Pain associated with Neurodynamic Dysfunction (see under conditions Altered Neurodynamics) occurs when there exists an alteration in the extensibility of the nervous system and or the mechanical interface due to vascular or mechanical injury. The loss of movement may result in functional and/or structural changes in the nerve fiber resulting in diminished blood flow. The end result may be one of the following changes to a nerves: microvascular environment, myelin damage, axoplasmic flow changes, axonal degeneration. These changes may become permanent if not properly treated.
The result of altered neurodynamics (increased compression or decreased extensibility) is always a loss of blood flow that nourishes the nerve (normal utilization of the nervous system is 20% of general blood flow). If a nerve is compressed or lacks mobility it needs to be freed to reestablish its normal blood flow. Specialized knowledge is required in anatomy of the specific nerves pathway as it courses through the nerve exit spaces in the spine as well as in the periphery. The next assessment level are methods necessary to selectively tension tissues in the areas adjacent to the pain region and those distant to determine if the nervous system is responsible for the primary complaint.
Once the clinician is confident with the functional diagnosis of altered neurodynamics the degree of reactivity (sensitivity of the tissues) must be determined. If the area is irritable then respect must be given to those tissues by developing a method of unloading the nervous system, again through knowledge of the anatomy and response to the unloading. Nearly always a position of ease can be accomplished which will allow pain-free resting and working positions. The patient will then become less irritable, and then mobility becomes the more important aspect of treatment. Knowing that movement/lengthening of the nerve bed will typically result in diminished blood flow, nerve gliding/flossing/movement should be considered. Again, knowledge of neural pathways is required so that maximal tension is not occurring during the treatment. Once the patient can tolerate movement without maximum tension, the patient can proceed to more tension related patterns of stretch. Once full excursion of the neural pathway is reestablished then the patient will not have loss of blood flow (other than that which is normal in that nerve) when the patient performs activities of daily activities, nightly activities, or sporting activities. Happily, pain will be eliminated along with the restoration of mobility.
The physical therapists at Sports & Orthopaedic Therapy Services are experts at the evaluation and treatment of altered neurodynamics. Robert Grossman, PT, OCS has been teaching post-graduate continuing education programs to physical therapists for years on this topic and has taught with David Butler, as well as at various University DPT programs.
Do you have sciatica, carpal tunnel syndrome, or any other entrapment neuropathy? Do you find it difficult to get comfortable enough to sleep, to sit, or to drive. Do you have radiating pain into the upper extremity or lower extremity? Do you have tingling or numbness into the upper or lower extremity or elsewhere? Do you have unexplained weakness of the upper or lower extremity? If you have any of these symptoms you may have an entrapment neuropathy. Please request a one-on-one consultation and full evaluation of your symptoms. We’ve helped many others and can help you too.
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