If any part of the nervous system is denied movement through trauma (e.g.: whiplash) or wear and tear, pain and other symptoms (local and referred) result.
Physiotherapists are often the first health care professionals to come into contact with people suffering painful problems related to nervous tissue dynamics. These conditions can include tennis elbow, plantar fasciitis, carpal tunnel syndrome, sciatica and even chronic ankle sprains to name a few.
Nervous System Trauma, Wear and Tear
The nervous system moves and adapts itself with every body movement by sliding and by rising the tension within the system. Nervous tissue is flexible and pliable, but is relatively inelastic. If any part of the nervous system is denied movement through trauma (e.g.: whiplash) or wear and tear, pain and other symptoms (local and referred) result.
Adverse Neural Mobility
Adverse neural mobility is usually associated with muscle imbalances and connective tissue and joint dysfunctions. I.e.: scar tissue around a nerve root following a discotomy, protrusion of a disc, facet joint irritation, sclerotic or fibrotic tissue lesions on muscles and tendons near a peripheral nerve, abnormal alignment of a joint (i.e.; increase carrying angle in the elbow). It can also be linked to habitual postures, work position/practice and general level of fitness. Adverse neurodynamics can therefore be caused by unhealthy surrounding tissues which are considered as the ‘interface’. If any degree of ‘entrapment’ of nerve tissue occurs, normal movement can become painful and symptoms gradually spread around the body.
How is adverse neural tissue mobility assessed by a physiotherapist? The physiotherapist must first ask specific questions related to the symptoms; what movements or positions produce/reduce the pain? Are pins and needles present at end of range? A scan is then performed to rule out serious pathology and to ‘narrow in’ on the structures at fault.
Standard neurodynamic tests are then used to detect and monitor ‘dural irritation’ and nerve root compression. The Upper Limb Tension Tests described by Butler help to assess the mobility of the median nerve, the radial nerve and the ulnar nerve. The Slump test and the straight Leg Raise Test are performed to identify neural mobility dysfunctions in the sciatic nerve with a bias on the tibial, the sural and the peroneal nerves.
The Prone Knee Bend test can be used to mobilize the femoral nerve with a bias on the Obturator nerve.
Treatment Through Manual Therapy
Physiotherapists have manual therapy skills to address the interface by mobilizing stiff joints and breaking down adhesions which cause nerve entrapment. Once the interface has been established and treated, the physiotherapist can use other above mentioned neurodynamic tests as an exercise to ‘mobilize’ and desensitize the nerve tissue.
Ref: Butler, D.S. & Gifford L.S. (1999) The Dynamic Nervous System. N.O.I. Press, Adelaide