Nerve Mobilization Techniques

I would like to highlight one of the unique treatment techniques that we offer at OrthoWell.  As many of you know, we spend a lot of quality time during our biomechanical evaluation trying to “figure things out”. This is the reason that several of our referring physicians call us “THINKERS”.  We pride ourselves in determining your functional diagnosis. This diagnosis is what we use to develop your plan of care and to educate you in how to alleviate your pain or dysfunction. Many of our patients have seen several physicians or therapists before hearing about us. For this reason, we offer specialized evaluation and treatment services that our patients may not have heard of and that may be appropriate to alleviate symptoms that have been unresponsive to prior interventions.  One of these is Nerve Mobilization or NeuroMobilization. So what is it?

What is NeuroMobilization?

NeuroMobilization or Nerve Mobilization is a technique that we utilize to treat nerves that may be adhered, irritated, or compressed.  Many patients that have been unresponsive to other physical therapy and present with a chronic history of referred symptoms like pain, numbness, or tingling into the arms or legs may respond to NeuroMobilization.  Every patient that presents with referred symptoms or pain that has been unresponsive to localized treatment receives a complete neural tension evaluation.  Neural tension testing is a way for your therapist to determine the extent of nerve involvement.  By mobilizing a nerve, we can determine, in combination with manual traction and sensitizing maneuvers, whether your pain is originating from the spine or the periphery.

NeuroMobilization Techniques

We can then perform NeuroMobilization techniques utilizing controlled neural tension maneuvers to mobilize the nerve up and down.  David Butler,PT, has been at the forefront of these techniques for over 20 years.  Although we still do not completely understand the exact mechanism, he proposes that NeuroMobilization (what David Butler calls Neurodynamics) can accelerate nerve healing and quiet down what he calls an “altered impulse generating system (AIGs)”.  These AIGs may respond to the oscillations of NeuroMobilization by enhancing circulatory exchange or ion transfer in and around the nerve.  You can read more about the techniques and science in David Butler’s book The Sensitive Nervous System.

Here is a video that highlights a sciatic nerve tension test and Neuromobilization.

 

Is your tennis elbow a pain in the neck?

What came first, the chicken or the egg?  The fundamental premise behind this question can be applied to orthopedic physical therapy as well.  What came first, your pinched nerve, your shoulder pain, your elbow pain, or your poor posture?  Let me explain.

We live in a society dominated by “slouching” syndrome.  We prefer to sit in a soft chair with forward flexed posture instead of a firm chair with erect and supported posture.  Draw a line from the middle of your ear to the center of your shoulder to the center of your hip joint and, bio-mechanically speaking, you are lookin’ pretty good

 

We need to maintain a normal inward curve at our necks and low back as well as a normal outward curve in our mid backs.

 

So what is the connection?  Sit or stand with really slouched shoulders and attempt to raise your arm overhead.  Now, sit straight and try it again.  You have much more freedom of motion in your shoulder while sitting straight.  Now, think about how many times you reach during the day with forward flexed posture.  Each and every reach in this forward position will cause a “pinch” or impingement of your rotator cuff tendon in your shoulder. According to Flatow et al in the American Journal of Sports Med, all of us, physiologically, have a certain amount of “normal” impingement in our shoulders.  Compound this “normal” impingement with the exaggerated impingement that occurs with poor posture and you have a recipe for the pain of rotator cuff tendonitis.  Refer to my post on Impingement Syndrome for more details.

 

Do you know of anyone who has chronic tennis elbow (pain on outside of elbow) or golfers elbow (pain on inside of elbow)?  You may want to mention to them the results that were published in an article in the journal Sports Health. The authors evaluated 102 patients with documented cervical radiculopathy ie pinched nerve in the neck and found that more than half of the patients also had medial epicondylitis ie golfers elbow.  The prevalence of tennis elbow and neck involvement has also been documented and Berglund et al article is one example. What this means is that your therapist and YOU need to be aware of this connection and the appropriate steps need to be taken to rule out your neck as the CAUSE of your elbow symptoms.

 

The chicken or the egg?  Maybe you need OUR help.