A recent meta-analysis published in The Journal of Orthopaedic & Sports Physical Therapy suggests that neurodynamic techniques may be useful for patients with back, neck and foot pain (Basson et al. 2017).
What is Neurodynamics?
Neurodynamics - “A clinical concept that uses movement (1) to assess increased mechanosensitivity of the nervous system; and (2) to restore the altered homeostasis in and around the nervous system.” (Grieve's Modern Musculoskeletal Physiotherapy).
Therapists often use neurodynamic movements to tension major nerves of the limbs to help identify sites of inflammation and/or irritation. Palpation of an involved nerve is another way to investigate symptoms (Schmid et al. 2009).
In cases of deep radiating pain, therapists may search for areas along the entire path of the involved nerve for tenderness.
Neurodynamic Treatments: A Biophyschosocial Framework
A biopsychosocial framework helps put into context the interconnected and multidirectional interaction between: physiology, thoughts, emotions, behaviors, culture, and beliefs. In terms of clinical responses to therapy there are a couple of proposed mechanisms of action, including but not limited to:
Neurodynamic movements have a modulatory affect on peripheral and central processes. This anti-nociceptive effect of massage therapy can help ease discomfort in patients who suffer from nerve irritation (Bishop et al. 2015, Vigotsky et al. 2015).
Sensitivities of Axons Exposed to a Pathological Environment
Neurovascular bundles may be exposed to mechanical irritation at many different points. Prolonged irritation may result in a reduction of intraneural blood flow. In turn, local hypoxia of a peripheral nerve leads to a drop in tissue pH that triggers the release of inflammatory mediators, known as “inflammatory soup”. This noxious substance can disrupt the normal function of nerves (Fisher et al. 2015). The application of specific soft tissue treatment may help to diminish intraneural edema and/or pressure by mobilizing neural tubes (Gilbert et al. 2015).
Inflammation and Mechanical Pressure are Interrelated
Ongoing tissue hypoxia or inflammatory responses lead to molecular signaling that promote the development of fibrosis, this may contribute to further peripheral nerve dysfunction (Fisher et al. 2015). The application of appropriate shear force and pressure impart a mechanical stimulus that may attenuate tissue levels of fibrosis and TGF-β1 (Bove et al. 2016).
Non-pharmacological therapeutic interventions are being embraced by the medical community because they are often simple to carry out, economical, and have relatively minor side effects (Busse et al. 2017, Chou et al. 2017, Nahin et al. 2016, Qaseem et al. 2017).
Nerve mobilizations are non-pharmacological options for musculoskeletal pain that patients can discuss with their physician. None of these options are a panacea, but they may help you put together a individualized multi-modal program to manage persistent symptoms
More to Explore
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