When is neural mobilisation necessary?
Under normal circumstances our nerves are well positioned and specially
adapted to move freely and without pain, as our backs and limbs move.
As soon as a nerve has been injured [or sometimes minimally repetitively
injured!], the nerve becomes sensitive to mechanical stress, e.g. elongation
and pressure, and responds with pain on movement or position.
How do we detect mechanical sensitivity
of nerves as a reason for pain?
Physiotherapists use special neural dynamic tests which put the spinal
column or limb in a specific position and thus force the nerve to elongate
accordingly. When the typical pain of the patient is experienced, one
could say that the nerve is sensitive to movement and thus the source
of the experienced pain.
What is Neural Mobilisation?
Neural mobilisation is a gentle movement technique used by physiotherapists
to move nerves. Initially this technique was referred to as neural stretching,
because earlier clinicians detect ‘stiffness’ when trying
to put stretch on a nerve. Recent research has demonstrated that the resistance
encountered with neural dynamic tests [of which the Straight Leg Raise
Test for the Sciatic nerve is one of the oldest!] comes from a muscle
response [in this case, the hamstring muscles], to protect the sensitive
nerve from gliding and elongation. Specific gentle movements of nerves
stimulate the blood supply to the nerve; it improves the axoplasmic flow
in the nerve and loosens scar tissue between the nerve and its ‘bed’
after injury. This treatment relieves pain and restores functional movement.
When we move, our nerves need to be able to adjust with the movement.
As an example, moving the spine from a fully extended or upright position
to a fully flexed or bent position means the spinal cord has to lengthen
5 – 9 cm. The nerves in the arms and legs also need to adjust when
we move. With injury, such as a whiplash injury, bleeding can cause scar
tissue which may in time impede the normal movement of the nerve. After
spinal operations [surgery] the formation of scar tissue often prevents
the nerve from normal pain free movement. Also, the initial injury has
rendered the nerve mechanically sensitive, and this restriction of movement
can lead to symptoms such as pain, tingling and burning sensations.
Why do we use neural mobilisation?
Nerves conduct impulses from our brain to our body in order for us to
move. If the normal movement of a nerve is disrupted this can have an
effect on the nerve's function. After an injury (such as whiplash), or
back surgery, it is important for muscle, joint and nerve to commence
with gentle movement within limits of pain. The movement helps to improve
the circulation to the injured parts and this in turn will assist the
healing process. Your doctor and /or physiotherapist can advise you as
to when you should start with movements depending on the severity of the
injury (or operation). Neural mobilisation can also be very important
in maintaining tissue health when we work in prolonged or static positions
such as computer work, gardening and packing or unpacking.
Possible home exercises
The exercises listed below should be done as gentle, large amplitude
relatively pain free movements.
Exercises for the back and legs
1. Lying on your back – hip bent to 90? (knee relaxed), foot bend
up; straighten the knee slowly up to where a pull is experienced.
In this position, the foot can be moved up and down.
Alternatively, keeping the foot bended upwards, bend and straighten the
knee only. Repeat 10 big range movements. This should only be done with
one leg at a time.
2. Sitting – (this exercise is more advanced and should not be done
first thing in the morning) slump the back backwards; bend your head to
your chest. Straighten one leg at the knee until pull is experienced.
The movement can be done by bending and straightening the knee or by lifting
and bending the head. Repeat 5 times for each leg or 10 times for the
Exercises for the arms and neck
1. Sitting in an upright position [hands resting on your lap] –
move your shoulders in a backward circle aiming to get the shoulder blades
down and together behind your back. Repeat 5 times.
2. Sitting in an upright position – side bend your ear to your right
shoulder and gently push down [drop] the left shoulder. Repeat on the
opposite side. Repeat 5 times to each side.
3. In standing arms down your side – turn your arms out [palms forward],
bend your wrists up and drop your shoulders alternating left and right.
Repeat 5 times each side. Then [your palms still facing forwards], lift
your arms up sideways to where you feel a pull, extend you wrists back.
Repeat 10 times.
4. In standing arms down your side – turn your arms in, palms facing
the back, Lift your arms sideways to where you feel a pull, flex and extend
your wrists. Repeat 10 times.
5. In sitting or standing – put your hands on to your ears [fingers
facing down] with the little fingers behind you ears, stretch your elbows
back to where you feel the pull. Repeat 10 movements.
6. Repeat Nr 1
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