gms | German Medical Science

Objective: 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 by performing joint movements.

Trauma from an injury or surgery can create edema, scarring, tightness in the surrounding tissue which may prevent the nerve from gliding in its bed. If Intra-neural adhesion's are present when gliding the nerve with exercises, is the nerve really gliding or stretching from the entrapment site?

Materials and Methods: ULTT is used to determine the sites of entrapment.

Baseline Scratch Collapse Test (SCT) to find the entrapment sites.

NG exercises performed. SCT repeated to determine if the NG occurred, since the SCT would be (-) after the exercise if the NG occurred.

MFR with NG was then performed to release the nerve at the adhesion site before gliding it to prevent tensioning the nerve. Then a combined MFR with NG was performed & re-tested with SCT to ensure if a release occured. These findings were confirmed with Ultrasound visualization

Results: SCT baseline: Patient collapses at the entrapment site.

2nd SCT: after 5 median NG exercises, patient collapses more.

3rd SCT: After MFR with nerve glide: Patient was able to hold position.

Ultrasound to confirm the NG before & after MFR showing improvement in the movement of the nerve.

Conclusions: The clinically observed effects of neural mobilization was validated with the SCT & diagnostic ultrasound proved that NG exercises in itself is not effective. The mechanical effect of MFR 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.