Disclaimer: While the information on this web site has been helpful to many people, you should check with your medical doctor or other health care professional in deciding what is the best course of action to take for your situation. This information is designed to help you be a better partner in your care, and not as a do-it-yourself guide to diagnosing and/or treating your health care issue.
What Is Nerve Mobilization?
Nerve Mobilization is a way of thinking about the body that uses the nervous system as a frame of reference. This is often helpful whenever one is experiencing tingling, numbness and other “nervey” sensations.
The length, elasticity and irritability of the nerves and spinal cord are used to guide treatment and home care decisions.
Neural tension tests are used to physically assess nerves. There are conventional tests like the straight leg raise that are often used to identify when a nerve is irritated.
Sensitizing Movements Identify Where Nerves are Compressed +/or Irritated
What is unique to Nerve Mobilization are the sensitizing movements that are used to identify which branches of a nerve are affected as well as where they are most compromised. This approach has been explored most fully by David Butler, PT. For more information on David Butler’s approach go to the Neuro Orthopaedic Institute at http://www.noigroup.com
In the picture below I am dorsiflexing and everting the foot and ankle to place specific tension on the tibial nerve and to lock it under the flexor retinaculum at the inside of the ankle. This stresses the nerve and can be used to identify the inside of the ankle as a significant location for further assessment and likely treatment of the nerve.
Massage therapists are not diagnosing clients when we physically evaluate their nervous system. We are simply determining the length, elasticity and irritability of their nerves to determine what would most likely be good treatment and/or home care choices. And by re-evaluating the nervous system after treatment and over the course of a treatment series we get the information we need to help the client improve the health and resiliency of their body and the nervous system.
While we aren’t diagnosing our clients we do have a responsibility to refer people to their physician if they have signs of ominous medical problems or if they aren’t responding well to treatment.
Nerve Irritability Guides Treatment Interventions
When the location(s) of most compromise to the nerve are identified, one needs to decide what type of treatment is most indicated. What I have found is that when a nerve is very irritable, there is usually localized inflammation (swelling) at that location. This is best treated with hands-on techniques the milk the swelling from the area.
Once fluid congestion around a nerve has been lessened the nerve is less vulnerable and structures that have been compressing the nerve can usually be loosened and the nerve decompressed.
In the YouTube video below, the fluid around the tibial nerve is milked out of the area in order to lessen compression and irritation to the nerve. Then, the flexor retinaculum – a dense connective tissue bracelet that overlies the tibial nerve – is loosened to decompress the nerve and prevent continued irritation of the nerve.
There are often multiple structures at any one site that are compressing a nerve. In the YouTube clip below the Abductor Hallucis muscle is treated to further decompress the tibial nerve at the ankle and inside margin of the foot.
Clients Often Have Homework
While hands on interventions often reduce inflammation, compression and adhesions, clients often have to meet the therapist at least half way in order to heal. Some types of homework are relatively easy, like daily stretching, while other homework can be uncomfortable or even difficult to perform.
Aside from flossing their own nerves, client’s often need to improve their posture and even to breathe in a different pattern. Clients with back pain and sciatica often need to learn how to awaken muscles that have been asleep in their abdomen and low back, and use them again. Your therapist can help you determine which exercises are likely best for you.
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