Consideraciones para la positividad en las pruebas neurodinámicas

Carlos López Cubas

Resumen


La prueba neurodinámica es una combinación de movimientos que pretende valorar las capacidades mecánicas y la fisiología de una parte del sistema nervioso. La aplicación de movimientos, debidamente administrados y secuenciados, estresan o alivian las diferentes estructuras neuromusculoesqueléticas, con especial atención al tejido neural. De esta forma, la prueba neurodinámica evalúa la mecanosensibilidad del tejido neural. Para ello, persigue la reproducción de los síntomas neurógenos en una determinada área corporal. Una vez reproducidos, mantiene dicha área corporal inmóvil y valora los cambios provocados por un movimiento de una articulación involucrada en la prueba, pero situada a distancia del área sintomática. 

Esta maniobra, denominada diferenciación estructural, señala al tejido neural como fuente de los síntomas. La diferenciación estructural, sin embargo, es insuficiente para asegurar la relación entre los resultados de la prueba neurodinámica y el sistema nervioso como fuente de los síntomas. De hecho, la necesaria implicación de las diferentes estructuras musculoesqueléticas durante los movimientos de una prueba neurodinámica, hacen que resulte imprudente afirmar que esta prueba refleja directamente la función mecánica del sistema nervioso.

La prueba neurodinámica, además, no tiene un carácter patognomónico, en tanto que la información obtenida con la misma no apunta a un síndrome o enfermedad concretos. Son múltiples los estudios en esta dirección que han intentado medir la capacidad diagnóstica de estas pruebas, algunos de ellos en relación con el síndrome del túnel carpiano o la radiculopatía cervical.

La prueba neurodinámica evalúa clínicamente la mecanosensibilidad del tejido neural, y es hacia la valoración de esta mecanosensibilidad hacia la que resulta óptimo dirigir la atención durante la exploración.


Palabras clave


terapia manual; mecanosensibilidad neural

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Referencias


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