Practical Science on Movement and Pain

Nerve Mechanics Part III

nerves of left upper extremity
Image via Wikipedia

In the first two posts on nerve mechanics I discussed how nerves move and how that movement can cause pain. This post is about making sensitive nerves healthy again. Without getting into a bunch of complicated anatomy about how to tension or slide certain nerves and when it’s safe to do so, here’s a general recipe for recovering pain free movement of any part of your body, including your nerves:

Move as much as you can in the direction of where you want to go without causing pain, wait for the body to make a favorable adaptation, and then try to move more next time. If you can keep this up, eventually you will recover your normal movement pain free. That’s it.

You may recognize this process as a simple application of the SAID principle, which means that the body adapts to the specific stresses it encounters. In the case of nerves, this might play out something like this. If you mobilize a nerve (without injuring it) it will improve its circulation and get healthier because the movement may help squeeze out local inflammation (motion is lotion). If the movement occurs without pain, the brain will receive feedback that the movement is safe and will be more likely to allow the movement without pain in the future. Further, moving safely will increase your skill at moving safely and make it even easier for you to do so next time. Remember, pain free movement is a skill like any other, and you get better at what you practice. If you are consistently moving in a way that causes a nerve to make contact with a rough piece of bone or cartilege, you need to subtly alter your movement pattern to avoid that contact. It’s a skill that will improve with practice.

So, if you mobilize a nerve without pain, it should be a little easier to do move it next time. Now you can try to move it a little further or a little faster, again without pain so that favorable adaptations can occur that will allow greater and faster movement next time. This positive feedback loop is the road to recovery and it essentially works the same for any type of movement, whether that movement is restricted by injured nerves, bones, muscles, etc.

The opposite of the road to recovery is the road to injury, which involves exactly the opposite feedback loop. If you move in a way that hurts your nerve, this will cause a minor amount of inflammation, which will crowd out blood supply and make the nerve less healthy and more sensitive. The painful movement will also further convince your brain that the movement is to be avoided, and this will make it more likely that the brain will give you a pain signal next time you attempt it. You will also further ingrain a bad movement habit, making it harder to break. Next time you move the nerve it will be even more sensitive, which will cause more pain, making it more sensitive next time, and so forth. The “no pain no gain” mentality is the best way to fall into this trap.

So, a fine line must be walked to ensure you stay on the right road. You must challenge the nerve to do new things so it will improve, while at the same time not causing any injury that will make it worse. The best way to walk this line is to never move into pain. Find the extent, speed or nature of the movement where the pain just starts, then dial it back a little so you are doing the same movement, but in a reduced range or speed that causes no pain. Safe work in this area will expand the range for next time. Patience is required. Pay very careful attention to what you are doing – move slowly and mindfully – this will greatly increase your movement skill.

What if you can’t move the painful area at all? The solution is to mobilize the nearest area that can be moved pain free. Remember that the body is a unit. If you improve the mobility of any joint it will lend “slack” to others that need it. This is particularly true in the case of nerves, which have tensional relationships that cross many joints. So, if it hurts to move your shoulder, move the neck or elbow or upper chest. If its hurts to move the low back, move the hip or mid back, and so on.  A little anatomical knowledge helps in figuring out what to move, so consult a trainer or PT who knows their stuff. And how do you move? Anything mindful, precise, slow, curious and exploratory should work.  Z-Health, feldenkrais, somatics or tai chi are excellent examples.

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20 Responses to Nerve Mechanics Part III

  1. paul steele says:

    great series of posts explains why z health works so well thx

  2. Great stuff Todd!
    Rock on

    Mike T Nelson PhD(c)
    Z Health Master trainer

  3. Loved this post mate.

    Great series of articles. Has given me a bit of a wake up call and reminded me. That there is a bit more to function than just muscles and bones.

    I have not done the gift programme but have trained under one of Gary and daves disciples. A guy call phil Mansfield, who by some accounts of a couple of people I have spoken with who have done gift is teaching human function and rehab a bit better and in more depth.

    Alot of the rehab techniques you talked about here are very similar to what we do and has given me a bit better understanding of the whole Z Health principles so I stand corrected on some of my comments in my last post.

    Keep em coming mate. I’m becomming a fan.

  4. Justin Zabroski says:

    Hello, I am a martial arts instructor and sport fighter. I am working in depth to develop innovative training routines and corresponding teaching methods to increase performance and reduce injury along the lines that you describe. However, I lack an educational background in kinesiology, etc. Would you be receptive to sporadic questioning from me on this matter? My field is one of the places where the highly masculine and harsh attitudes toward the body are most prevalent.

  5. Glenn says:

    This three part series was great. The first two especially caused that excited, “Wow!” reaction you get when you come across something that makes a lot of sense and a light sort of goes off, saying, “Yes… that explains a lot!”
    Sorry if that sounds corny, but I read so much that cause me to go, “Ugh, that’s bogus: to easy to be true” or “No kidding.” It’s great to actually _learn_ something new!

  6. dale says:

    Great post. Although it’s a little like your mother’s advice to always leave a party half an hour before you stop having fun. It’s great advice, but… how do you know? — as William Blake said, you never know you’ve had enough until you’ve had too much :-)

    But as you say, mindful and cautious does the trick. It’s important not to get scared away from movement because it might hurt, and also important to stop as soon as it does hurt, and back off. Always a bit of a tightrope, and you’ll always make some mistakes along the way.

    I love the point that even if you can’t move a joint without pain, you can still improve matters by moving the joints around it.

  7. The 3 article series were extremely helpful putting many of the pieces together. With your permission, I would like to translate them to Hebrew and hand them out to my colleges and friends.

    Israel Halperin

  8. […] and this creates further pain and tightness. This is of course exactly the wrong approach. In the next post I’ll discuss a better one. Tweet « Previous PostNext Post » 8 Responses to […]

  9. […] This leads to some interesting questions about the causative relationship between neural and muscular pathology in the case of pain in the back of the thigh. First, was there ever any actual hamstring strain in the first place? If so, was it caused by preexisting issues with neural mobility? Or did damage to the hamstring and associated inflammation and fibrosis limit neural mobility? The study was unable to answer those questions, but it does make clear that people looking to fix “hamstring” issues should consider the possibility that the real issue is with neural mobility. For some basic ideas on how to increase neural mobility, see here. […]

  10. Another fantastic series of articles, thanks.
    I’ve just bought Shacklocks NeuroDynamics book, so these articles have provided a great precursor as well as convincing me I need to revisit many clients notes and re-evaluating for neural involvement.

  11. ktee says:

    I finally sucked it up and started doing some ‘nerve flossing’ as recommended by my physiotherapist. I used to find it unbearable, until I backed off a little (like you recommend–just go to the point of pain). I also notice a significant increase in flexibility. One curiosity though: I’ve noticed the muscle definition in my legs improve VERY quickly when I floss. Is this a typical result? Note that I tend to respond to therapeutic practices quickly, have little body fat, but that I also tend to give up on flossing (in the past) because it hurt… so I never did get too far into it.

    • Todd Hargrove says:

      Hi Kirsten,

      Thanks for your report, glad you are getting results. I have no idea how flossing could affect muscle definition. There are only two ways to make a muscle more defined – lose fat around it or make it bigger. Maybe the nerve flossing gives you a little temporary “pump”.

      • Lock says:

        Do nerve tension and pinched nerve refer to the same thing?

        Is nerve flossing done for nerve tension as opposed to a pinched nerve?

  12. Lock says:

    Hi Todd,

    Great series of posts. I have a question (which happens to be my problem): i.e. are muscle tension and range of motion (ROM) mutually exclusive? I was told it was. E.g. neck can rotate more to the right, yet left neck muscles are more tight and knotty. Is this because the nerves in the left neck muscles are “tighter” than those of the right? I hope I’m making sense here.

    I’ve done crazy amounts of soft tissue release and trigger point therapy over the past year but to no avail. I saw a rehab specialist recently and he told me tension and ROM are mutually exclusive and mine is a nerve/nervous system problem.

    • Todd Hargrove says:

      Hi Lock,

      I’m not sure I understand your question. If the idea is that excess tension causes loss of ROM, I would tend to agree.

      I don’t think nerves get “tight” because they cannot contract AFAIK. They can become sensitive to lengthening, and the muscles contract to protect them. Or I suppose they could become tight by adhesions, scarring, inflammation or disease processes that makes elongation physically harder.

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