Your nervous system moves. When it can't — when a peripheral nerve becomes irritated, compressed, or mechanically restricted along its course — the symptoms can look like a shoulder problem, a knee problem, or a hip flexor strain. Standard PT treats the wrong tissue and wonders why nothing improves. Neurodynamic physical therapy identifies the nerve, finds where it's restricted, and uses targeted mobilization techniques to restore its movement. At Solas PT, Dr. Cisneros specializes in this approach — and patients who've seen no improvement for months often experience significant relief within one to two weeks.
"I've been a patient with Andrew for over a year, primarily for dry needling therapy, and I can't recommend him highly enough. He has helped me significantly relieve chronic muscle pain, and every session brings noticeable relief. His approach is both effective and personalized — Solas Physical Therapy is absolutely worth it."
"Andrew is a wealth of knowledge! I had terrible back pain and he adjusted me and wow it was amazing! I can't wait to go back!"
"Dr. Cisneros is one of a kind. Not only is he excellent in making you feel better but also getting you moving like you're supposed to again. He is so kind and compassionate and just an overall good person. Do yourself a favor and book an appointment — you won't regret it one bit!"
Neurodynamics is the study of how the nervous system moves mechanically through the body — how peripheral nerves slide, glide, and tolerate tension as you move your limbs and spine. Healthy nerves need to move freely through the surrounding tissue: through tunnels in bone, between muscles, past ligaments and fascial sheaths. When movement is restricted, or when the nerve becomes sensitized from compression or irritation, the result is neuropathic pain — burning, shooting, tingling, numbness, or weakness that doesn't behave like muscle or joint pain.
This is a widely underutilized area of physical therapy. Most clinicians apply standard musculoskeletal protocols to what is actually a neural problem — and see little or no improvement. The biomechanics of the nervous system require a different examination framework and a different set of treatment tools.
At Solas PT, Dr. Cisneros specializes in neurodynamic assessment and treatment. When the nervous system is the source of the problem — and it's correctly identified and treated — results can be immediate and dramatic, often within one to two weeks.
Peripheral nerves are not static structures. The sciatic nerve, for example, lengthens by several centimeters as the hip flexes and the knee extends simultaneously. When surrounding tissue restricts this movement — through scar tissue, muscle tightness, postural compression, or bony narrowing — the nerve becomes mechanosensitive: it produces symptoms in response to positions and movements that should be painless.
A patient whose shoulder pain is driven by a C5–C6 radiculopathy will see minimal improvement from rotator cuff exercises and shoulder manual therapy. A patient with femoral nerve irritation presenting as anterior knee pain won't improve with quad strengthening protocols. Identifying the neural pain generator changes everything — including which stretches are helpful versus which will flare the condition significantly.
When the correct neurodynamic technique is applied to the right presentation, the nervous system responds quickly. Improvement within the session — reduced pain, increased range of motion, decreased neurological symptoms — is common. For acute and subacute nerve irritation, significant lasting improvement in one to two weeks is achievable.
Neurodynamic mobilization is not a single technique — it's a clinical decision between two mechanistically different approaches. Applying the wrong one to a sensitized nerve can cause a significant and prolonged flare-up. This choice requires clinical skill, not trial and error.
Sliders move the nerve through surrounding tissue without applying sustained tension. One end of the neural structure is lengthened as the other end is simultaneously shortened — so the nerve slides back and forth like dental floss through a narrow space, without being stretched. This is the gentler technique and is preferred for highly irritable, acutely sensitized presentations.
Patient seated. Extend the right knee (lengthens the distal end of the sciatic nerve) while simultaneously tilting the head back (shortens the proximal end). Then reverse: lower the leg while dropping the chin forward. Repeated rhythmically, this creates a sliding motion of the sciatic nerve through the lumbar foramina, sciatic notch, and down the posterior leg — without tensioning it at both ends simultaneously. Well tolerated even in acute presentations.
Tensioners apply sustained stretch to the neural structure by lengthening both ends simultaneously. This creates greater mechanical load on the nerve and its surrounding connective tissue, producing a more intense and targeted stimulus. Tensioners are used for less irritable, more chronic or stubborn presentations where the nerve has adapted to reduced mobility. Applied incorrectly to a sensitized nerve, they can trigger prolonged symptom flares.
Patient seated or supine. Lift the leg with the knee extended (straight leg raise — loads the distal end) while simultaneously flexing the chin to chest (loads the proximal end through the dural tube). Both ends under tension simultaneously. This is significantly more provocative than the slider — it's the technique that confirms sciatic involvement when pain is reproduced, and it's the technique used therapeutically only when irritability has been assessed to be low enough to tolerate it.
Why technique selection matters: The nervous system, when sensitized, responds very differently to mechanical input than normal tissue does. Many patients with nerve pain have been given "nerve glides" from YouTube or a previous PT and experienced worsening symptoms — because the technique was applied without assessing irritability level. The slider-to-tensioner progression is a clinical decision that depends on the specific nerve, the degree of sensitization, the symptom behavior, and how the patient responds. Dr. Cisneros makes this assessment every session.
Peripheral nerves originate in the spinal cord, exit through bony foramina, travel through muscle compartments, pass around joints, and terminate in the skin and muscles of the extremities. Restriction or irritation can occur anywhere along this course. A thorough neurodynamic examination identifies not just which nerve is involved — but where along its path the mechanical problem is occurring.
The sciatic nerve is formed from five lumbar and sacral nerve roots. Disc herniation, foraminal narrowing, or facet joint hypertrophy at any of these levels can compress the nerve root before it even enters the peripheral nervous system. Treatment: Spinal manual therapy, joint mobilization, and traction-based techniques to decompress the root. Spinal manipulation activates the central nervous system's own pain-modulating pathways — producing an endogenous opioid response that significantly reduces neural sensitivity.
The sciatic nerve exits the pelvis through the greater sciatic notch and passes beneath — and sometimes through — the piriformis muscle. Piriformis tightness or hypertrophy can compress the nerve here, producing buttock pain and posterior leg symptoms that mimic a disc herniation. This is piriformis syndrome, and it responds to very different treatment than discogenic sciatica. Treatment: Dry needling the piriformis directly, hip external rotator stretching, and nerve sliders to restore sciatic mobility through this region.
As the sciatic nerve travels down the posterior thigh, it can become restricted within the hamstring compartment — particularly in people with hamstring tightness, prior hamstring injuries, or sustained sitting postures. Symptoms: posterior thigh pain that behaves like a hamstring strain but doesn't respond to hamstring loading. Treatment: Neural sliders through this region combined with soft tissue work to the hamstring compartment.
Below the knee, the sciatic nerve divides into the tibial and common peroneal nerves. Common peroneal compression at the fibular head — from a knee injury, prolonged sitting, or compression — produces foot drop and lateral leg numbness. Tibial nerve irritation at the tarsal tunnel produces heel and sole pain that looks like plantar fasciitis. Treatment: Site-specific nerve mobilization, joint mobilization at the ankle, and correction of the mechanical cause of compression.
Double crush syndrome occurs when the same nerve is compressed or irritated at two separate points along its course — one proximal and one distal. The concept: a nerve that is already under metabolic or mechanical stress at one site has significantly reduced tolerance for compression at a second site. Each lesion alone might be subclinical or barely symptomatic; together, they produce significant and often confusing symptoms.
Cervical nerve root compromise at C6 combined with median nerve compression at the carpal tunnel. The patient presents with hand numbness and tingling that looks like carpal tunnel syndrome — but treating only the wrist provides only partial relief because the proximal root compression is also contributing. Both sites must be addressed for full resolution.
Manual therapy — including joint mobilization and spinal manipulation — addresses the proximal site. Spinal manipulation triggers an endogenous opioid response that reduces neural sensitivity throughout the pathway. Neural mobilization (sliders or tensioners as appropriate) restores nerve mobility at the distal entrapment site. Both components are necessary.
Double crush syndrome is frequently missed at clinics that treat only the distal site — because that's where the patient points. A neurodynamic examination that assesses the full course of the nerve is the only way to identify both lesions.
These are conditions where the nervous system's mechanical behavior is a primary or contributing driver of symptoms — and where neurodynamic treatment is indicated alongside or instead of standard musculoskeletal PT.
The most common presentation of sciatic nerve mechanosensitivity. Neural sliders and tensioners — combined with lumbar manual therapy or manipulation — address both the neural irritation and the spinal component driving it. Cross-link: Sciatica Treatment Guide →
Nerve root compression at the cervical spine producing pain, numbness, or weakness that radiates into the shoulder, arm, or hand. Cervical manual therapy combined with upper limb neurodynamic mobilization (median, radial, or ulnar nerve bias) addresses both the root and the peripheral nerve behavior.
Median nerve compression at the carpal tunnel, ulnar nerve entrapment at the cubital tunnel — and the proximal contributions from cervical and thoracic spine that double crush syndrome adds. Nerve sliders through the wrist and elbow combined with spinal treatment for proximal involvement.
Brachial plexus or subclavian vessel compression between the clavicle, first rib, and anterior scalene muscles — producing arm heaviness, hand tingling, and shoulder symptoms that look like rotator cuff problems. Neurodynamic assessment of the brachial plexus combined with first rib mobilization and scalene soft tissue work.
Femoral nerve irritation — from hip flexor tightness, lumbar plexus involvement, or psoas compression — produces anterior thigh and knee pain that mimics a quad strain or patellar tendinopathy. Neural assessment distinguishes the neural component from the musculoskeletal one and directs appropriate treatment.
Burning, shooting, or electric pain that doesn't map cleanly to a muscle or joint — often the result of peripheral nerve sensitization from injury, compression, or systemic factors. Neurodynamic assessment identifies the affected nerve, and graded mobilization — starting with sliders — desensitizes the neural system progressively.
Neurodynamic treatment rarely works in isolation. For radiculopathy and nerve pain with a spinal component, manual therapy to the spine is an essential part of the picture — and spinal manipulation in particular produces effects that nerve glides alone cannot.
High-velocity spinal manipulation — the technique that produces the characteristic "pop" — activates mechanoreceptors throughout the joint and surrounding tissue that trigger the central nervous system's own opioid response. This endogenous release of pain-modulating substances reduces the sensitivity of the entire peripheral nervous system, making subsequent neural mobilization both safer and more effective. For patients with highly sensitized nerve pain, manipulation can change the treatment landscape within a single session.
Once the central nervous system's sensitivity threshold is lowered — through manipulation, manual therapy, or dry needling — the peripheral nerve can be mobilized more effectively. Neural sliders and tensioners restore the nerve's ability to move through its surrounding tissue without provoking symptoms. This is the mechanical component: the nerve needs to slide freely, and mobilization teaches it to do so again.
Peripheral nerves run through and between muscles — and hypertonic, trigger-point-laden muscles can compress a nerve through its course. Dry needling to the piriformis for sciatic nerve impingement, to the scalenes for thoracic outlet contributions, or to the forearm flexors for median nerve involvement directly addresses the muscular component of peripheral nerve entrapment. The combination of dry needling, spinal manipulation, and neural mobilization addresses all three layers of the problem simultaneously.
The biomechanics of the nervous system is an underrated specialty. Most PT training covers it briefly. Most clinics don't treat it. At Solas PT, neurodynamic assessment is part of every evaluation where symptoms may have a neural component — because missing it means treating the wrong tissue indefinitely.
Neurodynamic physical therapy addresses the mechanical behavior of the nervous system — specifically how peripheral nerves move, slide, and tolerate tension as the body moves. When a nerve becomes mechanosensitive (irritated, compressed, or restricted in its movement), it produces neuropathic pain, tingling, numbness, or weakness. Neurodynamic treatment uses specialized techniques — nerve sliders and nerve tensioners — to restore normal nerve mobility and reduce pain sensitization. At Solas PT, Dr. Cisneros specializes in this area and regularly achieves significant improvement in 1–2 weeks for patients who haven't responded to standard PT.
Nerve sliders — also called neural flossing — move the nerve through surrounding tissue without applying sustained tension. One end is lengthened while the other is simultaneously shortened, so the nerve slides back and forth. For sciatic nerve symptoms: extend the knee while tilting the head back, then lower the leg while dropping the chin — repeated rhythmically, the nerve slides without being stretched. This is the gentler technique and is preferred for acutely sensitized presentations. Tensioners apply stretch to both ends of the nerve simultaneously, creating more intense mechanical load. They're used for less irritable, more chronic presentations. Applying a tensioner to a highly sensitized nerve can cause a prolonged flare-up — this selection is a clinical decision, not a patient self-treatment choice.
Double crush syndrome occurs when the same nerve is compressed or irritated at two separate points — one proximal (near the spine) and one distal (further in the extremity). A nerve already stressed at one site has significantly reduced tolerance for compression at a second site. A common example: cervical nerve root compression at C6 plus median nerve compression at the carpal tunnel — together producing hand numbness that looks like pure carpal tunnel but only partially responds to wrist treatment. Treatment must address both sites: spinal manual therapy for the proximal contribution and neural mobilization for the distal entrapment.
Yes — and this is one of the most commonly missed diagnoses. A nerve that is irritated or mechanically restricted can produce pain that feels exactly like a shoulder problem, a knee problem, or a hip flexor strain. Standard PT that treats only the joint — exercises, manual therapy, dry needling to the surrounding muscle — produces minimal improvement because the actual pain generator is neural. A thorough neurodynamic examination identifies when the pain is being generated or maintained by the nervous system rather than the joint or muscle, and redirects treatment appropriately.
Sciatica and lumbar radiculopathy, cervical radiculopathy with arm pain, carpal tunnel syndrome presentation, thoracic outlet syndrome, piriformis syndrome, ulnar nerve entrapment, femoral nerve irritation, meralgia paresthetica, and other peripheral nerve entrapments. Also effective for chronic or widespread pain with central sensitization — where the nervous system's overall sensitivity threshold has been chronically elevated.
When the correct technique is applied to the right presentation, results can be immediate — within the session or within 24–48 hours. For acute or subacute nerve irritation treated early, significant improvement in 1–2 weeks is common. Chronic, long-standing nerve sensitization takes longer. The key is accurate diagnosis and correct technique selection. Dr. Cisneros specializes in this assessment and frequently achieves results for patients who had no improvement after months of standard PT.
No. Texas is a direct access state. You can book directly with Dr. Cisneros at Solas PT without a physician's referral. He will perform a thorough neurodynamic examination to determine whether your symptoms are nerve-mediated, which nerve is involved, where along its course it's being affected, and what treatment approach is appropriate. If imaging or specialist referral is warranted, he will coordinate that.
Neurodynamic assessment and treatment is a specialty that most PT clinics simply don't offer. At Solas PT in west El Paso, Dr. Cisneros evaluates the full mechanical behavior of the nervous system — and treats the actual source of your symptoms. Same-week appointments. No referral needed.
Sciatica: What Actually Works → | Dry Needling for Nerve Pain →