Clinical Neurodynamics

Shacklock's book is a wonderful gift as well as a triumph of clinical reasoning and careful research. Examination of the nervous system typically does not extend beyond a search for neurologic signs and the most rudimentary mobility tests of major portions of that organ. Given what we've learned during the course of the neurobiologic revolution, this seems wholly inadequate. Shacklock describes specific testing of virtually every portion of the peripheral nervous system and reasonably asserts that this approach is necessary to complete the diagnostic picture of our patients with painful problems that display no relevant evidence of pathology. That is, something that requires healing or repair. My own students assure me that these patients comprise the majority of those with a primary complaint of pain. To me, this knowledge fills a hole in therapy through which countless patients have fallen. The author fills this book instead with a wonderful exposition of the deep model of neurobiology as it is currently understood and relevant to the clinician seeing patients in pain. He then tackles the nuts and bolts of testing and treatment, liberally providing all he can about the intricate nature of nervous biomechanics, paying careful attention to what is known of the bodily interface and the nature of its sensitivity. Every possible test is carefully illustrated and many pages are peppered with this master clinician's personal experience. For the sural nerve alone there are three pages devoted to its place in symptomotology, the intricate nature of its testing and specific thoughts about its treatment along with three clear and concise photographs. What more could a clinician seeking direction ask for? Oh yes, a CD-ROM provided with the book further illustrates his approach to the median, posterior tibial and ulnar nerves as well as the brachial plexus at the thoracic outlet. This is a wonderful addition to the text. Barrett L. Dorko P.T.