Nerve Mobilization Techniques

Nerve Mobilzation Techniques

Nerve Mobilization Techniques

 

Erik Dalton demonstrates a simple sciatic nerve mobilization routine.

Nerve Mobilization Techniques

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

NERVE PALPATION (SCHMID ET AL. 2009)

NERVE PALPATION (SCHMID ET AL. 2009)

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).

Key Point

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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Research Links

Baselgia, L.T., Bennett, D.L., Silbiger, R.M., Schmid, A.B. (2017). Negative Neurodynamic Tests Do Not Exclude Neural Dysfunction in Patients With Entrapment Neuropathies. Arch Phys Med Rehabil.
https://www.ncbi.nlm.nih.gov/pubmed/27449322

Basson, A., Olivier, B., Ellis, R., Coppieters, M., Stewart, A., Mudzi, W. (2017). The Effectiveness of Neural Mobilization for Neuro-Musculoskeletal Conditions: A Systematic Review and Meta-Analysis. J Orthop Sports Phys Ther.
https://www.ncbi.nlm.nih.gov/pubmed/28704626

Berthelot, J.M., Laredo, J.D., Darrieutort-Laffite, C., Maugars, Y. (2017). Stretching of roots contributes to the pathophysiology of radiculopathies. Joint Bone Spine.
https://www.ncbi.nlm.nih.gov/pubmed/28115269

Boudier-Revéret, M., Gilbert, K.K., Sobczak, S. (2017). Effect of neurodynamic mobilization on fluid dispersion in median nerve at the level of the carpal tunnel: A cadaveric study. Musculoskelet Sci Pract.
https://www.ncbi.nlm.nih.gov/pubmed/28734168

Bove, G.M., Harris, M.Y., Zhao, H., Barbe, M.F. (2016). Manual therapy as an effective treatment for fibrosis in a rat model of upper extremity overuse injury. J Neurol Sci. 
https://www.ncbi.nlm.nih.gov/pubmed/26810536

Bove, G.M. (2008). Epi-perineurial anatomy, innervation, and axonal nociceptive mechanisms. J Bodyw Mov Ther.
https://www.ncbi.nlm.nih.gov/pubmed/19083672

Chang, K.V., Lin, C.P., ... Özçakar, L. (2017). Sonographic tracking of trunk nerves: essential for ultrasound-guided pain management and research. J  Pain Res.
https://www.ncbi.nlm.nih.gov/pubmed/28115867

Coppieters, M.W., Butler, D.S. (2008). Do 'sliders' slide and 'tensioners' tension? An analysis of neurodynamic techniques and considerations regarding their application. Man Ther.
https://www.ncbi.nlm.nih.gov/pubmed/17398140/

Dilley, A., Lynn, B., Pang, S.J. (2005). Pressure and stretch mechanosensitivity of peripheral nerve fibres following local inflammation of the nerve trunk. Pain.
https://www.ncbi.nlm.nih.gov/pubmed/16154692

Dong, Q., Jacobson, J.A., ... Kim, S.M. (2012). Entrapment neuropathies in the upper and lower limbs: anatomy and MRI features. Radiol Res Pract.
https://www.ncbi.nlm.nih.gov/pubmed/23125929

Fisher, P., Zhao, Y., Rico, M., Massicotte, V., Wade, C., Litvin, J., . . . Barbe, M. (2015). Increased CCN2, substance P and tissue fibrosis are associated with sensorimotor declines in a rat model of repetitive overuse injury. Journal of Cell Communication and Signaling. (OPEN ACCESS)
https://www.ncbi.nlm.nih.gov/pubmed/25617052 

Gilbert, K. K., James, C. R., Apte, G., ... Smith, M. P. (2015). Effects of simulated neural mobilization on fluid movement in cadaveric peripheral nerve sections: Implications for the treatment of neuropathic pain and dysfunction. Journal of Manual & Manipulative Therapy. (OPEN ACCESS)
http://www.ncbi.nlm.nih.gov/pubmed/26917940

Gilbert, K.K., Smith, M.P., Sobczak, S.,.... Brismée, J.M. (2015). Effects of lower limb neurodynamic mobilization on intraneural fluid dispersion of the fourth lumbar nerve root: an unembalmed cadaveric investigation. J Man Manip Ther. (OPEN ACCESS)
https://www.ncbi.nlm.nih.gov/pubmed/26955255

Govea, R.M., Barbe, M.F., Bove, G.M. (2017). Group IV nociceptors develop axonal chemical sensitivity during neuritis and following treatment of the sciatic nerve with vinblastine. J Neurophysiol.
https://www.ncbi.nlm.nih.gov/pubmed/28701542

Manvell, J.J., Manvell, N., Snodgrass, S.J., Reid, S.A. (2015). Improving the radial nerve neurodynamic test: An observation of tension of the radial, median and ulnar nerves during upper limb positioning. Man Ther.
https://www.ncbi.nlm.nih.gov/pubmed/25892706

Manvell, N., Manvell, J.J., Snodgrass, S.J., Reid, S.A. (2015). Tension of the ulnar, median, and radial nerves during ulnar nerve neurodynamic testing: observational cadaveric study. Phys Ther. 
https://www.ncbi.nlm.nih.gov/pubmed/25592186

Nee, R.J., Jull, G.A., Vicenzino, B., Coppieters, M.W. (2012). The validity of upper-limb neurodynamic tests for detecting peripheral neuropathic pain. J Orthop Sports Phys Ther.
https://www.ncbi.nlm.nih.gov/pubmed/22402638

Neto, T., Freitas, S.R., Marques, M., Gomes, L., Andrade, R., Oliveira, R. (2017). Effects of lower body quadrant neural mobilization in healthy and low back pain populations: A systematic review and meta-analysis. Musculoskelet Sci Pract.
https://www.ncbi.nlm.nih.gov/pubmed/28637597

Olivo, R., Tsao, B. (2017). Peripheral Nerve Injuries in Sport. Neurol Clin.
https://www.ncbi.nlm.nih.gov/pubmed/28673416/

Quintner, J., Bove, G., & Cohen, M. (2015). A critical evaluation of the trigger point phenomenon. Rheumatology.
https://www.ncbi.nlm.nih.gov/pubmed/25477053

Rade, M., Pesonen, J., Airaksinen, O. (2017). Reduced Spinal Cord Movement With the Straight Leg Raise Test in Patients With Lumbar Intervertebral Disc Herniation. Spine (Phila Pa 1976).
https://www.ncbi.nlm.nih.gov/pubmed/28542104

Rodríguez-Sanz, D., López-López, D., ... Calvo-Lobo, C. (2017). Effects of Median Nerve Neural Mobilization in Treating Cervicobrachial Pain: A Randomized Waiting List-controlled Clinical Trial. Pain Pract.
https://www.ncbi.nlm.nih.gov/pubmed/28734105/

Schmid, A.B., Nee, R.J., Coppieters, M.W. (2013). Reappraising entrapment neuropathies--mechanisms, diagnosis and management. Man Ther. 
https://www.ncbi.nlm.nih.gov/pubmed/24008054

Schmid, A. B., Brunner, F., ... Coppieters, M. W. (2009). Reliability of clinical tests to evaluate nerve function and mechanosensitivity of the upper limb peripheral nervous system. BMC Musculoskeletal Disorders. (OPEN ACCESS)
https://www.ncbi.nlm.nih.gov/pubmed/19154625

Sluka, K.A., Clauw, D.J. (2016). Neurobiology of fibromyalgia and chronic widespread pain. Neuroscience. 
https://www.ncbi.nlm.nih.gov/pubmed/27291641

Torres, J.R., Martos, I.C., ... Valenza, M.C. (2015). Results of an Active Neurodynamic Mobilization Program in Patients With Fibromyalgia Syndrome: A Randomized Controlled Trial. Arch Phys Med Rehabil.
https://www.ncbi.nlm.nih.gov/pubmed/26143052/

Urban, L.M., MacNeil, B.J. (2015). Diagnostic Accuracy of the Slump Test for Identifying Neuropathic Pain in the Lower Limb. JOSPT.
https://www.ncbi.nlm.nih.gov/pubmed/26107044