The Evolution of Neurodynamics with Michael Shacklock
Unlock the secrets behind nerve biomechanics and discover how cutting-edge research is revolutionizing neurodynamics in rehab. If you've ever wondered why some patients respond differently to treatment or how to better assess nerve health, this episode is your ultimate guide. Join Michael Shacklock, a pioneer in neurodynamics, as he delves into the latest breakthroughs, revealing how nerves respond to load, compression, and movement—showing that nerves aren’t just static structures but adaptable tissues with cellular properties that change over time. Learn how validation of neurodynamic tests can improve diagnostic accuracy and influence treatment strategies, especially for conditions like carpal tunnel syndrome and radiculopathies. You'll discover: How nerve movement isn't just about strain but involves compression, stiffness, and the energy dynamics within nerves. The latest research on nerve adaptation, neurogenic inflammation, and how nerves respond to injury, metabolic factors, and systemic health issues.Practical insights into how to incorporate neurodynamic principles into everyday clinical practice—using simple yet effective techniques like openers and dual-system approaches. How joint restriction, connective tissue changes, and movement sequencing impact nerve health and treatment outcomes. Understanding the difference between cooperative and competitive models of anatomy can prevent common pitfalls in rehab. This episode emphasizes that advancing your practice means blending science with creativity, applying mechanisms systematically, and staying curious. Whether you're a seasoned clinician or a student, you'll walk away with a clearer understanding of how to integrate nerve mechanics with musculoskeletal rehab—ultimately helping your patients move better, heal faster, and prevent injury. Don’t miss this chance to elevate your neurorehab toolbox. Perfect for physiotherapists, chiropractors, and trainers eager to keep pace with innovation and those committed to practicing with precision rather than protocol. Guest Michael Shacklock is a renowned researcher and clinician, known for pioneering work in neurodynamics and neural biomechanics, transforming our understanding of nerve behaviour in health and disease. Stay ahead—embrace scientific curiosity and learn how to make neurodynamics work for you today!
Full Transcript
Michael Shacklock (00:00.406)
at one of the Aon conferences and people said, look, know, what did you have to do to write your book or whatever? And I said, deal with lack of sleep. I used to write from 10pm until 2am after treating patients all day. you know, it's part of my habit. Yeah, that's right. Yeah. My pleasure. Absolute pleasure. Thank you.
Beau Beard (00:00.722)
Ahem.
Beau Beard (00:15.302)
And now this was the result. Yeah. Well, thank you. Well, how have you been?
Michael Shacklock (00:26.158)
I've been good, working hard, growing the business recently. We've moved to a better e-commerce system. Got a lot of new ideas for some new material and yeah, changing the curriculum, developing stuff. What can I say? It's great. Doing research. I published another couple of studies recently on nerve biomechanics, which was one of my favourite areas. I know there's a lot of discussion about going into pain science and chemistry and sensitivity and all that sort of stuff. Good. But also mechanics.
Beau Beard (00:39.974)
Yeah.
Michael Shacklock (00:56.162)
how you move I think, certain times in the nervous system can be important.
Beau Beard (01:00.358)
Well, that's kind of where I wanted to start. That was my first question was what are some big updates or evolutions within NDS, whether that's from the research standpoint or things that you started to think about differently. So maybe we can dive into some of the research that you got going. Yeah.
Michael Shacklock (01:17.826)
Yeah, yes of course, I can give you good summary of some of recent research, partly what we've done and other groups as well, yeah absolutely.
Beau Beard (01:23.6)
Yeah.
Yeah. So what, uh, what have you been working on?
Michael Shacklock (01:28.896)
Okay, so I work in a lab in Barcelona, which is a, it's Acium, Acuma, and anatomy, I think they're going to change their name, but it's a functional anatomy lab. Now there's, in the past has been quite a lot of criticism of using cadavers, but how long can we, we need to look at cadavers for, but actually we've got a fresh new look at them and particularly measurement. And so we're now looking at not just strain in nerves, which has been a
hot topic for a long time but actually more expansively how nerves move and what are the physical behaviors inside the nerve and in relation to the interface. know fortunately we've pretty much validated how to how if you change the specific sequence of your neurodynamic test you can now change the diagnostic efficacy rating for something like carpal tunnel syndrome.
and we've we've always been looking for a variable and one of them we initially started with strain so we're thinking that if you start testing at the wrist with the neurodynamic test and then finish at the neck then you would put more strain on the nerve and the wrist therefore it be more sensitive but after quite a few studies including other groups such as michelle coppola's group and with bob knee that wasn't found to be true and so we will i got caught
Beau Beard (02:31.238)
Mm-hmm.
Michael Shacklock (02:52.3)
I got quiet and a little bit worried that maybe we were teaching a certain good thing, but for the wrong reasons or reasons that we didn't understand. And now we've really got a good handle on it now. We've now realized that strain is only one of the physical variables in a nerve when you load it. It's also compression. if you do wrist extension, it naturally elongates the nerve here, but you also compress the nerve in the tunnel. And so strain is only a longitudinal measurement.
Beau Beard (03:19.43)
Mm-hmm.
Michael Shacklock (03:22.224)
It's not a transverse measurement. And so what we've learned is that if you measure a variable that combines the two, bingo, there you have it. And it's about the energy in the nerve that potential energy will stretch in the compression, actually turns out to be stiffness.
and still a girl he says a loaded structure a stiff structures a loaded structures a stiff structure true and the same with the tendon or nerve and we've found that you can load a nerve with movement with sequencing producing greatest stiffness at various locations depending on the sequence now that's all very academic but actually we've also shown that the changes the diagnostic efficacy ratings in carpal tunnel syndrome sufferers compared gold standards such as electrophysiology so that's really good
Beau Beard (03:44.944)
Hmm.
Beau Beard (04:08.742)
Mm-hmm.
Michael Shacklock (04:09.552)
from a specific perspective. You're very experienced with this. You will know that there's a big movement in physical therapy to be more general. Don't worry, be happy, be healthy, move well, move a lot, keep your BMI down, your glycemic index correct and so forth. Absolutely true. But that has a lot of generality about it. So if you just do move a lot and you move reasonably well, you're okay. But we're finding that
Beau Beard (04:33.606)
you
Michael Shacklock (04:39.522)
with the specifics at certain locations, certain situations can be really important. And that's one example of validating a mechanism through to diagnostic outcomes in the clinic.
Beau Beard (04:44.486)
Mm-hmm.
Beau Beard (04:50.438)
Well, for people that might be listening that aren't, you know, extremely familiar with neurodynamics, if we use dive in, cause I'm, I mean, I'm, could ask you a million questions as I kind of prompted you with, when we're looking at that stiffness, you know, parameter of a nerve, and then we know, you know, kind of like tendons, right? If we have a compressive side of the tendon work and on tendonopathy, we know that that doesn't always work out the best. How does that change what we're doing?
diagnostically and then how does that change what we're doing treatment wise or is it just change how we're looking at it? Do those not change?
Michael Shacklock (05:22.942)
right. good. Right. And so changing what we do subsequently like in treatment, that's important because, you know, I think science should provide benefit to the community, you know, society. And then you see a lot of ivory tower science that doesn't really show you that it's got no practical value yet. And so terms of practical value, we now can localise where the problem is a bit better. And we're also showing in another work with Elena Bueno up in the University
of Theragatha there where they do electrophys on various techniques on the wrist, showing that nerve mobilizations improve electrophys better than, sorry, the static opening techniques that we do, we teach, actually improve electrophysiology better than nerve slider techniques, or nerve mobilizations. so, yeah, yeah, so the idea is that they're included on the basis of suspected carpal tunnel syndrome.
Beau Beard (06:09.35)
Regardless of the diagnostics, like if we tried to suck out like,
Beau Beard (06:22.15)
Mm-hmm.
Michael Shacklock (06:22.21)
then they're tested electrodiagnostically and found to have it, and of those people, you can do a static opener technique or a nerve slider technique, and the static opener improves electrophores better than the slider technique. Now, that's kind of...
That's challenging because again, we used to think we'll just slide the nerve. It's about sensitivity It's not about loss of nerve movement true to some extent But we're finding that certain techniques from different directions produce better effects of the biological area anyway And some people that that could go through to better clinical outcomes But that's just an early study where we're measuring variable but biological variables showing good results with specificity There's a compressive problem Sorry
Beau Beard (06:57.893)
Mm-hmm.
Beau Beard (07:04.912)
Well, think I've even, I don't want to put words in your mouth, but I think I've even heard you say if you had to kind of, if you had to almost like guess your way through a neurodynamics treatment, you, I think you've even said like lean on openers. Like if I had to like kind of just like do something and maybe I, maybe I heard that wrong, but I thought I heard you kind of.
Michael Shacklock (07:22.09)
No, you're correct. That's correct. That's absolutely correct. You know, on the course, we say, look, if you come to the end of the course, it's just a little overwhelming because it's packed with stuff. And you kind of can't integrate it all on day one. So just pick out the parts that are high value at first and then migrate to other more technical things. Unloading nerves, I think, is a big feature. And as you say, openness, absolutely. I agree.
Beau Beard (07:44.474)
Mm-hmm.
Beau Beard (07:49.382)
Well, on that topic, question I've had for a very long time, literally, I got in the last podcast I did with you is I want to say five years ago. Um, but the further I've gotten to practice, just the more, you know, you kind of see things and how things do and don't work out. So, uh, mutual friend of ours, Brett Winchester, obviously one of the world's greats in terms of, you know, joint mechanics and palpation and mobilizations, manipulations. When we look at.
Michael Shacklock (08:08.75)
Yeah, yeah, absolutely.
Beau Beard (08:17.634)
Neurodynamics and we look at sequencing, you know, if we go essential to distal distal to central and now you're talking about compressive sites or compression, you know, adding to the stiffness of the nerves dynamics. How much does joint restriction play in? And I know we have to then, you know, decipher joint restriction, what is causing it? Is it a real phenomenon? But one of my thoughts, and this is, I've literally just want to ask this question is if even if we went through sequencing, we had a joint complex that isn't moving.
It kind of negates the ability to open or close. So then we're kind of left with the periphery in my opinion. So I just wanted to hear you break down like, you're completely wrong. Yeah, that makes sense, but we can go about it this way. But how do we decipher that?
Michael Shacklock (08:57.912)
No, no, I like, I like.
Yeah, I like that idea. if we go back, or my history is in manual therapy, physical diagnosis and treatment, general physiotherapy, of course, but then pain sciences. And one of the things we learned early was how to do accessory movements for a joint and physiological and so forth. And, know, we're told, don't use your you know, can't help things accurately, but I trust my observations and you can move someone, can even see it, and you can see that something isn't moving enough and you feel it.
say, gee, that is stiff. know, that, compared to the other side is a big difference. And so my feeling is that somewhere in there, it's not moving properly. And that might change the tissue fluid behavior, such as compression and release as you move. And instead of having a big variation, you're getting this sort of variation in pressures and tensions in the tissues. And so there's not a squeeze out effect and an imbibe in effect.
as much over time that's not that's just a hyper that's just conjecture it's premise on you know and but it's I think exercise and movement is a case of chemically out with the old in with the new and and if you do that if you don't do enough that with it whether it be a wrist joint or a lumbar spine or hip or whatever I think that's common between them all and if we load people better we probably can change their chemistry which then changes their viscoelastic behavior in that area congestive mechanism
And my feeling is if someone's joint isn't moving enough, is the nerve experiencing enough compression, decompression, or pumping effect of those tissues to keep its viscoelastic behavior going? And a hypothesis might be no, it's not enough. and we know that nerves develop native changes. This is really interesting, according to the load they're subjected to. And it's about where it is occu...
Michael Shacklock (11:01.353)
as well. And so if you look at, so the camera can see, that wrist extension, and there are different segments, there's across the joint here, in between the joints here, and across the joint here, in between here. Now we know that if you measure the strain in the nerve across the joint compared with between the joints, it's different.
there's more strain across the joint and less between the joints.
Now that means the nerve is behaving according to how it's moved locally, very locally. Then you could say, well, of course that would happen because the joint's producing the movement and that's what the nerve has to respond to. But if you remove the nerve and do the same elongation value, you get the same variation along the course of the nerve where it was over the joint or was over the gap between the joints. And so the basis, the step that
corollary is that nerves respond to the load they're subjected to in a specific way and so my feeling is that if you can't move your wrist properly or your carpal joints aren't moving properly or your tendon's not sliding properly then how is it possible for the nerve to experience a healthy force?
Beau Beard (12:21.51)
So let me make sure I'm hearing right on that. it almost, so we think of nerves as nerves, right? But we think of the continuum is of tissue as, know, well that's muscle, ligament, tendon. Are we seeing change, are you saying there's changes of the nerve of how it was loaded along the tract? And if you take that nerve out that it will present with those same properties?
Michael Shacklock (12:38.229)
Yeah.
Michael Shacklock (12:41.889)
Yeah, same property. So if you look at the connective tissue content across the joint and versus between them, it's actually different.
Beau Beard (12:48.346)
Mm-hmm.
Michael Shacklock (12:48.716)
And so the nerve, most likely over time, from babyhood to adulthood, over time adapts to those local forces with changes in viscoelastic behavior, but also connective tissue thickness and content and so forth. And so this has actually become a native property of nerve. Now the fundamental property is ability to respond. But the result is it responds in a certain way according to the load. And that's cellular now.
That's really Meccano transduction finally, isn't it?
Beau Beard (13:22.874)
Well, again, I don't want to beat a dead horse, to try to make sure I'm scratching my own itch. So if I'm, let's just take a specific example. If I'm going central to distal, you know, working through median nerve and somebody had inability, whatever we call it, restriction stiffness, you know, around cervical thoracic junction. Can we still do a,
a full neurodynamic workup if that joint complex isn't moving or are we kind of at a stall worth because the joint's not moving?
Michael Shacklock (13:52.521)
I see.
Yeah, good question. Technically, I think that's an adaptation or a compromise. It's imperfect and probably not enough and this is and so And we're now getting into the idea of adaptation adaptive mechanisms and so if you imagine that a C a CT junction isn't moving well and instead mid cervical is moving a lot or thoracic is not moving as much as well those nerve tissues I mean if we extrapolate from the studies those nerve tissue
will probably be softer or more pliable in the mid cervical but less pliable or compliant in the low cervical, CT junction. And so when you do a neurodynamic test, maybe the in those tissues will be different and in the form of an adaptation. Now, for me, if someone is adapting, something's wrong or it's imperfect.
Beau Beard (14:42.555)
Mm-hmm.
Michael Shacklock (14:50.444)
And so we need optimisation of visco-daster behaviour and movement which comes from musculoskeletal but we think it can reach the nerve. Well, a of studies on dysgeopathy for instance show it really reaches the nerve. And so my feeling is move well in your musculoskeletal and your nervous system should follow as long as you're generally a healthy person.
Beau Beard (15:03.718)
Mm-hmm.
Beau Beard (15:12.346)
Yeah, that makes sense. Well, thank you. Obviously, you know it better than anybody and we talk about the properties of the nerve. We talked about a little bit of the mechanical properties. When we look at more of the cellular properties, one thing I wanted to go through is something that I found, which I'd never seen true cases of a neurogenic inflammation.
Right. Where you literally see inflammatory markers in the periphery that with specific treatment also subside, which kind of then wrapped, you know, put the bow on the diagnosis. Right. It's kind of hard to say, this is it until you see, this treatment, you know, as best we can in a clinic to have an experiment that's run, you know, free of any other variables. But how, how does that come about? So for clinicians that may not understand that they're not well versed on it.
Michael Shacklock (15:35.084)
Mmm. Mmm.
Michael Shacklock (15:45.004)
years.
Beau Beard (16:00.219)
How does neurogenic inflammation occur and present itself within a patient?
Michael Shacklock (16:06.165)
Right, okay. So back to the studies on mechanisms, it's, you know, I've gone back in the literature to the late 1800s on this and it's phenomenal what the early neuroscientists would do. They would, I mean, you'd anesthetize an animal and then they would do micro surgery on a rabbit or a cat or a dog or something, rat, and they would cut the dorsal nerve root.
and then they tap the distal stump distal end which leads to the periphery and within several minutes the dermatome is starting to go red and get swollen and it's like yeah
Beau Beard (16:43.044)
This is after it's been cut.
Michael Shacklock (16:46.406)
Yeah, so there's quite a lot of research on this, on the line of events. Now, the nerve stores inflammatory mediators and it releases them on certain types of depolarization. And then the C-fibre, is an afferent nociceptor, if it backfires into the periphery, can release substance P and other inflammatory mediators. And so the idea was that the tapping of the distal nerve
nerve stump was produced, the hypothesis was producing, it produces efferent release of pro-inflammatory mediators. So the nerve, the nerve tone became red and swollen. And that happened within a really short time. But Thomas Lewis, who's done a lot of work on inflammation and nerves in those days, 1920s, he would cut the nerve and then stimulate the nocicepto, like with a histamine substance, like a bee sting. And he found that if you just cut the nerve and then put the bee sting type stuff in,
It did get red and inflamed.
So he's saying, well, what's happening with the nerves cut, but it's still active. And then he would, the other group, he'd wait a couple, about a week to two weeks. And that's when the reactions start. So that's what he showed. He showed that probably the neuron is restoring these inflammatory mediators that are released when, the nerve is stimulated a certain way, but it has to have them there. So it dies and loses all those neurotransmitters.
Beau Beard (17:54.278)
Mm-hmm.
Michael Shacklock (18:19.458)
and it can't produce depolarizations, it can't release those substances. And so the key thing is healthy nervous system. If you've got a healthy nervous system, it will regulate inflammation appropriately. Or if you've got an unwell one or a damaged one, it may not.
Beau Beard (18:32.198)
you
Michael Shacklock (18:35.904)
We now know that if you have a peripheral neuropathy that's hyperactive and you move and you stimulate it mechanically, it can produce inflammation into the tissues. But if you have a hypoactive one that's dead, paralyzed, no sensation, no abnormal neurodynamic testing, then the healing reactions in those tissues are less than normal.
And so you've got a balance of hyper and hyperactivity and hopefully the balance is healthy, well a healthy balance is good for you. So it's an efferent mechanism. When I read this stuff I was like jeebus, I wish more people knew about it.
Beau Beard (19:07.312)
Hmm. It's very interesting. Yeah.
Beau Beard (19:15.684)
Well, and what I kind of, the more I dug into it, the more, you know, you feed into kind of the, central sensitization process of like, that kind of runs a muck and then it's kind of dinging the WDR of, know, then you just get, it's kind of cyclical, you get more. How much, I guess, again, I know that can start with, you know, irritation, the periphery irritation centrally, you get a mechanism in the periphery. But if we're, let's say we're using.
Again, I know we have a bunch of tools, not just neurodynamics, but we're using a neurodynamic workup in treatment and we see symptoms like that. I'm assuming, and you kind of said that you don't have to have a positive neurodynamic test, whether that's over or covert to have that in the periphery, correct?
Michael Shacklock (20:01.375)
No you don't.
True, true, yes. If you have a hyperactive neuropathy, if the impulse is passed down through the C fibers, then there's a good chance, that's the mechanism for producing neurodegenerative inflammation. But if you have a hypoactive one, because the nerve's dead, then it's less active than normal. Now neurodynamic tests actually follow a similar pattern. So if you have a hypersensitive nerve, you're more likely to get an abnormal neurodynamic test, we think. But if you have a dead one, you're less likely to get an abnormal neurodynamic response, because it can't respond.
Beau Beard (20:22.907)
Mm-hmm.
Michael Shacklock (20:34.478)
So, a requirement is actually sensitivity, but it's not the only thing. Mechanics are important in a lot of people with this.
Beau Beard (20:41.956)
And just since we're on that topic, one of the questions I had for those people listening, what are the things outside of injury and mechanics? And we've kind of alluded to this that can make, you know, whether it's a general nervous system, but in particular with neurodynamics, the peripheral nervous system more sensitive or highly, or more easily to elicit pain from a systematic standpoint. Like what are those things that like,
when we see things on a history or when we're doing the patient interview and they're trying to tell us these things like, okay, that could play into this.
Michael Shacklock (21:13.061)
diabetes is probably the most commonly recognized
factor in predisposing to peripheral neuropathy or nerve compression syndromes. Carpal tunnel syndrome you're much more likely to get if you've got diabetes. Tussle tunnel syndrome as well. So they're sort of metabolic. And there's another thing called PPNP. PPNP, I've got to practice this. Predisposition to peripheral nerve pressure. That's a genetic profile that actually makes nerves vulnerable to compression. And the clinical scenario
I think it's not personally I think it's not spectrum where if you've got a severe form of this genetic abnormality You get really easy Very easily you get neurological symptoms from peripheral nerve compression and it might be something as simple as I'm actually sitting with my Stretching my peripheral support my ankle on my knee here and and someone who who leans on their back for an hour or so watching TV Will come up with the come out with
foot drop.
Just an hour or two and then that might take days to recover That's on the high end of the spectrum and there are other people who just do this for half an hour and they've got an old neuropathy for a short time and so and clinically if we see someone who's got a palpated nerve and you reproduce their symptoms I think we have to compare in other parts of that limb and with the other side because some people have a generalized sensitivity and
Michael Shacklock (22:49.242)
for someone who's got a unilateral symptom, the palpation has to be out of pattern. if they're generally sensitive with all their nerves, or many techniques palpating their nerves, and all the neurodermatologists are quite sensitive, to localise that to the current problem on one side, you need something local and unilateral to be abnormal. And so part of what I do when...
is talk about how to contextualize someone's palpation findings. And so to me, diabetes, PP in P, I think there's some argument that alcohol, too much alcohol is obviously not good for your nervous system anyway. fact, I believe that any alcohol, no alcohol is good for you, I heard. Dang.
Beau Beard (23:32.314)
Yeah.
Yeah, we'll just bury that one.
Michael Shacklock (23:40.519)
And smoking is also not at all good for your nervous system. also thyroid disease is not good as well. They're sort of generalised type problems.
Beau Beard (23:50.457)
on that same line, what about for the clinicians, like when we're going through, cause I always say your patient encounter starts with the paperwork, right? You start formulating a hypothesis when you're kind of looking at, you know, what they're telling you and the medications. Is there anything when we're looking at somebody's intake or in particular when we're doing the interview that when they're, you know, like in McKinsey, you know, a traumatic, it's been less than two weeks. We start to think, okay, that might be, you know, some sort of joint derangement.
Is there anything in NDS where you're like, hey, when you hear these things and their presentation, you know, how it presents, what they're telling you, they're like, you, know, not that we wouldn't always do that work up. You're like, you gotta be sure you work this up, you know, in a neurodynamic kind of framework. Is there anything that sticks out?
Michael Shacklock (24:34.836)
Yeah, and in the subject of neurological symptoms like pins and needles, I think would be the most common that suggests nervous system. Now almost everyone that comes to physical therapists and chiropractors like yourself, it's mostly because of pain and they've lost function. But often accompanying inside that or subgroup is people who have pins and needles and numbness. They might even have a weakness. the thing we look for early on is neurological symptoms. But unfortunately, a lot of people don't have
but they still have a neurodemic problem.
And so for me, one of the things that I look for in a patient, say a level one patient, they have continuous pain, severe, easily provoked. Radiating pain is another one. Now that's not exclusive to nervous system, but it is one of the ones that is common with neurodynamic problems. So for me, neurological symptoms and radiating pain are probably the most common. But there's also a subgroup where they don't have any of that. They just have localized pain with extensive movements. And that's where we have
Unfortunately, at the end of the subjective, we often don't have good information about neurodynamics. And so we have to decide at some point whether we can just check the neurodynamics to exclude them or to include them. Especially at high-functioning patients who move extensively and only have local symptoms. They're the ones that we can miss. And often we need to do advanced testing on those people.
Beau Beard (25:48.582)
Mm-hmm.
Beau Beard (26:03.174)
Do you still believe the exclusionary kind of percentages around that like 30 ish percent are neurodynamic, you know, involvement?
Michael Shacklock (26:13.526)
You know, we haven't done a prevalence study on this. don't know of one. In fact, a recent one did look at it. can't remember the results. I haven't fully read it. I have to be careful because I like to read papers fully before I quote them. I haven't fully read it yet. now if you got, so if you're a chiropractor, probably see a lot of spinal problems. Okay. And so, and if you even focus more, so a clinic is just a spinal clinic and that would give a fair bit of neck pain.
and a lot of low back pain. On a really busy neurodynamic day, I still only reckon that it would be about 15 to 40 percent of patients would have a neurodynamic problem on a really busy day. Now we might say well on a day there's not many of them, it might only be one or two patients, of course, but it's still a really important problem for some people. And if you think of 15 to 40 percent of people who have back pain have a neurodynamic abnormality, that is millions of people.
Beau Beard (26:45.456)
Mm-hmm.
Beau Beard (27:01.744)
Mm-hmm.
Beau Beard (27:11.28)
Yeah, yeah. Which just pays again. So I'll throw the commercial out there for neurodynamics of, well here, let's put it this way. So neurodynamics has gotten very popular, right? To where it's kind of, I wouldn't say common knowledge in terms of people really understand it, but people know that it's a thing. Clinicians are aware of it. A lot of people have went through the coursework, but also like anything that's out there, know,
joint manipulation and soft tissue techniques, things are gonna get over glamorized, things are gonna get over scrutinized and then things are gonna get bastardized. So in the neurodynamics realm, what do you feel like is kind of being, maybe people are getting it wrong or it's being bastardized of what you're seeing, whether it's social media or when you go out and you're teaching, you're on the road of like.
God, I wish people would stop thinking about it this way or stop doing this when they're trying to apply it, maybe they don't understand it.
Michael Shacklock (28:05.376)
Mm-hmm, yeah.
Yeah, I'm glad you asked me that. And my feeling is that the first is intellectual and thinking the first mistake or misconception is thinking that neurodynamics and neural mobilisation are the same thing.
Michael Shacklock (28:39.024)
And within clinical neurodynamics, only some of those people deserve or need neural mobilization.
it's a new organization from his a subgroup of me possible to have most of kids near the next group and only some new model of new members nation a lot of me unloading is you sign better to protect or unloaded as a irritated new sometimes in the next month was it and that's the first thing the second one is uh... so many techniques are demonstrated online i'll stop watching them
because i don't read are not what's fifteen to twenty videos over a period of time and none of them were wrong
I feel bad about saying that because I don't want to say get on one and be dramatic and say stop doing it this way you're doing it wrong do it my way follow me give me a break everyone everyone's doing that and so I will not have to do that strategy but you know this is a really I'll step back and show you this is a really common one this is a slider technique for the cervical nerve roots actually it's not because the the the frame and moves with the nerve root so there isn't any sliding
Beau Beard (29:44.454)
Mm-hmm.
Beau Beard (29:50.651)
Mm-hmm.
Michael Shacklock (29:52.11)
It might help for various other reasons, but it's not a slight technique. that to me is probably emblematic of the fact that I think a lot of people do not understand how nerves move.
Beau Beard (30:07.248)
Yeah. Which I think it's like you said, you know, a functional anatomy study. So if we looked at, you know, a muscle, you know, conceptually, we get taught these things. I think that's one of the. The missteps here is we get taught a nerve and dissection as a static structure, more or less. Like I still remember in the cadaver lab, you know, they might've shown how like the brachial plexus moved through the anterior middle scaling. They might've shown how the sciatic nerves slid a little bit through.
you know, on the hamstring musculature, but like you're looking at these and they're pin static, whereas a muscle, what do we learn? You know, origin, insertion, action. Um, so do you think there's a way to take, obviously not the comprehensive, you know, intellectual concept, but to take a portion of neuro dynamics and put that into, you know, the base education for, know, physios, Kairos, PTs and things like that to where it would start to improve that understanding generally.
Michael Shacklock (31:01.825)
Yeah, are still a lot neuro dynamics laws. They're like laws of physics. And if people understand those, you actually often don't even need to visualize how nerves move. We do that naturally with bones and muscles, stuff like that. But you just apply the laws. You know, one of them is convergence. Nerves slide to the joint where tension is being applied. And so if I just do elbow extension, nerves, the nerves are drawn from the shoulder and practice goes this way. But the median nerve goes properly.
Beau Beard (31:21.488)
Mm-hmm.
Michael Shacklock (31:32.173)
relative to its local interface. It's not and it changes along the course of the nerve. It's not a it's and it's based on how the interface reacts with or behaves relative to the nerve as well and that's just one of them. They supply some of the laws and I mean ultimately you've got to learn the techniques really. If you're to teach techniques you've got to know the technique. Funny that.
Beau Beard (31:57.895)
Yeah. Yeah. It's how it goes. But like you said, to be able to, well, to be able to teach something, which if that's what somebody's doing to, you know, you know, online or wherever it's really, it's understanding. So even if we parrot something, so if we went to a course, you know, and then, you know, like I'm, I helped solve, I'll take part of the blame. So I helped start rehab to performance RTP, which is a lot of student led groups that. Yeah. That teach, but then the problem is, this, you know, I've been very, uh, you know,
Michael Shacklock (32:20.282)
good, yeah great organisation.
Beau Beard (32:27.802)
boisterous about this is, you know, a student will go to a weekend seminar and then part of their job as an RTP rep is to go back and teach some of that material to the students. Well, now you have a student, not that they can't be, you know, bright and smart, but they don't have, you know, years of experience with a patient or hands-on or any time based on the weekend that they just took the course, go back and teach people. It's kind of like the blind lead of blinding. And then pretty soon we may have a very rudimentary
Or kind of a Dunning-Kruger effect of like, I think I know what neurodynamics is. And then we, we go about our way and then we're applying it. And like I said, maybe you get lucky and you're doing something and it does change something. Um, but I really think that the thing across our whole profession is, the lack of understanding rather than just kind of mimicry that we think we're doing something.
Michael Shacklock (33:15.337)
the neurodynamics, thinking of the research basis, know, early days, people did some really good measurement and accurate measurement of nerve movement and they applied it to Carpal Tunnel Syndrome and compared symptomatic with from asymptomatic and there wasn't any difference. So the big word became don't mobilize nerves because they're not restricted to movement. But then it was on over the sensitivity issues, absolutely. So mobilize it for other reasons. But then the pendulum went
to don't worry about movement or specifics, just worry about sensitivity. And that's been found to be wrong.
And so sensitivity is a requirement for a neurodynamic test or movement to be abnormal or painful with movement. But it's not always the cause. It's a general response. It's actually, I'm starting to present it as a general stress response. Because you can have a sliding dysfunction with mechanosensitivity which produces an abnormal test. But you can have a tension dysfunction as well. But it's mechanically quite different. But the commonality is the sensitivity and the abnormal pain.
Beau Beard (33:59.815)
Mm-hmm.
Beau Beard (34:19.365)
Mm-hmm.
Michael Shacklock (34:22.731)
But what we have specifics in is the movement pattern that provokes and eases the movement, eases the pain.
Beau Beard (34:28.592)
Well, talking about some of those, you know, like sliding dysfunction and, know, have any of the classifications change from your original book? Cause when I, mean, I have this flag that that section, which I have from the beginning of like, Hey, you need to be able to, know, kind of like, you know, Annie O'Connor's work of like, can you classify pain, you know, properly? Can you classify the mechanism? Because then in my opinion, I'd love to hear yours. Like it tells us what's going on from the neurodynamic kind of lens, but then it also tells us, if you have.
Michael Shacklock (34:37.737)
Yeah.
Beau Beard (34:57.978)
you know, a muscular interface issue, like, well, that may not just be a neurodynamic treatment. Like you're going to go treat the interface per se, right? Get it moving and go back and retest. And there may still be something left on the table. Has any of that changed in terms of how we're classifying or, you know, categorizing?
Michael Shacklock (35:14.089)
you know it not a constant of any substantial changes uh... probably this morning style uh... in ten and he's had a tease these things out uh... but fundamentally uh... i'm not seeing any changes of compression compression uh... lots of sliding is lots of sliding in sensitivity through pathophysiology in the scheme in the formation that they're all signed this to that still understanding how news malfunction and so fortunately uh... no
Beau Beard (35:30.49)
Mm-hmm.
Michael Shacklock (35:44.143)
big changes in the classifications but there are some improvements in detail on how to treat them particularly with progressions from low to high function because sometimes we can jump too fast and it provokes a patient but we've got finer ways of varying the treatment techniques now.
Beau Beard (35:49.766)
Hmm.
Beau Beard (36:00.551)
Yeah. Um, so let's say somebody has never taken a nerd dynamics course and they have heard about it. And, uh, I know now what I think all courses, there's an online portion and then there's the live portion because there's a lot of preempt material because like you said, it's an intellectual framework and there's a lot to work through there for somebody that can't make it to a core, say they're a student and they're listening to this and they're a try for, so they're only a year into school.
Maybe it's, you know, telling us what some of those other laws were or is there anything that you could say, Hey, if you thought about it this way, not that you're to go practice, but like if we start to, if we're looking at a patient and say, you're like almost putting handcuffs on somebody, Hey, we're not going to test them neurodynamic. We're going to treat them, but I want you to be aware of these things or know these laws so you can start kind of conceptualizing it. And then when you go to a course, we can open up Pandora's box.
Is there anything you would tell that person that's very new in this whole realm of, you know, how do you go about starting to understand this study, apply it?
Michael Shacklock (37:03.367)
Yeah, good, good one. Learn how nerves move. That's available in the literature and my book, of course. Learn how to do standard or basic testing. And then learn how to unload nerves.
even if it's not purely related to the diagnostic category because it's really safe and effective for a lot of people. And then if that's not working, then dive bit deeper into whether it's a closing problem or opening or sliding or tension and grading progressions and stuff like that. Start with the simple stuff. Learn how nerves move. Do basic testing. Do openers if you're in doubt. And then go into closing and other more complex dysfunctions. That's what I'd recommend.
Beau Beard (37:42.705)
Yeah. when we, yeah, we kind of talked about the joint restriction. One thing that, gets used a lot for other reasons in rehab is like the utilization of isometric loading where that's, we're looking at, you know, analgesia, know, tendinopathy rehab. but I know that there's literature and I I've never heard you specifically speak on this. So this is what I wanted to ask you is we talk about.
you know, the 3D kind of gain when we have a muscle that's contracted that can, you know, supposedly create a more easily movable interface for the nerve. is there within neurodynamics, how much is our isometrics talked about? Do you think that is something that is, you know, viable and useful from a neurodynamic lens? And then how could we apply that in the treatment realm?
Michael Shacklock (38:36.646)
Yeah, good. And that relates to diagnostic categories. If you imagine, this is a common pattern. If you do, someone can't do contralateral lateral flexion very well of the neck and stretching that muscle is tight. The scapula might be a little bit higher too because it's tight. Now, that is not necessarily a neurodynamic problem, but we can figure out if it's related. And so we can do a neurodynamic test and check the muscle behavior with the wrist and extension.
there and then flex the wrist, not the elbow, to flex the wrist to see if it changes the muscle behavior. And so we would, the idea then is that if the muscle changes its behavior when the nerve is on and out of load, then this relationship might need a dual treatment.
And so I'm not saying nerves got priority, but I'm just saying that if they're interacting, then one might be an obstacle for the other or whichever way it might be. Now, if someone's got the tolerance to this, you could actually in the neurodynamic position do a muscle technique that actually attacks both mechanisms. And we call that a multi-structure or multi-mechanism one. In the advanced courses, do, that's the muscle hyperactivity neurodynamic dysfunction.
and I'm not saying which is the bigger cause, it's one of the ones that nerve might be an obstacle to that muscle releasing. if you, the pattern might be that the muscle's not releasing the way you expect it would, so then I would check the nerves to see if it's affecting it. And then you might do a dual or multi, but a trick both in the same maneuver. That's called a 3C technique. Level three high function and C being the classification of multistructural. So that's one, and that's kind of along the system.
Beau Beard (39:56.934)
you
Beau Beard (40:16.944)
Mm-hmm.
Michael Shacklock (40:26.1)
that they're kind of working together, but there's also, say, a piriformis problem that might be affecting the sciatic nerve or deep gluteal problem, or it might be pronated with a throwing activity. And in that position, we would have the patient in that symptomatic position, we would resist manually the contraction of that muscle, such as pronator, in the neurodynamic position. And while they're doing that, we might differentiate it with the neck to see if it changes. And if it does, then we might do a nerve treatment at the same time as
Beau Beard (40:26.502)
Mm-hmm.
Michael Shacklock (40:56.05)
muscle or even in that position you use your hands my facial techniques while the muscles are active on the nerve can also be used.
For me, that's actually a big future because in the old days we used to do nerve mobilisation because it's a nerve problem. It's incomplete. I treating the nervous system as isolated and that's not how we move. And so I'm a big fan of integrating the systems, muscle, MSK and nerves. And that's kind of a little explanation of how we might do that.
Beau Beard (41:12.368)
Mm.
Beau Beard (41:26.64)
When I know I don't want to pull back the veil at all on this, cause it's not my place, but I know that you and I may, might be working with somebody that we both know, out of the great white North of Canada to work on how to integrate this stuff better. But I think you hit on a very strong point that basically. When we looked at, if we just looked at, if we alphabet soup DNS, you know, MDT, NDS, all these things, not that we're all saying the same thing, but if you don't.
Michael Shacklock (41:49.264)
Mm, mm, mm, mm, mm.
Beau Beard (41:55.767)
understand all the pieces and then utilize them together, you're always going to be missing something, right? Like you just said, like it's incomplete to think that we're going to nerve mobilize and then like muscle interface and then motor coordination. is there, I guess, kind of back to the, not like what are people doing wrong? But if we looked at like general rehab,
Michael Shacklock (42:01.308)
Yeah
Beau Beard (42:18.246)
So we just said, like you said, like there's this kind of movement optimism, like we just need to move generally, you know, better to get people out of pain, which yeah, we have more unhealthy people. So that's going to get a giant swath of people feeling better. But is there anything not in the neurodynamic treatment application, but in general rehab that flies in the face of neurodynamics in terms of like certain exercises or certain treatments, you're like, man, that is completely opposed to maybe what, you know, maybe that 15 to 40 % are presenting with. And you're like, that's going to really mess up your
Michael Shacklock (42:36.921)
all
Beau Beard (42:48.24)
treatment and findings.
Michael Shacklock (42:49.312)
Yeah, I think the main one for me would be really strong neurodynamic tests at the beginning of someone's rehab. I'm thinking of strong slumping because the nerve's tight. My opinion is that it does help. We know that it helps certain people, but you've got to be really careful with those patients because you might end up giving them a neurological problem.
Beau Beard (42:59.247)
Yeah.
Beau Beard (43:02.917)
Yeah.
Michael Shacklock (43:13.288)
And so that's one. Now, there's another one. I thought of another one. What was it? The one that flies in the face. yeah, that's right, models. Now, one of the problems that we have relating to MSK nerves is that we have this idea that if the MSK is causing the nerve problem, which is mostly the case in our area,
Then just fix a musculoskeletal and the nerve should improve true for some people This is actually quite logical and it's fair But in the garden two weeks later, they're still on the nerves not getting better. well, we'll just mobilize the nerve and And so then they mobilize the nerve and then
Beau Beard (43:43.695)
this is a good, I wanted to ask about this. So yeah.
Beau Beard (43:49.477)
Yeah.
Michael Shacklock (44:03.29)
something's not quite right here, it's not quite working. And so we are treating the two systems separately.
which is partly correct but as you say it's incomplete. Now unfortunately there are two models and they're well validated in terms of our understanding in model A and B. Model A is a cooperative model between MSK and NERV. And so if I'm thinking of pronation of the ankle or the foot in a runner who's got Tussle Tunnel Syndrome,
or new pain in the foot with running then deep running or prevention of pruning actually helps the news well if you are the kind of the idea the traditional ideas that prime too much promotions is bad for your ankle or at least you can balance it better by doing less pruning channel move between supernation and pruning should probably as you run balancing it well and that is actually good for me because less pruning she means this pressure intention on the good
Beau Beard (44:42.598)
Mm-hmm.
Michael Shacklock (45:03.581)
Model A is cooperative. They work together, so helping one should help the other. But unfortunately, there are areas in the body where it is the opposite. That's model B, which is competitive. And the classical one is the costoclavicular space with the brachial plexus. Now, if we think of the shoulder dyskinesia situation, if you've got an anterior rotated shoulder, tight peak minor, maybe your arthroprapegius or levator scab is a bit high, your lower
traps aren't active enough, serratus anterior aren't balanced well enough and so forth, then if you correct all that, that actually presses on the plexus. And so I'm not saying don't do it, but I'm saying in someone who's a level one patient who's got a lot of pain from their plexus down their arm, applying that model A often provokes them.
Beau Beard (45:42.672)
There's more. Yeah.
Beau Beard (45:56.998)
Mm-hmm.
Michael Shacklock (45:57.412)
And so we can't use the same logic with model B because it's a competitive situation. And so we have to do certain strategies to settle one system down or the other in preference initially, then migrate it to the other system depending on the needs of the patient. And that's where a misconception is applied. Fix MSK and the nerve should improve, but if it doesn't, that's all right, mobilize the nerve, we're getting both systems. But actually that doesn't always apply, model B.
Beau Beard (46:25.284)
I think you're hitting on a beautiful point, but also one that can be frustrating within our profession is there is a hierarchy, whether we, it's hard to determine chicken or egg, but if somebody presents with possibly an offloading position, it's like, well, did they start off like that with this, you know, kind of destabilized, decentrated scapula thoracic glenohumor joint, or are they trying to offload a nerve that was sensitive? then that's, that's our job, right? You're trying to figure out like,
What do I have to, what's the order of operations here? yeah, I think, I mean, there's no like, you know, right or wrong answer per se. I'm sure we could all sit around and have a giant, you know, bottle of wine and argue that for a while, but what, so what, I mean, that's a completely common presentation for just somebody not even in pain, right? Is this kind of. Into your shoulder, we're kind of loaded. And then if we put on our DNS hat and we said, okay,
Michael Shacklock (47:07.399)
Mm.
Michael Shacklock (47:15.675)
Yeah, it is.
Beau Beard (47:21.584)
We want to centrate them and get them back to neutral for people that are again, maybe not well-versed in NDS, but working on them as K side, right? A lot of us trainers, physios and stuff. Is there anything that maybe you're like, maybe it's as simple as like, Hey, what you're doing isn't changing anything. They keep presenting back here. Is there something that if they're not well-versed in that you can be like,
Michael Shacklock (47:23.644)
Yep.
Beau Beard (47:44.664)
If this keeps showing up, you need to like kind of start to realize like I need to go take a course. I need to put my NDS hat on when I'm trying to work in RiftK.
Michael Shacklock (47:51.408)
Yeah, yeah sure. Yeah sure, so I mean, movement analysis I think is really important to integrate with this. You've got DNS and Simon, you've got a lot of approaches. Fantastic. But one of the things I like to do is when the patient is in the clinic, right there now, do you have your pain?
and then I will test right there and then, say this is a brachial plexus here or shoulder problem, and I'll test various positions and movements and ask them what effect it has on their radiating pain. And if we do what's bad for MSK, unfortunately, which is anterior rotation and a bit of elevation, and we tight T, schnoff, pec minor, and they say, oh, that's much better, then I'm starting to think model B. But if we say, you can't function quite well, you're not using these parot flits, just stretch this.
And it doesn't provoke the arm that I'm much more interested in that approach as opposed to the first one and so I actually personally I'm a big fan of physical testing and it doesn't mean you're doing a medical Diagnosis with a physical test site luck wins or a neurodermic test for a cTS You're actually looking for movements of provocation and easing that can be a basis for starting movement And I'm not going to classify it according to DNS or other systems because I'm not I'm not skilled enough in those areas, but
I'm sure you will have those classifications and you could use them with progressions but then I'll be relating it to model A or model B and it's... sorry go ahead.
Beau Beard (49:19.206)
which I, I was just gonna say I love that because what I'm hearing is again, you have to layer things in because you could say, hey, I can do an orthopedic test looking at what it's testing from an integrity, structural integrity, tissue integrity, but then I can also look at it as a sensitivity and change possibly the sensitivity of the neural structures around there, retest with the same thing. If it changes it, you need to put your logic cap on and be like.
Well, surely an injury doesn't change, but sensitivity or pain can. And now we have to suss out as that position, motor coordination, X, Z, but too often, I think we just go through the paces, right? Urgassons, know, external, and then we're like, shoulder pathology versus, you know, what was the, what was the driver there? So I couldn't tell you how much I love that. And I think that's missed in the clinic. Yeah.
Michael Shacklock (49:58.353)
Yep, absolutely. Yeah.
Michael Shacklock (50:08.905)
thanks. I appreciate it. know, and I actually feel that thinking of the way our, maybe not your profession, but our profession has developed over the last 30, 40 years, we have really moved into research and science, which is an essential step. But unfortunately, I think a lot of physios are looking at science and reading it as a PDF and instruction book. the instructions don't come from the PDF, they're from the study. They come from the
Beau Beard (50:31.686)
Yeah.
Michael Shacklock (50:38.568)
based on your observations making changes in the patient today. I can't emphasize that enough.
Beau Beard (50:46.916)
you're speaking my language now. Yeah, this is, mean, we, I teach a course called art of assessment. There's a whole section just on not clinical observation, just observational skills. Like, are you observing overall? And then you, literally have to go through the filter of the clinical minutia that we've been taught over, however long you've been in practice in school. And I too often think that we just go in with the framework we've been taught instead of like,
Michael Shacklock (50:51.45)
Thanks.
Michael Shacklock (51:00.486)
Absolutely.
Beau Beard (51:16.494)
Hey, could you think about this as a person that just thinks about things rather than like, this is what I've been told to do. Even if that was, Hey, I'm, really into DNS or neuro dynamics. You still have to challenge your own biases. Even though you're the world's expert in this, sometimes I might go through what you taught me. And I'm like, well, it's not playing out how Michael told me. mean, we're, nobody's under an obligation to follow exactly, you know, the, the framework that we've laid out and that's where it gets tough in our profession. But
Michael Shacklock (51:29.062)
Yeah.
Michael Shacklock (51:44.326)
Absolutely.
Beau Beard (51:45.735)
That's where we need people like you that are at the forefront, you know, doing the research, reading the research, applying the research, applying it within a model that is we can all, you know, use. It's not so highfalutin that we're just, you know, it's impossible to put in the clinic and then say, well, let's keep thinking about this together. And I think that's one thing that is missed is that. Yeah, you are the expert, but we still need to go back and test. And then every once in a while I'll be like, you know, maybe.
you know, in five years, you're like, hey, we've been seeing this show up. And then you're like, hey, we were wrong or it's changed or I don't think that's bad. That's science, you know.
Michael Shacklock (52:18.289)
Yeah, absolutely. It's a learning process. you know, that to me, that's a mark of success. It's the circular process of observations, testing and reviewing your observations and so forth. you know, we as physios, we sort of have gone a little bit away from manual therapy for good reason sometimes. But...
People have used the word as an art, as a science and an art actually. I think we do better by saying we're applying science systematically and creatively.
which is a little bit different from painting a Picasso. There is part of it in it, but if we understand mechanisms and how people's body responds, we have the opportunity to change the mechanisms with observations first, trust your observations, and then make some changes understanding the mechanisms. To me, that is so important, critical.
Beau Beard (52:57.67)
Mm-hmm.
Beau Beard (53:05.702)
Hmm.
Beau Beard (53:11.814)
100%.
Yeah, I always bring up the jazz, jazz guitarist, Jack Caccini that talks about like, well, I'm going to play, you know, I'm the best like jazz musician, but he also says, well, the best classical guitarists are also the worst improvisers because they had to be so dependent on learning the classics and learning how to frame and, know, go through music theory. The thing is in our profession, we have to learn the theory and the basis so we don't kill people.
Michael Shacklock (53:38.575)
Yeah, we do.
Beau Beard (53:39.447)
so we don't hurt people, but then, you said, what we have to do is a creatively apply. It's not this like, you know, yeah, we're creating a Jackson Pollock. It's no, you have to apply the principles. And that's where we, think a lot of us get ourselves in trouble because we, we don't try to understand. just try to do, and then you, a, you don't learn and then you probably aren't, you know, benefiting your patients as best you could either. So.
Michael Shacklock (54:01.319)
And actually there's a kind of a spectrum I think between the basics and the finessing. And if you look at your favourite athlete or your favourite sports team and they've won the championship this year, they applied the basics consistently. But at the critical moment they did something special.
and you can't do something special to make it succeed without doing the basics because the basics provide you with the opportunity to do something special and the championships are won on a special moment but really it's also about the basics.
Beau Beard (54:38.022)
Man, amen. Put that on a t-shirt. Well, before we jump off here and let you get to bed or start writing your next book, I know we kind of started with this, but let's wrap it back up with this. So you said, you know, there's been some new things on the horizon. Is there anything you're wanting to explore that you kind of have like just the starting inklings of hypothesis or ideas or like?
Hey, there may be something here, but nothing's been studied yet. Nothing's been applied. Nothing's been added to the curriculum of NDS. Anything kind of stand out there?
Michael Shacklock (55:08.646)
That's a good one. really interested in looking, this is a long way away yet, but I'm looking, I'm really interested in looking at, we're really doing what I think is a good job with the Spanish people I work with, Elena and Miguel and Hacubo, there's a bunch of people I work with in Carlos up in Spain and fortunately I've got some really good technology and we'll hopefully at some point we'll be able to measure people's adaptive nerve functions, not just
fundamental nerve functions. So my feeling is if someone's nerve is adapting something's wrong, well it's not, it's imperfect. So I think in the long term we're going to be looking at adaptive mechanisms not just fundamental movements and so forth. And you know later I would like to be able to show that we might be able to change the natural history of lumbar radiculopathy.
And through, did a pilot study a while ago on opening techniques for people with validated lumbar adeclopathy with electrophies and radiology. And the outcomes were so good. The treatment group with the openers were just so much better than the the control group. They were both, keep moving, bend over regularly, keep walking. was a stay active approach. And we added the openers to that one, to the control group, which then became the intervention group. And the results were so good that we've now started a clinical trial
on.
uh... it with a recent rehab group with the neurologist electro physiologist and so forth uh... to free to figure out if we can change people's lumber to kill the problems uh... is really is possible uh... by unloading man i personally feel it for it really near or severe new york that is compressive in nature i think i'm going to next i'm i'm hoping that that that's a future for your dynamics and the other one is we've got the final one with high function of performance we've
Michael Shacklock (57:00.321)
learn how to move better with our nervous system on or off it depending on what the person needs.
Beau Beard (57:05.286)
Yeah. Well, again, I want to wrap this with a bow, but I'm just curious because you've, we've mentioned openers like five, six times as being kind of imperative and very important. Now we're showing, you know, pathology specific. Um, is there anything you could marry whether it's to what got them in that scenario of, know, a compressive kind of presentation of the, you know, the nerve root or the nerve itself.
or the rehab side of what we can marry with openers to keep them going on that. know, a friend of mine, Rachel, always says, we don't want to leave people playing with their derangements. We use the McKinsey model that if we're just going to do the same movement for the rest of their life, that's, you know, So if we need to open, you know, a neural, you know, kind of complex to offload symptoms, what do we need to do with that type of patient long-term to keep them there? Is there anything we need to marry with it?
Michael Shacklock (57:35.942)
yeah.
Michael Shacklock (57:54.66)
Yeah, My opinion is help them move well. Now, that means balancing forces. And so I'm thinking of movement approach like DNS. There's McGill's stability approach early on. I'm a big fan of early. I know that that's a little bit controversial for some people, but I like it, particularly early. But then DNS, you got to move, you move. And so, and the salmon approach as well. So I feel balancing forces are really important, which is about movement control for force and load management.
Beau Beard (58:11.802)
Mm-hmm.
Michael Shacklock (58:24.583)
But somewhere in there we're going to be introducing some neurodynamic techniques. So if you're doing IAP changes with your DNS and you're changing position at a hertz, then if that radiates down your leg, you might be to do a contralateral knee extension to bring the cord down and unload that nerve root on the painful side so you can then continue your DNS. And so I'm thinking now of techniques where you're actually doing similar in both systems
same time which I think is a future I like that future but you probably would compromise one system a little bit at certain points but if it gets them through a difficult time and then you can integrate them the way you need to perfectly later on so I sort of see integration as being big future.
Beau Beard (59:12.134)
And we're already, we're again, you're speaking our language. That's what we do on the clinic all the time. We're literally using DNS principles with neurodynamic principles and kind of marrying them together to do what you just said. So I, a hundred percent agree. And we see it work. And like I said, the goal is less, you know, um, reliance on us long-term. So we also need strategy to where people can apply this outside of the clinic and you'll keep themselves going and things like that. So yeah, I think that's imperative. Um,
Well, any last words of kind of, you know, to get people motivated, to get us thinking, words of wisdom before I jump off here.
Michael Shacklock (59:48.975)
Well, stay curious. There's a bright future for our professions in spite of the fact that AI is coming in and stuff like that. AI can't do manual therapy, physical diagnosis and treatment. It can't be so personal. So I'm feeling like, start up domestic, stay curious and stay committed. You'll succeed. That's a future for me.
Beau Beard (59:57.51)
you
Beau Beard (01:00:10.98)
Man, again, I truly appreciate your time, your treasure. Keep doing what you're doing. And yeah, next time you're stateside, hopefully I make it. know I just missed one that was over here not too long ago, yeah. Yeah. Thanks again, Michael. That's all I can say. It's just awesome.
Michael Shacklock (01:00:26.917)
Thank you very much, I really appreciate the opportunity. Thank you, bye.
Beau Beard (01:00:29.574)
All right, thanks, man.
