Our nervous system is a wonderful electrical system, sending and receiving all kinds of signals to and from the brain. It allows us to sense our environment through our senses and react and move in the environment by controlling muscles and joints. This is what it means to be alive and moving. Our brain, spinal column and nerves are wonderfully adapted to send and process information fast and efficiently. We have all seen the diagram of the nervous system in our biology books or on a TV documentary and have the basic structure in mind. However, in most cases we think of the nervous system as a static system, not moving and, well, just there. We use nerve mobilization to show you that your nervous system is dynamic and must move properly to relay messages rapidly and avoid injury.
What exactly is nerve mobilization?
Neural mobilization involves a process of getting the nervous system to glide smoothly and easily through the body, without restrictions. This includes soft tissues such as muscles, ligaments and organs as well as through bony openings or grooves. Any movement restriction of the nerve can cause irritation and inflammation which can produce pain, muscle spasm or loss of function.
The process of neural mobilization can be active or passive. When the therapist helps move the body in specific ways, the process is passive as you are relaxed and not participating in the movement. Thereafter, the therapist can show you the active mobilization exercises that can be done on your own.
Why we use nerve mobilization
Your nervous system is an extremely vital organ system in the body and controls all voluntary and involuntary aspects of our function. It is also a very sensitive system and vulnerable to irritation, compression and entrapment. This leads to a number of problems causing pain and even movement patterns.
They can include:
Irritation of normal organ functioning
Skin and circulation changes
As therapists, we want to create an optimal environment for the nervous system, so that the correct electrical flow can get from the brain or spinal column through to the receiving muscle. This creates the correct control required to activate the right muscles at just the right time, to keep a limb stable or produce large amounts of force.
Your physiotherapist always uses neural mobilization in conjunction with other manual and rehabilitation techniques during a treatment session. This can include soft tissue releasing, active and passive stretches, spinal or joint mobilization and electrotherapy modalities.
Physiotherapists are qualified to assess and treat any problems associated with poor nerve mobility. Your nervous system is a very sensitive organ and can be irritated easily with too much movement. Care must be taken not to overdo the movements to get the optimal therapeutic outcome. Your therapist will also advise you on the correct dosage of home exercises to do, which need to be followed correctly.
Different types of nerve mobilization applications
Traditionally, neural mobilization has been used to describe movement of the peripheral nervous system ( arms and legs). However, we now understand that the nervous system moves as a single unit, and as such should be seen and treated in its entirety. The area of nerve movement restrictions must be identified through sensitivity testing by your physiotherapist. Confirmation of the nerve involvement is achieved by stressing or releasing a structure above or below the point of restriction. In this way, we can differentiate between muscle spasm or stretching and true nerve involvement.
Nerve mobilization techniques are movement based, whereas muscle stretches and lengthening techniques are more passive in nature. When we mobilize a nerve, more emphasis is placed on eliciting and respecting only discomfort, whereas other soft tissue and joint techniques often require deeper applications to achieve the desired results.
Anatomical Changes you’ll notice after nerve mobilization
The reason we use neural mobilization techniques is to get the effected limb’s nerves to glide normally. Initially, you will feel restricted movement and range limitations that can feel very similar to a tight muscle stretch. There may also be some neurological symptoms, such as: pins and needles, more or even less sensitivity in the affected area, hot or cold sensations or a feeling of fullness or swelling (without any being present).
As the technique is applied, the changes in the neural glide should allow for an increase in movement as well as a more comfortable feeling during the movement. The neurological symptoms should start to ease and any protective reactions and muscle spasms starts to loosen.
Changes you’ll notice on a cellular level:
The starting point of the problem you have is pressure or restriction on the nerve. This has led to both mechanical and chemical adaptions around the nerve. Nerves have a blood supply of their own. With the restriction and pressure placed on them by other tissues, leads to decreased blood flow. This results in too little oxygen being supplied to the nerve. At the same time, there is a build up of carbon dioxide and waste material around the nerve – that’s not ideal for correct nerve functionality.
Constant pressure on the nerve also triggers an inflammatory response from your body and there is a rush of white blood cells and inflammatory chemicals creating a direct pain response in the nerve. This chronic inflammatory response can also lead to the creation of scar tissue or fibrosis, thus limiting the nerve movement even further and thus creating a vicious cycle and downward spiral that we need to control with therapy.
The normal flow of electrical currents within the nerve may also be compromised. Electrical currents are generated by the movement of chemical ions across the cell membrane (mostly Sodium and Potassium). Any restriction to this flow can interrupt the normal conduction of electricity along the nerve and thus leads to incorrect functionality of the muscle or organ that the nerve supplies.
What does nerve mobilization feel like?
Neural glides can often feel similar to a muscle stretch, but done with continuous movement. There may be some nerve discomfort and tingling initially, but should ease with the movement. It can often be described as the feeling you get when you hit your “funny bone” (ulnar nerve), but not as intense. Due to the nature of nerves being a sensitive structure, patients are often fearful of these movement as it recreates their known pains. Although, with an experienced therapist guiding you through the treatment, a slow gradual improvement in movement, and easing of pain is achieved.
How long does nerve mobilization take?
Treatment time depends on the severity of your condition, as well as how long it has been there. Severe restrictions around the nerve pathway requires more movement, but it all dependents on how the nerve responds. Considering your nervous system is highly irritable, progress is slow but steady.
Movements will be to the point of discomfort and is repeated 5 to 15 times. Together with other treatments this takes up to 3 to 5 sets of the movement. The reaction to the treatment and sensations felt helps guide your therapist to the correct treatment dosage.
How frequently should I get nerve mobilization therapy?
This will all depend on how severe the nerve restriction is and how long it has been giving you problems. You should feel a change in sensation and movement after the first session. Although, it needs to be repeated in every session and incorporated into a full home exercise program to achieve our long term goals.
Your physiotherapist will discuss a treatment plan with you, we’ll give you an idea of how long it will take for your condition to improve and how often treatment is needed. As we take pressure off the nerve, the healing time can begin. However, the time to heal can vary due to time and severity. Treatments are initially 2 to 3 times a week for the first 2 weeks and as you progress, this will decrease to 1 to 2 sessions a week. The whole process can vary between 8 and 12 weeks.
What can I do from home to ensure that the nerve mobilization therapy is effective?
The movements involved in neural mobilization are very specific and your therapist will show you how to do them correctly at home. The therapist will send you a program with the correct sequencing exercises, seeing as incorrect movement can cause irritation and not be as effective.
There are a few things you can do from home:
Stretch the surrounding tissue
Apply heat / ice to help with pain (your physio will advise you which one to use)
Follow your prescribed home exercises precisely as directed
Do not over train – in this case more does not mean quicker results and can be counter productive
There are certain medical aid rates for neural mobilization as a treatment, but they will never be applied in isolation. It forms part of a holistic and comprehensive treatment program and is never be charged as a stand alone code.
Nerve mobilization treatment in isolation will not fix your problem. It’s the complete treatment package that shows real improvement.
Medical Aid Code – 310
The neural tissue mobilization (NTM) treatment code 310 is used when neural tissue mobilization or neurodynamic therapy is used during treatment, and takes place at the same time as other techniques. The treatment is never done in isolation as the other underlying factors also need to be addressed. Most good medical aids offer re-imbursement for code 310, neural tissue mobilization.
Does it make a difference to have an experienced physiotherapist apply nerve mobilization?
This is a condition where experience really makes the difference. First, it needs to be determined whether the nerve is involved and the exact site of the obstruction or the restriction has to be pinpointed through a comprehensive diagnostic process. Together with our patients feedback, the correct treatment frequency and dosage is prescribed to get the real progress.
An in depth knowledge of muscle and nerve anatomy is essential in treating these conditions. On top of this, experienced therapists can evaluate the progress of the treatment and adjust accordingly, getting you moving normally again and bringing your pain levels down while doing more challenging movements. All our therapists are well trained in the field of neurodynamics and have years of experience in treating them.
With the correct diagnosis by an experienced therapist there is no danger in the technique. Care should be taken to identify the correct cause of the nerve irritation and then the appropriate therapy can be applied to treat it.
There can be a variety of feelings after treatment. It may feel as if some “life” is returning to the affected area, or that there is a tingling sensation. There may be an increase in sensitivity in the nerve as the pressure releases and the nerve starts to conduct electricity normally. It may take the body some time to “reset” itself and feel sensations normally again.