Scrape, Tape, Cup & Glide: Restoring Space, Motion, & Slack for Restricted Neural Dynamics of the Upper Quarter

radial-nerveThe concept of restricted neural dynamics is not new, however, its impact on our patients’ daily activities and movement tolerance is often overlooked during the examination and treatment of our patients.  This course integrates the basic concept of “test-treat-retest” as a foundation to manage these challenging patients.

The basic principle that neural tissue needs space, motion, and slack for optimal healing potential underpins all concepts covered. This upper extremity focused course features motion-based interventions consisting of:

  • neural flossing
  • nerve bed/nerve differential gliding
  • instrument assisted soft tissue mobilization (IASTM)
  • negative pressure soft tissue mobilization (cupping)
  • corrective exercises
  • taping

Please dress to allow access to your entire upper quarter to enhance the learning process.

During the hands-on lab sessions, the course instructor will evaluate each application for neural mobilization, IASTM, Cupping and Taping to determine 100% proficiency of all basic treatment techniques. This will be determined by direct observation and correction of any issues with techniques.

This course content is not intended for use by any participants outside the scope of their license or regulation.

Course Objectives:

At the completion of this course you will be able to:

  • Identify 2 main regions of the brachial plexus
  • Given a patient scenario in which the patient demonstrates a numb hand, map patients’ symptoms to the brachial plexus
  • Identify 2 conditions that increase the potential for nerve injury vulnerability in patients with cervical sprain/strain
  • Identify 2 signs and 4 symptoms of brachial plexalgia
  • Given a patient with medial/lateral elbow pain, “dead arm” syndrome and SICK scapula syndrome the participant will accurately bias the Brachial Plexus, Radial, Median and Ulnar nerve tissue and nerve bed using novel neural mobility grading scales (0-5)
  • Given a case scenario for a patient with lateral epicondylagia generate a treatment plan, including goals and prognosis based on exam results
  • Justify based on evidence how basic treatment to restore space, motion, and slack can be integrated into the overall treatment plan for patients with Thoracic Outlet
  • Given a patient scenario choose 3 appropriate IASTM treatments to enhance movement and space for movement dysfunctions resulting from restricted neural mobility in a patient with cervical strain
  • Choose 3 basic negative pressure soft tissue techniques (cupping) over the nerve bed to enhance space and movement for addressing restricted neural dynamics in patients with shoulder sprain/strain
  • Following the course and given a case scenario the participant will integrate cupping and IASTM strokes in a patient with Brachial Plexalgia (left chest wall & facial pain, numbness of the thumb, ring and small finger)
  • Choose 2 taping techniques to enhance slack promoting posture correction and inhibition of neuropathic pain for patients with cervical sprain/strain

CE Credits

14 contact hours

BOC Level: Advanced

This course is accepted by many professional credentialing organizations and state professional regulatory boards. Rules and regulations change frequently without notification, and apply differently to live and online courses. Please check with your state board to confirm accuracy of this list and acceptance of contact hours. Certificate of Attendance will be issued to all participants upon completion of the course and may be used for CEU verification of credits. CE credits vary by state. Please check with your state board/certifying agency to confirm conversion of contact hours to CE. See links below.


California OT Board: This course and instructor have been approved by the CA Board of OT for 13.75 contact hours of post-professional education in the advanced practice area of hand therapy. Approval #22-H21.

Physical Therapy Board of California: The Physical Therapy Board of California recognizes Rehab Education, LLC as an approval agency to approve providers offering continuing competency courses for CA licensed PTs and PTAs. This course is approved for 14 contact hours.

Maryland State Board of Physical Therapy Examiners: Approved by the Maryland State Board of Physical Therapy Examiners for 1.4 CEUs. (Course must be taken between 09-1-2017 and 09-1-2021)

New Jersey State Board of Physical Therapy Examiners: This course has been approved by the New Jersey State Board of Physical Therapy Examiners for 14 continuing education credits, Approval #2001-37. (Course must be taken between 02-1-2020 and 01-31-2022)

NJ Board of Chiropractic Examiners: The New Jersey State Board of Chiropractic Examiners has approved Rehab Education as a pre-approved provider/sponsor of chiropractic continuing education courses. This course has been approved for 14 contact hours. (Course must be taken between 09-1-2019 and 08-31-2021)

NY State Physical Therapy Board: Rehab Education, LLC is recognized as an approved provider of PT and PTA continuing education by the NY State Education Department Board of Physical Therapy. (Course must be taken prior to 05-10-2022)

PA State Board of Physical Therapy: Per PA rules and regulations, Pennsylvania Board of Physical Therapy now recognizes as approved any course certified by FSBPT’s ProCert or approved by another state PT Board, or approved by the APTA and its components which includes the state chapters, regional chapters, and sections.

Texas Board of Physical Therapy Examiners: This course has been approved by the Texas Board of Physical Therapy Examiners as meeting continuing education requirements for PTs and PTAs for 14 CEU. Approval #70835. (Course must be taken between 09-11-2019 and 09-11-2021)

Wisconsin Physical Therapy Association: This course has been approved by the Wisconsin Physical Therapy Association for 14 CE hours continuing education credits. Approval Approval #17861. (Course must be taken between 10-24-2020 and 10-24-2021)

American Occupational Therapy Association (AOTA) Approved Provider #6177: See states that currently recognize AOTA Approved Providers for OT

Federation of State Boards of Physical Therapy (FSBPT): Federation of State Boards of Physical Therapy (FSBPT): Federation of State Boards of Physical Therapy (FSBPT) / ProCert has awarded certification in the amount of 14 Continuing Competence Units (CCUs) to this activity. Approved CCUs are a unit of relative value of an activity based on its evaluation against a rigorous and comprehensive set of standards representing the quality of an activity. The CCU determination is a valuation applying many factors including, but not limited to, duration of the activity. No conclusion should be drawn that CCUs correlate to course hours. (Course must be taken between 01-14-2018 and 12-30-2021) Please check with your state physical therapy board to determine if they currently accept the Federation of State Boards of Physical Therapy (FSBPT) certification.

  • AOTA Approval States

    These states currently recognize AOTA Approved Providers for OT continuing education either in regulatory language or by formal written communication to AOTA:

    District of Columbia
    New Hampshire
    New Mexico
    New York
    North Carolina
    North Dakota
    Rhode Island
    South Carolina
    South Dakota

    *Disclaimer: Rehab Education LLC provides this list for your convenience. At the time of listing, the following state boards accept courses by virtue of approval by other organizations. It is the responsibility of the participant registering for a course to check with their state board to confirm rules and regulations regarding acceptance of contact hours for live and online courses.

    The following PT Boards accept courses approved by other state PT boards or APTA state associations*:

    North Carolina

    The following PT Boards accept courses approved by other APTA state associations*:

    Rhode Island

    The following PT Boards accept courses provided by AOTA approved providers*:

    District of Columbia
    Rhode Island

    *NBCOT…National Board for Certification of Occupational Therapy (view PDU requirements)

    +HTCC… Hand Therapy Certification Commission  (view recertification requirements)
    Hand Therapy Certification Commission (HTCC): This course is accepted by HTCC towards re-certification.

    State PT Boards
    State OT Boards


Day 1

7:30 – 8:00 Continental Breakfast and sign in
8:00 – 9:00 Introduction and background of basic concepts: Neural Physiology for Optimal Healing – Space, Motion, Slack
  Assessing the Sensitized Neural Tissue: The following Labs are focused on collecting baseline data for test-treat-retest guided clinical decision-making
9:00 – 9:45 Palpation Lab
9:45- 10:00 Break
10:00 – 11:15 UE Mobility Assessment Lab
11:15 – 11:45 Novel nerve bed examination techniques
11:45- 12:45 Lunch Break
12:45 – 1:15 Quiz for concept retention & treatment conditions
Review/ Quiz
1:15- 1:30 Indications/contraindications
  Patient Case Scenarios – Application of concepts
1:30 – 3:00

Concepts covered: misdiagnosed conditions & confusing symptoms, structural differentiation.  Treatment principles: nerve bed IASTM – clinical cases Lab

  • Cervical sprain/strain
  • Shoulder sprain/strain
  • Lateral & medial epicondylalgia
  • The numb hand
3:00 – 3:15 Break
3:15 – 4:15 Applying negative pressure (Cupping) principles in the treatment of the above clinical scenarios
4:15 – 4:45 Integrating IASTM and Cupping simultaneously over the nerve bed to promote space and motion in the above clinical scenarios


Day 2

7:30 – 8:00  Continental Breakfast and sign in
8:00 – 9:00 The Thoracic Outlet Syndrome – The Brachial Plexus
Thoracic Outlet Syndrome – Lecture (0.5)/lab (0.5)
9:00 – 9:30

Brachial Plexalgia Case Scenarios – Application of examination techniques. (Independent small group clinical case scenarios examination skills integration lab)

  • Baseball pitcher with medial/lateral elbow pain, “dead arm” syndrome and SICK scapula syndrome
  • Surfing stockbroker with L chest wall & facial pain, numbness of the thumb, ring, and small finger
  • LPN with burning along the posterior shoulder, dorsum of the forearm and hand, R chest wall spasms and pain, numbness of the middle to small finger
  Treatment concepts to promote space and slack along the nerve bed for the UE
9:30 – 10:00 Breathing Diaphragmatically – exercise lab
10:00 – 10:15 Break
10:15 – 10:45 Posture corrective exercises – cervical focus
10:45 – 11:15 Posture corrective exercises – scapular focus
11:15 – 12:15 Nerve bed mobilization with flossing
12:15 – 1:15 Lunch
1:15 – 1:30 Sustained cupping over the nerve beds while flossing the neural tissue
1:30 – 3:00 Taping along the nerve bed and for posture correction & treatment carry over
3:00 – 3:15 Break
3:15 – 4:15 Conclusion – small group skills integration clinical cases treatment lab – Brachial Plexalgia cases above


Mark W. Butler, PT, DPT, OCS, Cert. MDT

is a board certified Orthopaedic clinical specialist and Mckenzie certified specialist for mechanical diagnosis and treatment of the spine. He started his own practice eighteen months after graduating from the Philadelphia College of Pharmacy and Science (now the University of Science in Philadelphia), which he sold to NovaCare in 1997.

He is an Adjunct Assistant Professor at UMDNJ, guest lecturer at Stockton College in New Jersey, and Medical College of Virginia where he lectures on Advanced Orthopedics, Neural Mobilization, Radiology, and Evaluation and Treatment of TMJ Disorders. Mark is also a continuing education speaker on Evaluation and Treatment of Brachial Plexopathies, Neural Mobilization, the lumbar spine, and the shoulder. He was honored in 2006 with the James Tucker Excellence in Clinical Practice and Teaching Award by the APTAnj. He presented at the national conference in Hollywood of the American Society of Hand Therapists on Evaluation and Treatment of the Brachial Plexopathy Patient. His lecture series was selected as the featured topic on CD ROM to be available to the ASHT membership.

Mark is a frequent presenter at conferences, including the APTAnj annual conference, the InNovations and Sports Medicine conferences at the Philadelphia Eagles Complex, and the Cincinnati Fracture conference. He authored the shoulder chapter in the textbook Fundamentals of Hand Therapy: Clinical Reasoning and Treatment Guidelines for Common Diagnoses of the Upper Extremity, which was published in 2014. Mark continues to manage the NovaCare Medford outpatient clinic, where the majority of his caseload is brachial plexopathy, shoulder, and spine patients.

Classes taught by Mark W. Butler: