Understanding Neurodynamics

man stretching

Have you ever experienced a burning or tingling sensation running down your arm, hands, or feet? If so, you could be experiencing nerve pain, which can be quite uncomfortable.

It’s important to ensure that any mobility program doesn’t ignore the peripheral nervous system (PNS), which is closely related to how our bodies move and work. For example, neuropathies like carpal tunnel syndrome or sciatica are some conditions that physically interact with nerves and produce pain. And neurodynamics is frequently used to handle these sorts!

This post will review the fundamentals of nerve pain and how neurodynamics may help!

WHAT IS NEURODYNAMICS

Neural mobilization, also known as neurodynamics, is a loosely organized set of experimental stretching and positioning therapies for neuropathy. It uses the theory that stretching can assist in stimulating defective nerve tissue. Specifically, neurodynamics is an integrated biomechanical, physiological, and morphological functions of the nervous system. Our nervous system can adjust to different stresses, including elongation, angulation, compression, and sliding motions. If these load-tolerant motions fail, our nervous system may be vulnerable to ailments like neural oedema or nerve root compressions. Pain or restricted nerve mobility is a frequent outcome of neural tissue obstruction, and nerve discomfort and restricted movement may result from negative neural stress.

Your joints move, and your muscles contract and stretch, as is common knowledge. But our nerve tissue also needs to move freely and unhindered. Movement through neurodynamics releases obstructions or impingement in nerve root conditions. But not just any movement! Only very particular motions are required. So you can move in a way that emphasizes impacts on nerves rather than muscles and tendons. In order to get started without using too much vocabulary, “stretching” isn’t the best terminology. More specifically, drawing on the entire nerve could be feasible, as in neural tensioning, glide nerves in their sheaths, as in neural gliding, sliding, or flossing. Although some actions appear to be typical stretching at first glance, neural sliding and tensioning are also conceivable without the slightest hint of stretching.

THE NEURODYNAMIC TREATMENT

Our nerves need blood, motion, and space where they can move freely. They become irritated if we deprive them of one or more of these! Therefore, we must make sure that our nerves are moving steadily to offer them what they desire. Neurodynamics is a fantastic method for doing this. Inflammation of a nerve, frequently caused by inadequate blood flow to that nerve or by squeezing that particular nerve, causes numbness and tingling. In addition to nourishing our nervous system, mobilizing the nervous system makes your body more used to nerve motions. One characteristic of nerve movements is that pain may have a delayed impact after first working on them.

NEURAL TENSION TESTING

Clinicians frequently employ neural tensioning tests to ascertain if a patient has unpleasant neural stress. When a stretch is applied to a nerve simultaneously at both ends, tension, stress, or strain results over the entire length of the nerve. Multiple joints are placed in this tensional posture, lengthening the whole nerve and altering the vascular and axoplasmic flow. The patient will have signs and symptoms that have a neurological origin if a portion of the nervous system is irritated, confined, or injured. Carpal tunnel syndrome, cervical radiculopathy, and cubital tunnel syndrome are a few conditions that might be associated with unfavourable neurological stress. The doctor can ascertain if the cause of pain (or another symptom) is neural or non-neural by performing tensioning tests. Not all of your “positive” test results are related to pain. Stretching and pulling both have equal importance. Basically, you need to consider nerve components if you experience discomfort, tugging, or stretching in a specific place after tensing the nerve, which is affected by cervical movement.

Regarding the diagnosis of peripheral neuropathic pain, specific “likely” criteria include 1. The pattern of the symptoms is nerve-related 2. A nerve-related issue is correlated with a history of symptoms. 3. imaging or a clinical neuro test that rules in or confirms neurological damage.

NEURAL MOBILIZATION TREATMENT

When two joints are moved to apply a stretch at one end of the nerve while permitting slack at the other end, this is known as gliding, sliding, excursion, or flossing. Neural mobilisation treatments aim to improve normal neuronal physiology and reduce pain. In addition, in order to increase both extraneural and intraneural mobility, this movement reduces tension over the whole nerve while localizing nerve gliding.

Therapists need an in-depth understanding of neuropathic pain, biomechanics, and peripheral nervous system physiology to apply this approach successfully. In addition, techniques for neural mobilization should be used gradually and terminated before reaching the pain threshold.

Porretto-Loehrke and Soika present a specific approach that employs the acronym FLOSS to direct treatment: F: Fix the neighbouring joint, L: Limit the ROM, O: Oscillate proximal or distal (or both) to amount of compression, S: Slow, rhythmic motion, and S: Symptom-free. By mobilizing the nerves, nerve flossing helps ease uncomfortable sensations from irritated or pinched nerves.

Exercises for flossing the nerves can also improve overall flexibility and strength. Nerve flossing might be helpful to:

  • extend your range of motion
  • lessen nerve toxicity
  • lessen pain

People may choose to employ nerve flossing as a complementary therapy to medicine and other forms of treatment.

Remember that mobility is essential for effective nerve flossing; otherwise, it is just a stretch. Proper nerve flossing requires motion.

NERVE FLOSSING FOR CARPAL TUNNEL SYNDROME

Carpal tunnel syndrome develops when the median nerve in your wrist is aggravated or squeezed. People who perform repetitive hand or finger movements are more likely to develop it. Therefore, it may be most effective to use nerve flossing in conjunction with conventional therapies.

  1. Start by making a fist out of your fingers and thumb, with your thumb facing you and your wrist in a neutral position.
  2. Spread your fingers out into a neutral, straight position.
  3. Bend your wrist, so your palm is facing upward while maintaining straight fingers and a thumb.
  4. Extend your thumb away from your hand while maintaining the same posture for your hand.
  5. While maintaining the same posture of your hand and fingers, turn your wrist such that your palm is facing away from you.
  6. With your free hand, while in position 5, softly draw down on your thumb. Repeat the sequence three to five times, holding each position for five seconds.

NERVE FLOSSING FOR SCIATICA

Mobilizing Floss

  1. Lie flat on your back with your feet hip-width apart and both knees bent. If you’d like, you can support your head with a flat cushion.
  2. Tuck your chin in and make sure your upper body remains calm throughout.
  3. Draw your left leg close to your body.
  4. Hold on to the back of your left knee while gently straightening it until you feel a comfortable stretch. (An alternative is to raise both knees and hold them close to the chest.)
  5. Bring your knee back to its starting position gradually.
  6. Don’t forget to take calm, deep breaths, and avoid pressing your lower back into the floor.
  7. Your leg should be brought back to the beginning position on the floor by bringing it up to your chest.
  8. Perform five repetitions of the movement with each of your legs.

Seated Sciatic Nerve Floss

  1. Face forward while sitting straight on a chair with your knees spaced hip-width apart.
  2. Extend your right leg with your foot flexed inward.
  3. Position your head so that you are looking up and back at the ceiling.
  4. You should now slowly drop your head and knee, tucking your chin towards your chest and bending your leg just past 90 degrees rearward.
  5. Along with extending and lowering your leg, do the same with your head.
  6. Perform ten repetitions for each leg two to three times a day.

Hamstring Floss

  1. Keeping your left leg straight and toes pointing up, elevate it onto a step or other sturdy surface. (Alternatively, you can elevate your left leg and hold it in the air while holding onto a wall or other stable surface; you might want to attempt this variation once you’ve gained some strength.)
  2. Tilt your head and neck forward while maintaining a straight back until you feel a slight tug in your back (some individuals may not feel a pull; that’s normal).
  3. From here, flex your foot and lower your head to the ground while pointing your toe and bringing your chin to your chest. Five times, repeat these steps.
  4. Get back to the original position, and perform on the other leg.
  5. Repeat three times on each leg.

NERVE FLOSSING EXERCISES FOR PIRIFORMIS SYNDROME

The piriformis muscle connects your upper leg and the base of your spine. Due to the proximity of this little muscle to the sciatic nerve, piriformis syndrome can also be brought on by any irritation or compression of the sciatic nerve. In addition to pain, while standing up or sitting down, piriformis syndrome can also result in radiating pain to the hips, buttocks, and hamstrings.

Like sciatica symptoms, piriformis syndrome symptoms can be relieved by nerve flossing while improving flexibility and range of motion. However, the best results from nerve flossing for piriformis syndrome come from combining it with other therapies.

Mobilizing Floss

  1. Both legs should be extended while you lay backwards on the floor.
  2. Grip the left knee and foot by bending your left leg and lifting it.
  3. Holding it, gently lift your bent left leg toward your right shoulder, across your right side, and back to the starting position.
  4. Do this five times and repeat with your right leg after gently lowering your left leg to the ground.
  5. Perform five reps on each side twice or three times daily.

WHEN TO USE NEURAL MOBILIZATION AND TESTING

Neural testing can determine the target of neural mobilization procedures by revealing the location and sensitivity of a nerve. In addition, retesting offers helpful evidence of the nerve irritability’s progress.

The goal of neural mobilization therapy is to allow the intact nerve to move normally again to lessen discomfort. The therapist must use caution to prevent stressing a nerve that is already inflamed; it should never worsen symptoms and should only continue if the improvement is shown. The two main objectives of neural mobilization are increased nerve excursion with reduced nerve tension.

Neural mobilization may begin proximally or distally from the alleged site of irritation in the case of an irritable nerve. The current study highlights the significance of doing soft tissue mobilization in conjunction with, or before, neural mobilization since people with neuropathic pain frequently have additional related problems, such as muscle guarding and tenosynovitis. 

In addition to being inappropriate for some patients with nerve symptoms, nerve gliding is not recommended for people with malignancy, active inflammatory conditions, complex regional pain syndrome, recently repaired nerves, people without a precise diagnosis, and people who have lost protective sensibility. Before a patient can comprehend the benefits of nerve gliding and appropriately do the exercises in the clinic, nerve gliding should not be included in a home exercise regimen.

Although neural mobilization methods could be a beneficial non-operative treatment, clinical judgment is needed to choose the right frequency and length of treatment. This is because further research is necessary to make this decision.

THE TAKEAWAY:

Nerve flossing is a simple exercise you may do at home to gently mobilize your sore nerves, alleviate unpleasant sensations, and enhance your range of motion. Along with additional treatments, people may discover that nerve flossing is a successful treatment for ailments like carpal tunnel syndrome, sciatica, and piriformis syndrome.

If you’re unsure if nerve flossing is your best course of action, you should speak with a physician or physical therapist. When performing nerve flossing exercises, you should stop immediately and see a doctor if you feel any intense discomfort.

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