Effective Nerve Mobilization Techniques for Back and Leg Pain Relief

Understanding Nerve Dynamics for Pain Relief

Nerves require the ability to glide and stretch for optimal functioning. Issues like edema and fibrosis can hinder this movement, leading to neurogenic complaints. Nerve tension tests help identify altered neurodynamics, and nerve flossing is a technique aimed at restoring normal function and alleviating associated symptoms.

Identifying the Source of Pain and the Assessment Process

A 2020 study in JMPT revealed that over 40% of extremity complaints stem from an asymptomatic spine, likely due to altered peripheral nerve mechanosensitivity/neurodynamics. The double-crush syndrome hypothesis suggests that nerves originating from irritated nerve roots are more sensitive to pressure, contributing to conditions such as sciatica and peripheral joint complaints.

Neurodynamic testing involves tensioning selected nerves to identify abnormalities. Positive test results, indicated by the reproduction or increase in neurogenic symptoms, guide the diagnosis. While familiar tests like SLR, Bragard, and Slump help identify sciatic nerve involvement, alternative tests are needed for radiculopathies above L4 and other lower extremity neuropathies.

Effective Neurodynamic Treatments

Studies show that neurodynamic treatments, including flossing, gliding, and tensioning, significantly improve pain and range of motion for lumbar spine-related neurogenic complaints. A systematic review of chronic low back pain studies demonstrated improvements in Oswestry and VAS scores. Additional benefits include enhanced flexibility and motor conduction velocity.

Differentiating Nerve Tensioning and Nerve Flossing

Nerve tensioning, involving maximum stretch on both ends of a nerve, is primarily used for testing and late-stage rehab. In contrast, nerve flossing, which entails tensioning one end while releasing tension on the other, aims to glide the nerve through its path and release adhesions. Chiropractors can perform therapeutic nerve flossing in-office, or it can be included in a home-based program.

Nerve mobilization, through techniques like flossing, has proven efficacy for lower back pain and peripheral complaints. For practical demonstrations of in-office and home nerve flossing exercises, refer to the provided chart to enhance clinical outcomes for lower extremity issues.