Precautions with physical neural examination .

Precautions with physical neural
examination and
management
● Patients with suspected ‘red flags’ need to be identified and managed
accordingly.

● Take care with elongation and pinching manoeuvres with acute nerve
root disorders.

● Watch that repeated movements do not aggravate a central sensitivity
state.

● Be careful in acute states, when clinical pictures such as disc trauma
or compartment syndrome suggest that nerve irritation/compression
could occur.

● Take care with recent apparent peripheral severe nerve injury that
may, initially, be clinically silent. Wait for a few days to see what the
clinical expression will be.

● There are some states where peripheral nerves appear tethered and
will not move with various physical therapies.
Repeated attempts will just worsen the problem. A surgical opinion is
necessary.



● Take care with disorders such as diabetes, rheumatoid arthritis and
Guillain–Barré. However, programmes including graded mobilization and
fitness may be useful for symptomatic relief and to minimize
complications.