Nerve Mobilization Therapy (NMT) - Glides, Slides, and Tension

ABSTRACT

Nerve Mobilization Therapy (NMT) – Glides, Slides, and Tension Manual Techniques That Mobilize the Nerves

Nerve Mobilization Therapy or NMT is a manual technique combined with correct positioning of a nerve and with the objective of enhancing the repair and healing processes within and around a nerve or nerves. The therapeutic objectives of NMT are like the nerve “flossing” techniques used by physical therapists but NMT differs from the nerve mobilization techniques used by physical therapists in that NMT combines gentle nerve massage and mild compression with the neutral positioning of a nerve and the use of medicated topical applications for nerve pain, sedation, inflammation, trophic processes, and balancing fluid dynamics.

Dr. Gregory Lawton

Nerve Mobilization Therapy (NMT) – Glides, Slides, and Tension

Manual Techniques That Mobilize the Nerves

by Gregory T. Lawton, D.N., D.C., D.Ac. Manual nerve gliding, sliding, and tensioning is a therapeutic technique used to mobilize injured, damaged, inflamed, compressed, and/or entrapped nerves within the body. These therapeutic techniques aim to improve nerve mobility, alleviate pain, eliminate inflammation, and enhance overall nerve function.

Nerve Mobilization Therapy or NMT is a manual technique combined with correct positioning of a nerve and with the objective of enhancing the repair and healing processes within and around a nerve or nerves. The therapeutic objectives of NMT are like the nerve “flossing” techniques used by physical therapists but NMT differs from the nerve mobilization techniques used by physical therapists in that NMT combines gentle nerve massage and mild compression with the neutral positioning of a nerve and the use of medicated topical applications for nerve pain, sedation, inflammation, trophic processes, and balancing fluid dynamics.

NMT may be manually applied to any area of the body where nerves are accessible and where NMT techniques may be applied. This includes the cervical, thoracic, lumbar, sacral, and coccygeal regions, the upper extremities, the lower extremities, anterior and lateral chest region as well as the abdominal and pelvic areas. NMT techniques are designed to improve nerve movement within fascial and connective tissue structures, reduce pain, eliminate inflammation, and to reduce edema and fluid blockages around nerves.

There are three (3) basic components to nerve mobilization therapy which includes: 1. Correct and careful positioning of the anatomical area to be treated. This positioning includes – a) Placing the area to be treated in a neutral position to reduce tension on the nerve or over stretching of the nerve. b) Placing the area to be treated in a “folded” position to create “slack” and relaxation in the connective tissues around the nerve. c) Placing the area to be treated in a mild stretched position to gently “tension” the nerve and connective tissues.

2. Gentle gliding, sliding, or tensioning along the pathway (tract) of the nerve.

3. The application of a topical medicated (infused) oil along the pathway (tract) of the nerve.

Why Nerve Mobilization Therapy Is Performed Nerve mobilization therapy is performed if nerve tension or tightness is contributing to pain, weakness, parathesis, and/or the loss of range of motion of the affect area, region, or joint. The objective of nerve mobilization therapy is to restore normal movement of nerves, such as the peripheral nerves within their connective tissue or physiological environment.

Conditions for which nerve mobilization may be recommended include: Muscle strain – an injury caused by the overstretching of a muscle or a tendon.

Nerve entrapment syndromes – conditions where a nerve is compressed, entangled, or entrapped by fascia or connective tissue.

Sciatica - nerve pain in the lower back and legs caused by injury to the sciatic nerve.

Herniated disc - the bulging of the cushioning disc between spinal bones.

Cervical radiculopathy - the compression of a nerve exiting the spinal bones of the neck.

Carpal tunnel syndrome - the compression of the median nerve as it passes through a narrow tunnel in the wrist.

Cubital tunnel syndrome - the compression of the ulnar nerve as it passes through a narrow tunnel in the elbow.

Tarsal tunnel syndrome - the pinching of the tibial nerve as it passes through a narrow tunnel in the ankle.

Plantar fasciitis - inflammation of the band of tissue that runs along the bottom of the foot.

Piriformis syndrome - spasms of the piriformis muscle of the buttock that compress the sciatic nerve.

Thoracic outlet syndrome -the compression of nerves, arteries, and veins in the lower neck and upper chest areas.

Pelvic nerve entrapment - the compression of the pelvic nerves due to disease, injury, surgery, or ptosis.

Post-surgical or post-immobilization rehabilitation Nerve scar entrapment and entanglement – a condition where traumatic, burn, or surgical scar tissue and adhesions have compressed, damaged, injured, or trapped a nerve thereby compromising its function.

Examples of NMT Applied to the Upper Extremity

First, do no harm. NMT technique and therapy is a gentle technique applied along the antegrade pathway (tract) of a nerve and the flow of axoplasm through the nerve’s microtubules.

Median Nerve Mobilization Instructions To mobilize the median nerve (Assists range of motion of the wrist and fingers):

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Place the patient in a comfortable position.

Place the patient’s arm with the palm facing medially.

Begin at the medial, inner arm, between the bicep and the triceps.

Carefully palpate and locate the nerves of the upper arm (brachial plexus).

Perform nerve mobilization technique following along the pathway of the nerve.

Reposition the hand, wrist, and arm as needed.

If appropriate and if tolerated by the nerve and patient perform tensioning range of motion to the extremity.

8. Apply a topical medicated oil and repeat the nerve mobilization technique.

9. Repeat NMT along the pathway of the nerve five to ten times.

Repeat NMT technique as needed for any nerves of the upper and lower arm, wrist, and hand that need therapy such as the ulnar nerve.

Examples of NMT Applied to the Lower Extremity

Nerve mobilization techniques follow along the pathway (tract) of the nerve in an antegrade direction with the axoplasmic flow of the nerve.

Sciatic Nerve Mobilization Nerve mobilization techniques for the lower extremities are focused on improving the function of the sciatic nerve and its branches. To mobilize the sciatic nerve, follow these guidelines:

Sciatic Nerve Mobilization Instructions 1. Place the patient in a comfortable and safe position (side lying).

2. Place pillows and bolsters between the legs and bend the knees.

3. Carefully palpate and locate the sciatic nerve in the gluteal region.

4. Begin at the greater sciatic notch and follow the pathway of the sciatic nerve.

5. Perform nerve mobilization technique following along the pathway of the nerve.

6. If appropriate and if tolerated by the nerve and patient perform tensioning range of motion to the extremity.

7. Reposition the thigh, leg, ankle, and foot as needed.

8. Apply a topical medicated oil and repeat the nerve mobilization technique.

9. Repeat NMT along the pathway of the nerve five to ten times.

Nerve Gliding Safety Guidelines First, do no harm! Nerve mobilization therapy is a gentle and light to mild pressure technique. Do not apply deep pressure or compression to sick nerves, neuritis, or neuropathy. Never treat directly into deep pain or hyperesthesia.

To ensure patient safety, there are several rules to remember when performing nerve mobilization therapy: 1.

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Place the patient in a safe position.

Start slowly with gentle palpation to locate the nerve and problem areas.

Do not overtreat the patient.

Do not apply deep pressure, deep compression, or perform deep tissue work when performing NMT. Have the patient inhale and exhale slowly as you are performing the NMT technique.

Stop immediately if the patient reports sharp shooting pain, burning pain, or deep aching pain.

Do not treat into pain.

Do not repeat treatment if you are not getting positive clinical results.

NMT may cause a slight tingling or mild aching sensation, this sensation should subside in a few minutes, if does not subside terminate the treatment and follow recovery steps.

Recovery steps: 1. Apply a cold or cool pack.

2. Use light therapy such as a Bioptron device.

3. Apply a soothing and healing medicated or infused oil topically.

Can Nerve Mobilization Make Nerve Conditions Worse?

The simple answer is yes. This is why we follow the safety guidelines listed above. In cases of severe nerve inflammation, a nerve may be too inflamed for manual techniques to be effective. In these cases, consider the use of internal and/or topical applications that are known to manage inflammation and pain. If a patient’s condition and case are beyond your ability and resources to treat, refer them to a physician or physical therapist.

How Long Does It Take for Nerve Mobilization to Work?

Depending on the severity of a patients condition the patient may get immediate improvement from NMT or they may gradually improve through a course of therapy. It can take up to six or eight weeks, in some cases, to see improvement in a patient’s condition.

Summary Nerve Mobilization Therapy or NMT is a group of manual procedures that can mobilize, stretch, fold, bend, and release nerves that are trapped, entangled, and/or entrapped by fascia and connective tissues and as a result are compressed or injured. Nerve mobilization therapy assists nerve physiology and function by improving nerve nutrition and waste elimination via antegrade and retrograde circulation within the microtubules of a nerve axon.

The Author Dr. Gregory T. Lawton is the author of several hundred books, training manuals, and educational materials on healthcare and related fields. In 1980 he founded the Blue Heron Academy, a state licensed vocational school that offers classes in traditional and conventional health care. Dr. Lawton is a licensed chiropractor, licensed naprapath, a licensed acupuncturist, a registered naturopath, and a master herbalist. He is nationally board certified in radiology, physiotherapy, and acupuncture. Dr. Lawton is the former vice-president of the largest physical therapy group practice in Michigan and the former vice-president of the largest psychotherapy practice in west Michigan.