gms | German Medical Science

Clinical issue/s: The nervous system adapts to mechanical loads & undergoes elongation, sliding, cross-sectional change, angulations & compression. If these dynamic protective mechanisms fail, the nervous system is vulnerable to neural edema, ischemia, fibrosis & hypoxia, which causes altered neurodynamics.

The nerve gliding (NG) exercises attempt to induce sliding of the nerve relative to its surrounding structures with joint movements

Clinical reasoning: Trauma from an injury/surgery can cause edema, scarring, tightness in the tissue which may prevent the nerve from gliding in its bed. If Intra-neural adhesions are present when gliding the nerve with exercise, is the nerve really gliding or stretching from its entrapment site?

Innovative, analytical or new approach: ULTT is used to determine the sites of entrapment.

Baseline Scratch Collapse Test (SCT) to find the entrapment sites: patient collapses at the entrapment site.

5 NG exercises performed. SCT repeated to determine if the NG occurred, hypothesis: SCT would be (-) after the exercise if the NG occurred: patient collapses more with SCT.

Soft tissue manipulation (STM) with NG was then performed to release the nerve at the adhesion site b4 gliding it to prevent tensioning the nerve. Then a combined STM with NG was performed & re-tested with SCT. Pt. was able to hold position. Findings were then confirmed with Ultrasound visualization.

US to confirm the NG before & after STM showing improvement in the movement of the nerve

Contribution to advancing HT practice: The clinically observed effects of neural mob were validated with SCT & diagnostic US, proved that NG exercises in itself is not effective. The mechanical effect of STM on the mechanical interface to reduce nerve adherence, disperse noxious fluids, increase neural vascularity & axoplasmic flow is needed to restore the movement of the nerve thereby reducing intrinsic pressures on the neural tissue & promoting optimum physiologic function.

These findings can be applied to the other nerves to enhance the therapeutic benefits of NG.