What is Precision Neural Mobilization?
Precision Neural Mobilization (PNM) 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,” they become 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. PNM is about identifying what movements and postures are putting these irritable nerves on stress and showing your patients how to reduce these loads at home through either positioning or self “flossing” procedures as well as 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. What is critical to realize is that the symptoms that these clients will come in with, will on the surface present in the exact same way as other common muscular issues. The only way to determine the difference is to properly identify a neural compression or entrapment issue through examinations taught in the PNM 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.
Can Precision Neural Mobilization help Disc Problems and Sciatica?
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 researches in this area is Dr. Kobayahsi who has 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.”
Precision Neural Mobilization focuses on restoring this lost movement and restoring function to nerve roots and all extensions of the nervous system continuum. In a recent conference, the world’s leading researcher in Spinal Biomechanics, Professor Stuart McGill, stated that they 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 a 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 can be the key factor to unlocking your patients’ pain complaints.
How is Precision Neural Mobilization different than other types of massage or manual and movement therapies?
PNM 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, Tarsal Tunnel Syndrome and others. In a study conducted by Schafer and colleagues, 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 500% 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.