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.