How to do a brachial plexus slider for neural mechanosensitivity.

Our nervous system is a continuous unit. If you were to envision a tree (a crude analogy), as you move one branch you effect another nearby. Sometimes a nerve can develop mechanosensitivity. This can be for various reasons.

What does mechanosensitivity feel like? This could be pins and needles, numbness, burning pain, heaviness etc (Kosek et al., 2016).

How can we treat this? Enter neurodynamic exercises.

How do these work? Neurodynamic exercises look to leverage the excursion that happens between a nerve and the tissues it slides or glides against. Think flossing. The floss is the nerve. The teeth are everything the nerve must slide against and around.

The therapeutic effects of neurodynamic exercises may or may not be from biomechanical effects such as excursion (Schmid et al., 2018). Some recent research looking at patients with and without neck related nerve pain, found that 3 months of conservative management, that includes neurodynamic exercises, spinal mobilisations, and endurance training of the neck, significantly improved their pain and function. While we can’t say the positive effects were specifically from the neurodynamic exercises, we can note that the relationship between improved pain and improved nerve excursion was high (Thoomes et al., 2021)!

The pain relieving effects may also be from improved intraneural blood flow and antiinflammatory mediators stimulated both peripherally and at the central nervous system (Schmid et al., 2018; Thoomes et al., 2021).

What about chemical or thermal sensitivity? In theory neurodynamic exercises can also have a positive effect by improving neural blood flow. This occurs through thixotropic effects i.e. milking (Butler, 2006)!

As tends to be the case, more high quality research is needed across different regions of the body to improve our understanding of the analgesic effects of neurodynamic exercises (Basson et al., 2017). Fortunately, we know that neurodynamic exercises reduce pain and improve function of mechanosensitive nerves. So! If that is what you have, start with small amounts. Less is more. If there are no flare ups, increase and carry on!

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References:
Basson, A., Olivier, B., Ellis, R., Coppieters, M., Stewart, A., & Mudzi, W. (2017). The Effectiveness of Neural Mobilization for Neuromusculoskeletal Conditions: A Systematic Review and Metaanalysis. Journal of Orthopaedic & Sports Physical Therapy, 47(9), 593–615. https://doi.org/10.2519/jospt.2017.7117

Butler, D. S. (2006). Sensitive Nervous System (1st edition). OPTP.

Kosek, E., Cohen, M., Baron, R., Gebhart, G. F., Mico, J.A., Rice, A. S. C., Rief, W., & Sluka, A. K. (2016). Do we need a third mechanistic descriptor for chronic pain states? PAIN, 157(7), 1382–1386. https://doi.org/10.1097/j.pain.000000...

Schmid, A. B., Hailey, L., & Tampin, B. (2018). Entrapment Neuropathies: Challenging Common Beliefs With Novel Evidence. Journal of Orthopaedic & Sports Physical Therapy, 48(2), 58–62. https://doi.org/10.2519/jospt.2018.0603

Thoomes, E., Ellis, R., Dilley, A., Falla, D., & Thoomesde Graaf, M. (2021). Excursion of the median nerve during a contralateral cervical lateral glide movement in people with and without cervical radiculopathy. Musculoskeletal Science and Practice, 52, 102349. https://doi.org/10.1016/j.msksp.2021....

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