Many massage clients present with back pain; in fact, worldwide there is a lifetime incidence of 60 to 70 percent for back pain.
Sciatica is one potentially serious cause of back pain.
By learning a specialized massage technique called Precision Neural Mobilization, the therapist can better address the population of clients who suffer from this condition.
What Happens When a Disc Bulges
There have been numerous studies done on what happens when a spinal disc bulges or herniates and a person experiences symptoms within a nerve root.
One of the most prominent researchers in this area is Hisashi W. Kobayashi, MD, who found that although a disc or degenerative changes at the spine itself can cause nerve root compression, it’s the inflammation that occurs around the nerve that is the main factor in creating a nerve to become symptomatic.
Once a nerve has become bathed in these irritating chemical substances, they become highly mechanically sensitive.
Furthermore, they can become adhered with connective tissue, tethering the nerve root and again stopping the essential gliding and other critical movements of the nerve.
Kobayahsi states, “The presence of periradicular fibrosis will compound the nerve root pain by fixing the nerve in one position and thus increasing the susceptibility of the nerve root to tension or compression.
“These adhesions led to severe tension or compression on the nerve root, thus causing disturbance of intraradicular blood flow and breakdown of the blood-nerve barrier, resulting in intraradicular inflammatory changes such as edema and demyelination.”
Regardless of what sort of structure presses (compression) or strangles (entrapment) neural tissue, it will go through some fairly predictable changes depending on the time and intensity of the insult.
Susan Mackinnon, MD, a leading surgical researcher at Washington University School of Medicine, notes the common progression of nerve compression:
“The initial changes were a breakdown in the blood nerve barrier, followed by a subperineurial edema and fibrosis; localized then diffuse, demyelination occurred and finally Wallerian degeneration.”
Of these changes, there are different degrees of injury.
By far, what is encountered most often clinically is a degree 1 (neurapraxia) nerve injury.
“Pathological change consists of areas of demyelination (accounting for any observed slowing of conduction velocity),” explains Mackinnon. “Symptoms (e.g. pain), sometimes disproportionately severe, are said to be essentially the result of dynamic ischemia, not nerve injury.”
A degree-1 nerve injury is considered to be amenable to conservative care and does not typically require surgery for a full and complete recovery.
Restore Lost Movement
In a recent conference, the world’s leading researcher in spinal biomechanics, Professor Stuart McGill, stated that the most important factor to improving symptoms in patients with disc herniation, with sciatica and other nerve root issues, is to regain pain free movement of the nerve root in relation to the adjacent structures.
To examine this further, when studies have been conducted on patients with disc herniation and sciatica where an MRI confirmed the presence of disc material compressing the nerve root; when the patient became asymptomatic and the MRI was redone, the disc material was seen to be in the exact same place in relationship to the nerve root as before. (Gerwin)
Precision Neural Mobilization focuses on restoring this lost movement and restoring function to nerve roots and all extensions of the nervous system continuum, and can be the key factor to unlocking your patients’ pain complaints.
What is Precision Neural Mobilization?
Precision Neural Mobilization is an approach to identifying and treating various mechanical disorders of the nervous system.
When a compression or entrapment occurs, whether acute or chronic, edema and fibrosis are two of the most common consequences.
When nerves are exposed to fibrosis they lose their necessary capacity and capabilities to slide, bend and move around and through the various bodily tissues in which they traverse.
When a nerve loses this ability to move, it becomes subjected to further insult of compression and traction during normal everyday movement.
When this happens, these are precisely the people that come to our office requesting our help.
Identify Neural Compression
Precision Neural Mobilization is about identifying what movements and postures are putting these irritable nerves on stress and showing your clients how to reduce these loads at home through either positioning or self “flossing” procedures.
The technique is also about teaching the therapist the most effective and safe methods of restoring the lost relative movement between the nerves and their bodily interface, thus restoring their function and physiology.
The symptoms that these clients will come in with will, on the surface, present in the exact same way as other common muscular issues.
One way to determine the difference is to properly identify a neural compression or entrapment issue through assessments taught in the Precision Neural Mobilization intensive.
What makes this essential in the clinic is that the procedures for treating a muscular disorder will make a neural disorder, almost always, worse.
And what’s even more frustrating about this, is that by the nature of many neural issues, the response will be delayed, so the client may describe feeling looser or possibly more relaxed following a session only to have the complaint come on worse that night or just return unchanged the next day.
From investigators R.F. Ellis and W.A. Hing: “It is vital that the nervous system is able to adapt to mechanical loads, and it must undergo distinct mechanical events such as elongation, sliding, cross-sectional change, angulation, and compression.
“If these dynamic protective mechanisms fail, the nervous system is vulnerable to neural edema, ischaemia, fibrosis, and hypoxia, which may cause altered neurodynamics.
“When neural mobilization is used for treatment of adverse neurodynamics, the primary theoretical objective is to attempt to restore the dynamic balance between the relative movement of neural tissues and surrounding mechanical interfaces, thereby allowing reduced intrinsic pressures on the neural tissue and thus promoting optimum physiologic function. “The hypothesized benefits from such techniques include facilitation of nerve gliding, reduction of nerve adherence, dispersion of noxious fluids, increased neural vascularity, and improvement of axoplasmic flow.”
How Precision Neural Mobilization is Different From Other Types of Bodywork
Precision Neural Mobilization is highly focused on the mechanisms of injury and the precise methods of treating them in a graded manner with the patient’s disorder irritability in mind, as well as all other factors associated with the specific and individual behavior of their complaint.
Neural Mobilization has shown a definite and specific effect to identify neural issues such as carpal tunnel syndrome, sciatica and tarsal tunnel syndrome.
In one study, after subcategorizing patients with low back pain and sciatica they were all treated with procedures of neural mobilization.
As is common and expected with all sorts of interventions, all of the subcategories had some patients receiving positive results from the intervention.
What was unique and noteworthy was that the group that was determined to have symptoms predominately from peripheral nerve sensitivity responded with approximately a five-fold better success rate than the other back pain and sciatica groups.
Precision Neural Mobilization is a proven method that can take your practice to the next level and help you improve the lives of clients that could not have otherwise been helped.
About the Author
Seth Will, LMT, CPNMT, is the developer of the Precision Muscular and Neural Mobilization courses and longtime Precision Neuromuscular Therapy instructor. He has dedicated over a decade of both formal and informal training and education in massage, acupuncture, manual therapies, neuroscience and human dissection. Will practices therapy in Manitowoc, Wisconsin, and lives in Milwaukee with his wife and kids. He also runs a part time diversified organic farm with his family. He wrote “Can Massage Therapy Help Relieve Sciatica?” for MASSAGE Magazine’s May 2018 issue.
If you enjoyed reading this MASSAGE Magazine online article, subscribe to the monthly print magazine for more articles about massage news, techniques, self-care, research, business and more, delivered monthly. Subscribe to our e-newsletter for additional unique content, including product announcements and special offers.