What is Clinical Neurodynamics with USA course instructor Joseph “Joe” Gravino.

We recently interviewed our upcoming Clinical

Neurodynamics course instructor Joe Gravino, PT, DPT, Cert.MDT, in order to get to know more about the technique and the course. Here's how it went:

What is Clinical Neurodynamics?

Neurodynamics is often mistaken for neural mobilisation. For neurodynamics, we need a flexible system and this is what Shacklock's Clinical Neurodynamics is: diagnosis and treatment of neurodynamic functional disorders, some of which involves neural mobilisation and some of which doesn't. It's sub-grouping and treatment for neurodynamic problems, as McKenzie is for low back pain and function. There are times when neural mobilisation is provocative and can't be done. This is where the benefit comes because Shacklock's approach enables the clinician to categorize the patient in which first aid - pain relieving unloading techniques - can be done rather than applying force to the nerves that occurs during mobilisation. Patients can also be taken through 'rehab' to 'high performance' situations. What is the difference between NDS and other groups or individuals who teach and work with neurodynamic issues?

I am often asked this question. While I have tried to study many individuals' work in the world, including neurodynamics, the biggest difference to me is that NDS provides us a framework that is flexible to meet the patient in front of you on Monday morning, while giving you guidelines and understanding of principal information allowing you to make your own sound clinical decisions.

So Joe, tell us a little bit about yourself and your background?

In a nutshell, I am a father, husband, pet dad and major fan of the works of many writers including J RR Tolkien. On a more formal note, I received my Doctorate of Physical Therapy from Daemen College in 2015. Since then, I have deliberately undergone post-doctoral education in a variety of areas in orthopedics, manual therapy, and clinical reasoning. From 2017-2019, I worked closely with the World of Hurt team and Annie O’Connor and started my journey on trying to understand the pain experience more closely. This led me to being a staple in our community to treat more “complex patients”. After a while I realized I was not helping a lot of my patient with nerve-based symptoms or problems. So, in 2019, I started working with Michael Shacklock on an individual mentor basis. Michael and I have worked closely since.

I have a private practice, Elite Spine & Extremity Physical Therapy, which became credentialed in Mechanical Diagnosis and Therapy (MDT). Some of my professional accomplishments include presenting a case study pertaining to treating individuals with neuromuscular disorders and mechanical low back pain in 2017, a poster presentation on neurodynamics in 2019, and being awarded Daemen Universities Graduate of the decade in 2020. Currently, I am working on submitting my first publication(s). Additionally, I have worked as an adjunct professor at University at Buffalo and Daemen University in their orthopedics curriculum and has helped with the content production for a local orthopedic residency.

How did you become associated with NDS and Michael Shacklock?

In 2018, after a few years of working with patients with chronic pain and complex presentations, I found that I was not having good success with individuals with what seemed liked predominantly nerve-based pain. It seemed like this whole in my practice where I didn’t understand their problems well enough, nor could I help these patients along their journey. It was then that I started looking more into neural anatomy, pathology, physiology, injury, and recovery. I stumbled upon Michael Shacklock’s book and his courses at Neurodynamic Solutions. I remember hearing that he may be coming to the USA in 2020 and was excited. I purchased Michael’s book and started going deeper into his and other individuals’ material. Fast forward to 2020 and during the beginning of the pandemic I reached out to Michael on social media and asked if he would be willing to mentor me remotely. To my surprise he quickly responded that he would be willing. For the next two years I have worked with Michael and NDS on a personal basis as a mentee, taken his course work, and had my physical therapy staff take all his coursework together. After working with Michael this long it felt natural to try and help get Neurodynamic Solutions and Michael teach his material further into North America.

How was the training like with Michael Shacklock and NDS?

When my team and I went through the formal course work with Michael and NDS it was overall an amazing experience. We decided to take his course work in a hybrid fashion over roughly 10 weeks. This consisted of multiple check-ins with Michael, weekly and easily digestible didactic course work, weekly hands-on learning sessions with my team, and frequent critiquing of our knowledge and manual skills. This bonding that this course format fostered with my team is like no other. It truly was a great experience and blend of content in multiple ways affording different learning styles to thrive and done so in a decent pace.

How does your background as a McKenzie certified clinician relate to NDS?

My background in MDT or McKenzie has been really from the start of my career. I can’t speak more highly of the teachings and education I was afforded by early professors, mentors, and ultimately the formal MIUSA coursework. That said, I felt like I had difficulty when I landed on patients who could be sub-categorizes as peripheral nerve entrapments or mechanically unresponsive radiculopathies. I felt stuck and kept seeing more and more patients where this was more relevant. I feel like my training in MDT and NDS compliments each other greatly. When there is nerve pathology present, I rely more on NDS teachings and when they are not, I rely more on my MDT background. Sometimes the lines get blurry as they do in clinical practice, but I believe having a good understanding in both thought processes makes me a better clinician for more patients.

What should people expect from the lower quarter 1 clinical neurodynamics course?

The lower quarter 1 clinical neurodynamics is a great course to start your neurodynamics training. You will learn about pathophysiology of the spinal cord, lumbar nerve roots, and peripheral nerves in the lower extremities. You will learn how to give pain relief by UNLOADING lumbar nerve roots for acute severe sciatica (based on our validation studies), diagnosis with neurodynamic tests (inclusion/exclusion criteria), nerve palpation, diagnostic categories, and progressions for the dysfunctions of both neural tissue and interfaces, and physical treatment of neurodynamic disorders from FIRST AID TO THE ATHLETE.