|
|
The Sorehand Chronicles: The best RSI
info anywhere, from the people who've "been there, done that!" |
|
pre
Date: Thu, 30 Nov 2000 09:59:39 -0600 Subject: Re: adverse mechanical tension/adverse neural dynamics Adverse mechanical or neural tension is a phrase used by PTs, beginning in Australia, for disturbances in the mobility of the peripheral nerves. Our nerves, apart from performing their function of passing signals back and forth from the central nervous system to the muscles, have to have the capacity to adapt mechanically to movement of the body. They have to slide relative to the tissues around them. The theory, science, tests, and some treatment ideas, are set out in David Butler's book "Mobilisation of the Nervous System." The idea is that when you lift an arm, for example, the ulnar, radial, and median nerves need to have the freedom to slide relative to the tissues around them to adapt to this movement. Nerves can't 'stretch' very much before blood flow to them is cut off and they hurt, lots. So they have to slide. The most extreme form of nerves not doing this is in eg Carpal Tunnel Syndrome, where the nerve is so pinned down that its function in passing on signals is compromised, and that shows up on a nerve conduction test. What these PTs have done is develop hands-on tests to find when nerves are pinned down enough to compromise mobility, but not yet their signal-carrying capacity. The do this by manouevering your arms towards positions of maximum neural tension. One aspect of treatment is doing nerve mobilisation exercises, like very gentle stretches. Some maybe do hands-on work to break up adhesions. They say in their writings that while adverse neural tension is often found in RSIs and in typists, those cases are generally complex, and it is usually only one part of the equation. Many of Sharon Butler's stretches (Conquering Carpal Tunnel Syndrome) are like nerve mobilisation exercises--whereas the textbook by David Butler is expensive and doesn't actually contain many treatment stretches, so it's not terrifically useful for do-it-yourselfing. But it's worth looking at in a library if you have access to a medical library. Here's my personal adverse neural tension story. After a couple of years of no good diagnosis and no treatment that worked, a kinesiologist with training in muscle imbalance thought my shoulders were too high, so he taught me to hold them lower. I noticed no change as a result of this except that my sterno-clavicular joint (the notch at the base of the neck) became sore. Fast forward six months or so: a PT gave me these neural tension tests and I came out very positive on all of them. He would have given me treatment of thoracic spine manipulation combined with nerve mobilisation exercises, but I didn't live where he did and went home to try to find treatment based on that diagnosis. Another couple of months later, as it didn't seem to be working out to try to find one PT who would do what another PT wanted, I came across a PT with (more) training in muscle imbalance. He said, "no wonder you have neural tension and sore sterno-clavicular joints: your shoulders are too low." He did some postural taping on me, and I did lots of shoulder shrugs, and my shoulders came up, and my sterno-clavicular joint pain went away. None of the normal arm-hand symptoms had changed, so I went off back to the city of the PT who had originally done the tests for some treatment. And voila, my neural tension had in fact almost completely disappeared: the tests were normal now. But this change had no effect on my symptoms. So it's no magic bullet, in my experience, but nothing is. It might help you. Lots and lots of PTs seem to be trained in it these days. A chiropractic rough equivalent is active release techniques. Two years into my Feldenkrais training program, I begin to realize how much pain and distortion in my movement patterns comes from the idea/feeling that it would be dangerous to let my shoulder girdle rest on my ribcage, something I learned from the PT who corrected my sterno-clavicular pain...and so it goes. Hope this helps. ------------------------------ Date: Fri, 1 Dec 2000 09:32:57 -0600 Subject: Re: adverse mechanical tension/adverse neural dynamics That's probably not a neural tension test, judging by your description. To do a neural tension test, the PT (usually) lies you on a table, and takes your arm through a precise sequence of movements, stabilizing your shoulder and asking you to do different things with your head. The person testing you moves you. Neural tension could be the reason you won't/can't raise your arms, but that test doesn't sound like the test for it. Other things could cause that as well. What is the feeling that stops the movement for you? Is it a feeling in your shoulder, or something in your elbow or hands? Is it pain or just a "stuck" feeling? If you do this movement of lifting an arm and stop and hold your arm just before the pain/restriction comes on, and bend your head ear to opposite shoulder, or bend your wrist back, does that bring on the pain/restriction? Do you have Sharon Butler's book? The stretch where she has you lie face up, with an arm open to the side, forearm off the bed but sufficiently supported to be comfortable, palm up, and (slowly/gently) bend back your wrist, is a stretch you would likely feel strongly if you had adverse neural tension in the median nerve. But you could also feel that stretch strongly for a lot of reasons. Caveat: I'm not medically trained. I'm just a layperson, in a Feldenkrais training, who has read the Butler textbook and fiddled with the movements myself for a while, to no great effect. > Is it for this reason that when my physiatrist yesterday asked me to > stretch my arms out to the sides and raise them, that I couldn't move them > any higher than my chest? Is that what you refer to as neural tension? > Every time I've seen my doctor (since March), he's had me do this and I can > never raise them any higher than that.
pre
http://www.rsiprogram.com
Revised
Nov
21,
2000