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Deep massage to posterior calf muscles in combination with neural mobilization exercises as a treatm

Discussion in 'Biomechanics, Sports and Foot orthoses' started by NewsBot, Sep 14, 2013.

  1. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1

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    Deep massage to posterior calf muscles in combination with neural mobilization exercises as a treatment for heel pain: A pilot randomized clinical trial
    Bernice Saban, Daniel Deutscher, Tomer Ziv
    Manual Therapy; Available online 3 September 2013
     
  2. Admin2

    Admin2 Administrator Staff Member

  3. Bruce Williams

    Bruce Williams Well-Known Member

    Can anyone explain to me what "Neural mobilization exercises" are specifically?
    Bruce Williams
     
  4. Ian Linane

    Ian Linane Well-Known Member

    Hi Bruce
    Sorry if this is very brief. Depends on whether they are referring to the neuro orthopedic institute (NOI) techniques or not.

    http://www.noigroup.com

    NOI techniques are a long established mobilisation approach developed by David Butler et al and provide a way of "mobilising" neural tissue. That is, the relevant nerve, e.g. tibial nerve, is taken through a series of gliding manoeuvres (this is far more detailed than the slump test). These manoeuvres are termed often a "sliders" or "tensioners".

    It initially involves testing if a specific set of nerve(s) e.g. tibial nerve, may be involved in an otherwise unresponsive condition. That is, winding the nerve up. This is achieved by applying various types of traction upon it. If it is determined the tibial nerve is involved in the irritation to an area then it is possible to use tensioner or slider moves to improve the situation. These manoeuvres can be practitioner applied only or applied with the practitioner and pt working together.

    In effect the idea is that through the sliders or tensioners the nerve is moved up and down in specific and guided ways. There is much more to this approach in that Butler et al consider that this is as much about dealing with how the brain associates a movement with pain.

    It is a set of techniques I have used several times to good effect within the low leg, foot and ankle, but sometimes not.

    Sorry it is a brief response at the moment.
     
  5. Bruce Williams

    Bruce Williams Well-Known Member

    Ian;
    thanks for the explanation. My experience in manipulation and mobilisation is obviously based on what Howard Dananberg taught me. My thinking has always gone along the way that if you cant' move the joint efficiently, or at all, then there is very little way a muscular, or in this case a neurological, mobilisation will ever work for long or at all.
    That said, I have done several manipulations on patients with unilateral nerve pain issues in the foot and ankle and even at the lateral knee, with great success.
    I know that there will always be a chicken / egg discussion here and I know that biomechanical positions / compensations can have an affect on local nerve tissue. But, w/o also addressing the underlying issue how can you get the mobilisation to ever hold? I know I rarely can with my joint mobilizations, so I doubt the long term success this different approach as well w/o addressing the foot / ankle mechanics.
    my 2 cents. Thanks for your insight.
    bruce
     
  6. David Wedemeyer

    David Wedemeyer Well-Known Member

    "What is Neural Mobilisation?

    Neural mobilisation is a gentle movement technique used by physiotherapists to move nerves. Initially this technique was referred to as neural stretching, because earlier clinicians detect ‘stiffness’ when trying to put stretch on a nerve. Recent research has demonstrated that the resistance encountered with neural dynamic tests [of which the Straight Leg Raise Test for the Sciatic nerve is one of the oldest!] comes from a muscle response [in this case, the hamstring muscles], to protect the sensitive nerve from gliding and elongation. Specific gentle movements of nerves stimulate the blood supply to the nerve; it improves the axoplasmic flow in the nerve and loosens scar tissue between the nerve and its ‘bed’ after injury. This treatment relieves pain and restores functional movement."

    I want to know what basis there is to suggest a nerve gets "stuck'? The sciatic nerve SLR test test the nerve root for example (mostly L5-S1) not the 'stretch' of the nerve axon so what usefulness is a non-specific treatment for what is apparently an adhesion in the muscle belly & fascia? How much does a nerve stretch anyway?
     
  7. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Effectiveness of Deep Dry Needling vs Ischemic Compression in the Latent Myofascial Trigger Points of the Shortened Triceps Surae from Triathletes on Ankle Dorsiflexion, Dynamic, and Static Plantar Pressure Distribution: A Clinical Trial.
    Benito-de-Pedro M et al
    Pain Med. 2019 Sep 10
     
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