Question about nerve glides for sciatica

[dptontheway]

Hi all,

I've been an aide for two DPTs. The first didn't perform nerve glides at all for patients with sciatica, citing that he found it often made the patient worse. The second DPT is at the opposite end of the spectrum. I've seen him perform nerve glides with all the sciatica patients. All three are in extreme pain when he does them, even the guy who has no sciatica pain, only numbness. One woman literally begs him to stop, another cries, and the guy curses a storm and apologizes, gripping the table. I quietly asked the guy what the pain was like from 1 to 10 and he said an 8. I haven't learned about nerve glides yet but this seemed intuitively too aggressive.

The guy has since gotten ischial bursitis and hamstring tendonitis in the leg that was being treated. His exercise programming wasn't hamstring heavy and my guess is he got the bursitis /tendonitis from the nerve glides. Of course I don't want to question my boss's technique so I thought I'd ask you guys. How much are these supposed to hurt? I see online that pain should be nothing beyond mild discomfort. I could see if the nerve was severely inflamed it would hurt to move it at all, but the guy with pain and no numbness was in equal pain. My boss is literally breathing hard after performing them. He does 10 once a session. So what have you been taught about this? Thanks a lot in advance.

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[SuckyGolfer]

How to do them: Depends who you ask. I've always done them gently to as tolerated. Some don't do them as you've said. Sounds like your boss is being too aggressive to me too but, as far as I know, there really isn't evidence based guidelines on the force or how aggressively that one should do it.

 

[dptontheway]

Thanks for the answer. Are they discussed in a specific textbook? How does a DPT learn the technique? Also, isn't there some standard of care? Thanks again for your help.

 

[SuckyGolfer]

I used to own this book but I don't have it any more. I don't think there is a standard of care in terms of doing them or not doing them, and if you do do them at what dosage, so to speak. You learn the basics about them and how to do them in PT school.

Michael Shacklock FACP MAppSc DipPhysio

Clinical Neurodynamics: A New System of Neuromusculoskeletal Treatment​

 

[LostLlama]

Why would your "...boss literally be breathing hard after performing them"? HE shouldn't be doing anything?