Differential Diagnosis for Nerve Injuries of the Lower Extremity

Course Outline

This two day intermediate level course provides an in-depth look at nerve injuries and pathologies of the lower extremity from the lumbar spine to the foot. Extensive lab sessions allow participants to practice safe, effective handling techniques that may be used for both assessments and treatments. We will discuss and practice systematic evaluation techniques that emphasize nerve gliding/neurodynamics that may be used to differentiate between proximal lumbar spine pathologies, distal nerve entrapments, and other common orthopedic tissue disorders.

This course will present a foundation by reviewing the structure, anatomy, physiology, and biomechanics of the nervous system and examine how the nervous system responds to stress and immobilization. Neurodynamic evaluation and treatment techniques will require the participant to have a strong knowledge and understanding of anatomy. Participants will learn how use neurodynamic techniques to treat disorders such as piriformis syndrome, hamstring syndrome, tarsal tunnel syndrome, metatarsalgia, knee pain, and groin pain. The material and lab exercises presented can be immediately applied in the clinician’s practice. The clinician will also have an extensive course manual that illustrates all the techniques discussed and practiced during this course.


Course Objectives

• Describe the basic concepts of neurodynamics/nerve gliding and how they can be used clinically.
• Understand the biomechanics of the nervous system and how it responds to stress and immobilization.
• Describe the pathophysiology of the nervous system as related to nerve compression or entrapment.
• Describe pain mechanisms and how they can influence patient problems.
• Demonstrate safe, effective techniques for neurodynamic tests for the lower extremity.
• Demonstrate provocation tests related to the lower extremity peripheral nerves and how to differentiate between peripheral nerve injuries, proximal lumbar spine pathologies, and other lower extremity injuries/pathologies.
• Provide treatment/intervention ideas and progression of treatments for case studies and current patients.
• Develop comprehensive treatment programs utilizing therapeutic exercises, joint mobilizations and nerve gliding techniques.

Schedule of instruction

  Day One   Day Two
7:30 8:00 Registration 8:00 8:45 Femoral Nerve Entrapments
8:00 9:00 Introduction to neurodynamics   • Vulnerable sites
  • Structure and biomechanics of nervous system   • Clinical presentations
  • Nervous system response to stress and immobilization   • Differential diagnosis between groin pain, disc derangement and medial knee pain
  • Classification of nerve injuries   • Assessment and treatment techniques
  • The use of neurodynamics clinically 8:45 9:30 Lab: Femoral Nerve
9:00 9:45 Nerve Physiology   • Nerve gliding for the femoral nerve
  • Nerve Conduction   • Provocation tests
  • Neurotransmitters   • Treatment techniques
  • Ion channels 9:30 10:15 Branches of the Femoral Nerve
9:45 10:00 Break   • Obturator nerve
10:00 10:45 Physiology of Pain   • Saphenous nerve
  • Nociceptive pain   • Lateral femoral cutaneous Nerve
  • Peripheral vs. central pain   • Clinical presentations
  • Output mechanisms   • Assessment and treatment techniques
10:45 11:30 • Spine 10:15 10:30 Break
  • Meninges 10:30 11:15 Lab: Branches of the Femoral Nerve
  • Peripheral Nerves of the lower ext.   • Nerve gliding for the obturator, saphenous, and lateral cutaneous nerves
11:30 12:30 Lab: Palpation of Lower Extremity Peripheral Nerves   • Provocation tests
  • Peripheral nerves of the lower ext.   • Treatment techniques
  • Related structures 11:15 12:00 Lumbar Spine
  • Using nerve palpation for assessment and treatment   • Screen techniques
12:30 1:30 Lunch (on your own)   • Differential diagnosis of proximal vs distal pathologies
1:30 2:30 Core Neurodynamic Tests   • Clinical prediction categories for assessment and treatment
  • Slump   • Quick active tests
  • Straight leg raise   • Passive neck flexion
  • Long sit slump 12:00 1:00 Lunch on your own
  • Using core neurodynamic tests for assessment and treatment 1:00 1:45 Treatment /Interventions
2:30 3:15 Sciatic Nerve Entrapments   • Home exercise program
  • Vulnerable sites   • Using Joint mobilization with neurodynamics
  • Differential diagnosis between hamstring syndrome, piriformis syndrome and other orthopedic injuries   • Biasing nerve gliding for optimal results
  • Clinical presentations 1:45 2:00 Break
  • Assessment and treatment techniques 2:00 3:30 Case studies/problem solving
3:15 3:30 Break   • Review lab
3:30 4:15 Tibial Nerve Entrapments   • Discussion on patient problems
immediately applying neurodynamics with your patients
  • Vulnerable sites    
  • Differential diagnosis between lateral knee pain, chronic ankle sprains    
4:15 5:00 Lab: Tibial Nerve    
  • Nerve gliding for the tibial nerve    
  • Provocation tests    
  • Treatment techniques    
5:00 5:45 Peroneal (Fibular) and Sural Nerve Entrapments    
  • Vulnerable sites    
  • Differential diagnosis
between, lateral knee pain, chronic lateral ankle sprains and other orthopedic injuries		    
  • Clinical presentations    
  • Assessment and treatment    
5:45 6:30 Lab: Peroneal (fibular) and Sural Nerves    
  • Nerve gliding for the peroneal and sural nerves    
  • Provocation tests    
  • Treatment techniques    
       
       
       
       

Downloads

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Course Brochure for Differential Diagnosis for Nerve Injuries of the Lower Extremity

Scheduled Dates and Locations

 

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Course Instructor
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John Ragonese, PT, OCS, CSCS received his Masters degree in Physical Therapy from Northwestern University in 1998. He is a Senior Physical Therapist at Loyola University Medical Center on the Orthopedics and Sports Rehabilitation teams. He is an adjunct faculty member at Midwestern University’s College of Health Sciences in the Physical Therapy Program.

John was recognized by the American Physical Therapy Association in 2005 as a board certified specialist in clinical orthopedics (OCS) as well as a strength and conditioning specialist (CSCS) by the National Strength and Conditioning Association.

John is a member of the US National Tennis Academy and USA Triathlon and has a strong background in orthopedic and sports related injuries.
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