Neurodynamics: a method that treats nerves
CONTENTS
1. Where does the name come from?
During the treatments carried out in our offices, our patients often hear this technical term. But what does it mean? If you translate the Latin words and look at their meaning, you will see that:
dynamics = a force related to movement.
The concept of neurodynamics, that is, neural mobilization, is very new. Although the relationship between movement and pain was already observed at the beginning of the previous century, it was only 27 years ago that Gifford introduced the exact explanation of neurodynamic methods and the treatment itself to the field of medicine and physiotherapy.
Nerves are responsible to register stimuli and transfer them towards the central nervous system and to carry the outgoing messages from the brain and the spinal chord.
The nerves emerging from the spine run towards our limbs and torso, and provide instructions for the muscles, the skin and the blood vessels. If for any reason the peripheral nerves are under pressure or suffer an injury or damage, they will only carry out this function incompletely or not at all, causing various symptoms: tingling sensation, numbness, reduced strength, muscle cramps and last but not least, pain.
Before a more detailed exploration of the method itself, let’s learn some more about nerves.
2. How nerves track our movements
Our nerves are well suited to be able to follow every movement of our body, while not making us feel any pain. In resting state, peripheral nerves are relaxed and have a wavy form. When slight stretching is applied, these waves are straightened out. You can imagine this like pulling on a relaxed thread on both ends so that it becomes tight. In addition, nerves have the ability to stretch along their length, like a telescope. These two phenomena result in about 15% increase in length. The flexibility of the connective tissue structures within the nerve adds another 5% of lengthening potential.
Nerves are wrapped in three connective tissue layers that allow them to follow the movements of our body in a flexible way. Let’s see an example. The nerves controlling our fingers emerge from the cervical spina and run along our arms to the tips of our fingers. If you reach back in your car for your bag, or you simply lean or your arm, you can feel a tension in your muscles in the inner part of your arm. This tension affects the nerves as well, but as it fortunately has room to spread, the movement will not generate pain. In addition to adaptation for movement, this ability to slide and lengthen has an essential role in ensuring the proper blood supply and function of the nerves.
3. How our nerves give us signs in case of problems?
3.1. Pain
Anyone who ever experienced it knows that neural pain can be remarkably strong. Patients report shooting or shocking pain that runs along the limb in a very definite line, in varying length. The most common example is ischial pain, which occurs in the back part of the lower limb.
3.2. Symptoms related to sensory functions
The patient may experience varying and sometimes strange symptoms in case of neural involvement. We have different technical terms for their exact description, such as paresthesia, hyperalgesia or allodynia. Tingling sensation, pins and needles, skin crawling, numbness – the most common terms we hear from our patients. Sensory symptoms also include when the skin above the affected area becomes particularly sensitive, or when the patient feels any impact of pressure differently in the area. The opposite can occur too: the area innervated by the nerve becomes numb.
3.3. Motor symptoms - the glass falls out of my hand!
The nerves transmits specific prompts from the central control systems about when and how strongly to contract the muscles. If this fails because of the impaired function of the nerve the patient feels weakness in the affected limb, they are unable to exert force or, if the lower limb is affected, they have a limp or weak gait, and can only lift the lower limb with difficulty. Another set of symptoms is related to the function of lower abdominal organs. The innervation of the urinary bladder or the anal sphincter muscles can become impaired if the nerves exiting the spine at the level of the lower back are affected. The patient experiences difficulties with or is completely unable to hold their urine or stools.
4. Causes of neural involvement
4.1. Pressure
A leggyakrabban hallott szó evvel kapcsolatban a spinal disc hernia: due to a loosening or tear in the outer layer of the disc located between the vertebrae, the gel-like inner part is dislocated and pushes on or irritates the nerve emerging from the spinal canal. This causes pain along the path of the nerve, right until the tips of the fingers or toes. However, the nerve can be pressed at other sites, not only near the spine. Just think about when you have a good night’s sleep and lay on your arm, so you wake up with numbness. Of course this is a short-term impact, so you do not have to worry, the unpleasant sensations will cease in a couple of minutes.
The term tunnel syndrome speaks for itself. The space where the nerves passes through narrows, thus pinching the nerve to its surroundings. This is most commonly seen in the wrist, which is called carpal tunnel syndrome. But we can name some more: cubital tunnel at the elbow, tibial tunnel in the lower leg, tarsal tunnel in the feet, and the list goes on. A similar phenomenon is often observed at the upper part of the chest, at the neck. This is called TOS syndrome.
4.2. Inflammation
During inflammation, fluid accumulates in the tissues, making them swollen and thus causing the narrowing of the available space and a reduction in blood supply.
4.3. Trauma (injury)
Traumatic events affecting the nerve exiting from the spine, for example whiplash injuries, falls or hitting can stretch or damage the nerve, causing symptoms on long or short term.
4.4. Scars
During the healing process after any injury – burns, surgeries, tearing of the tissues surrounding the nerve –, scars are formed in the skin and the underlying tissue layers, which can put tension on the surroundings of the nerve.
5. Healing abilities of nerves
All of this might sound scary but fortunately, nerves have an excellent ability for regeneration. Still, it has to be noted that in case of serious injuries or tears, recovery is slow and often unsuccessful or only partially successful. However, most often this is not the case, and we can help the healing process. In physiotherapy, we utilize the basic ability of nerves to follow movements, and by this we can influence the flexibility of the neural tissue and its surroundings by using certain movements.
6. What is neurodynamic treatment used for?
Neurodynamic techniques provide a great aid in this process and during the treatment. By following certain specific and pre-defined steps, we can find the position in which we will observe the behavior of the nerve and other tissues and provoke the symptoms.
If neural involvement is suspected, the physiotherapist will apply neurodynamic tensioner tests for diagnostic purposes. We apply stretching on the nerve itself and the tissues surrounding it. By using different grips we can locate the neural areas under compression and assess the degree of compression.
Of course there are some cases when we are not able to aggravate the existing symptoms with neurodynamic testing. In this case, we should suspect other physiological processes and look further to identify the root cause.
With some slight changes, neurodynamic techniques can also be used as therapy. Slider techniques are more gentle and softer compared to the aforementioned technique. We only apply the stretching on the tissues of the limb, then we ask the patient to perform a certain movement. In this case, only the surroundings of the nerve located between the muscles and tendons. This way the nerve will glide pleasantly in the fascia (connective tissue) around it. This characteristic movement might already be familiar for patients who already received neural mobilization exercises to be practiced ad home.
7. Using neurodynamics in the physiotherapy office
We often use neurodynamic techniques during our work, from the status assessment to the complete absence of symptoms. It can be combined well with conventional physiotherapy exercises and several manual therapy techniques we use: Maitland, Stecco, Mulligan, McKenzie, and other therapeutic methods.
We consider the precise execution of neural mobilization exercises crucially important, so we take our time to make the patient understand the underlying theory and to ensure precise execution. Thus when performing the exercises at home, the patient can cooperate effectively in their healing.
The blood supply of the nerve and the muscle strength are restored, and the tingling sensation and numbness cease. By the end of the treatment, the patient becomes complaint-free and can return to their usual everyday life.
8. Frequent questions and concerns
Most patients listen to the explanation regarding the principles of neuromobilization with amazement and interest. However, there are some doubts and questions that need addressing.
Can I tear the nerve?
If you perform the exercise correctly, you cannot do any harm to the nerve. We only give slider technique exercises to be practiced at home, when only the soft tissues surrounding the nerve are stretched. Do not worry that you will tear the nerve – just as you cannot tear any other part of your body with a voluntary stretching movement. Our automatic protective systems activate during dangerous situations: our muscles get tense, pain emerges and the nervous system simply does not allow you to do any harm. You can trust it!
In the past, the tensioner technique was used during late phases of rehabilitation as well, which resulted in temporary untoward consequences occasionally, and it is less and less used nowadays.
What to do if my symptoms get worse?
In this case another consultation session is required, as we need to make changes in the started therapy (which consists of several other methods apart from neurodynamics).
How often do I have to practice at home?
You should practice neuromobilization once or twice every day, performing 30 to 40 repetitions..
9. Neurodynamic case studies
Attila works as a truck driver. He suffered a serious accident 24 years ago, when an object above his head fell on him, and most likely his head was also thrown back. He needed surgery for multiple vertebral injuries, however, the continuous pain in his neck and shoulders, the regular headache behind his ears and the numbness and pain in his fingers remained. His grip strength also reduced with time, which made it difficult to him to do his job.
I started the treatment with gentle neck movements, then I manipulated several points in order to resolve the tension in the connective tissues. This immediately resolved the numbness and pain. During the next sessions, we performed the mobilization of the thoracic spine and back exercises combined with exhalation. Of course I used neurodynamic methods for testing, as a therapy and as an at-home exercise as well. The complaints gradually decreased, the numbness and pain in the fingers completely stopped, and the muscle strength started to return to his hand. The headache remained, although reduced in severity, for which I had to find another method.
As you can see, neurodynamic techniques were an essential part of the therapy in case of this patient. Completed with other therapeutic methods, it immensely helped to speed up the recovery of the nerve and to achieve the appropriate regeneration.
10. Neurodynamic treatment prices
Status assessment, is the first step to take in every case, which takes 60 minutes.
The status assessment session costs 17.000 HUF.
If a senior physical therapist performs it, it costs 22.000 HUF.
The status assessment includes consultation, testing and treatment.
The further treatment sessions are 50 minutes long and cost 17.000 HUF.
If a senior physical therapist performs them 20.000 HUF.
11. Summary
The neurodynamic method is a diagnostic and therapeutic method we use in case of neural involvement. Usually it is used as an accessory treatment in combination with other methods, manual therapy or physiotherapy exercises in order to eliminate neural symptoms: tingling, pain or muscle weakness. To improve results, we prescribe exercises to be performed at home, with education on their correct execution.
4.9 / 5
VCT - Visceral Therapy
Stecco Method
Mulligan Manual Therapy
McKenzie Method
Maitland Manual Therapy
Kinesio-Taping Method