTTOM LINE: In individuals with musculoskeletal impairments, evidence exists to support the use of neurodynamic exercises, such as sliders and tensioners, to improve pain and pain-related disability when neural sensitivity exists. STRENGTH OF RECOMMENDATION: Grade C evidence exists to support the use of neurodynamic exercises in college athletes with a musculoskeletal impairment.

Diagnosis of Concussion on the Sidelines.

The forthcoming discussion will review the current state of the literature surrounding best practice guidelines for diagnosis of sports-related concussions on the sidelines. A sports-related concussive event is a complex process to define, which further increases its diagnostic process. At present there is no singular, gold-standard assessment tool available for the diagnosis of sports-related concussions on the sideline. Current best-practice recommendations suggest the utilization of a multifactorial examination process in a controlled environment. Sideline evaluations must include assessments of symptoms, physical and neurologic status, cognitive function, balance capabilities, and clinical assessments for the presence of cervical spine injuries, skull fractures, and intracranial bleeds. Clinical utility is emerging for involvement of assessments of oculomotor and reaction time function, medical spotters/replay technology, and equipment-based motion/impact sensors. The diagnostic process of sports-related concussions can be enhanced when performed by a sports medicine professional with specific experience with the patient at hand due to increased familiarity with premorbid patient disposition and function. Larger scale research studies with sound methodological processes is needed to further bolster best practice recommendations, with specific attention to the youth demographic.