Nervous System - Nerve Manipulation
The Therapeutic Value of Nerve Manipulation

A nerve only functions correctly when it is able to move feely within its surrounding structures. The modality of Nerve Manipulation facilitates nerve conductivity and intraneural blood supply for local and systemic responsiveness. By understanding the detailed anatomy of the nervous system, one can clearly see the potential for pathological change when nerves are restricted. Nerve Manipulation as developed by Barral and Croibier is known for its specificity of technique. Through identifying the local fixations' effects on the rest of the body.

Manual therapy, as it applies to the treatment of nerves, follows the standard principles of mobility and function. For optimal function nerves must be able to move freely within its surroundings. This freedom of movement is essential for:

• nerve conduction
• electromagnetic conduction
• intraneural blood supply
• intraneural nerve supply
• local and systemic responsiveness

Neural Fixation

When a nerve is fixed, it typically looses its ability to glide and/or stretch in length. The intra- or peri-neural pressure dramatically increases, at the same time there are changes in consistency. The nerve pathway shows functional interferences (blood supply or electric and/or electromagnetic conductivity).

With fixation smaller nerve sections can harden. They feel like buds and are very sensitive or painful to the touch. Such "Nerve Buds" are an indication of an intraneural interference, an overload of physiological pressure points or a local fibrosis. Nerve buds can be released very quickly, sometimes within one therapy session.

Palpation of the skin branches of peripheral nerves can be useful for evaluative, as well for therapeutic considerations. When evaluating the skin branches, if they are sensitive or painful to pressure, typically there is a fixation of the deeper nerve branches.

Effect on Organs with Nerve Treatment

Visceral Manipulation techniques can affect the movement apparatus and vice versa. It is important to note that the release of sensitive nerve buds can have a favorable effect on the functioning of the corresponding visceral organs. The nervous system is involved in all body functions and without neural control certain visceral activity cannot be maintained. The stimulation of nerves is processed centrally and reported back to the body as feedback. This sequence of responses functions providing no interference (fixation) is present.

Whether the structures involved include joints, fascia, viscera, brain and peripheral nerves, or emotional centers, proper evaluation is essential for good therapeutic results. The treatment of a normal nerve section (without fixation) has no adverse effect, however a local nerve irritation can result.

Generally, one thinks of a trauma as a severe injury that causes damage. This definition encompasses different gradients of external forces acting on the body. For example, not every joint trauma leads to a fracture or dislocation, which is verifiable by x-ray. From a medical standpoint, patients are often considered to be perfectly healthy, even though they are not at all the same as they were before sustaining a trauma. The same is generally true for the nervous system and the nerves. Traumatic nerve lesions typically do not result in a recognizable, well defined, clinical picture. Instead a broad spectrum of disturbances can be found. Because of their inconsistency and lack of evidence (with conventional examination methods and imaging procedures) symptoms are often overlooked.

Often functional nerve lesions develop after neurotropic diseases (like herpes zoster) or as a result of posture imbalances. More frequently they derive from mechanical forces and energies: friction, pressure (compression) or traction forces (stretch), all of which affect the nerves. To bring about lesions, a trauma does not have to be severe. Often, it is a matter of repetitive micro-traumas. For example, a non-physiological movement, a harmless sprain, faulty posture or muscle contractions. Pathological processes can take place intra- and extraneurally.

Intraneurally the trauma affects distinct nerve structures:

• demyelination, neurinoma, hypoxia of certain fibers (in the conducting nerve tissues),
• epineural scarring, perifascicular edema, fibrosis, irritation of the arachnoid space or the dura mater (in the neural connective tissue).

These categories of pathology are rarely found in isolation. Clinically we typically find several together. Extraneural disturbances are caused chiefly by a narrowing of the spinal canal. Trauma can also impact the "nerve bud" or a functional intersection of the nerve tissue. For example, a nerve or epidural hematoma, an epineural tissue fixation, a dura adhesion in the spinal canal, as well as pressure caused by bone or muscle swelling can result.

Intra- and extraneural function disturbances often occur in tandem. In our opinion, they are closely connected with a neural fixation dysfunction and/or are even the cause of it. Our aim is to treat this kind of fixation with manual techniques or at least to minimize their negative results.

How Does Nerve Manipulation Help You?

With interferences in certain body zones, the respective spinal cord and/or brain stuctures may also be irritated. A peripheral nerve treatment can influence these so-called facilitated areas and therefore promote a common or systemic effect. Manual treatments are basically effective due to the mechanical effects that cause neural stimuli, which can be transmitted at a local or central level. Manual neural manipulation changes intra- and extraneural pressure, improves sympathetic function to blood vessels due to the auto-innervation of the sympathetic gangli and sympathetic innervation of peri-neural connective tissues both of which are affected with treatment of fixations in the nerve sheaths.

How is Nerve Manipulation Performed?

Treatment to nerves is through precise applied pressure. The tension of the perineurium and all other neural connective tissues is transmitted down to the root sheaths, so the distal contact has a central effect mechanically and reflexogenically.

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Jean-Pierre Barral, D.O., MRO(F)
Alain Croibier, D.O., MRO(F)