Non-pharmacological therapeutic interventions are being embraced by the medical community because they are simple to carry out, economical, and have relatively minor side effects.
One treatment approach that can be used as part of an individualized multi-modal program to manage persistent pain is nerve mobilizations. The most recent meta-analysis on the topic was published in The Journal of Orthopaedic & Sports Physical Therapy. This study suggests that nerve mobilizations are useful for patients with back, neck and foot pain (Basson et al. 2017).
Nerve Mobilizations Are Used To Assess for Increased Sensitivity of The Nervous System
Therapists use a variety of movements to assess for sites of irritation. Sometimes patients may test negative, but this does still not rule out nerve irritation, in these cases a more refined assessment along the entire path of the involved nerve may be needed.
Nerve Mobilizations Are Used To Restore Homeostasis in and Around The Nervous System
Neurovascular bundles may be exposed to mechanical irritation at many different points. Prolonged irritation may result in the release of inflammatory mediators, known as “inflammatory soup”.
In some cases of peripheral nerve inflammation may contribute to ongoing symptoms without overt nerve damage. In these cases five minutes of passive mobilization may help to diminish intraneural edema and/or pressure (Boudier-Revéret et al. 2017). This will have a modulatory affect on peripheral and central processes.
In longer standing cases the development of fibrosis, may contribute to peripheral nerve dysfunction. If implemented early the application manual therapy that may attenuate tissue fibrosis and restore motility of peripheral nerves (Bove et al. 2016).
There is a fair bit of research to support the use of nerve mobilizations for musculoskeletal pain. Furthermore, a biopsychosocial framework of manual therapy helps put into context the interconnected and multidirectional interaction between: physiology, thoughts, emotions, behaviors, culture, and beliefs.
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