a nervous mess….
Two days in a row, two patients with the oh-so-common complaint of foot pain. In treatment we always begin with the loudest complaining body part. And feet were the screamers. We let them have their say before I open the door to what else is talking. Both folks reported a history of chronic low back pain with bouts of sciatica. I duly explained why examination of the spine would be our journey’s initiation. It amounts to malpractice to do otherwise. Besides, they had already been massaging feet and hoping for relief way too long.
The clinical term adverse neural tension entered my lexicon in 1991 with the publication of Mobilisation of the Nervous System by David Butler. Which was groundbreaking in its day. Before 1991 I knew how to screen for sciatic nerve involvement but fumbled (to the best of my ability) treating this common, often persistent, complaint. David Butler methodically laid it out. At the risk of over-simplification I’m just gonna briefly elucidate.
Our big juicy brain receives signals from, sends messages to and regulates every conceivable body part and function. These signals travel from brain to spinal cord with nerve roots exiting and entering the cord completing the loop. All this back and forth communication happens most optimally when the uber-delicate nerve tissue can fluidly move through the surround of muscle and fascia.
I am guessing that optimal is very rare. If you are a living breathing moving human being you have sustained physical trauma more than once. Most of us? Scads of times. You don’t even remember that day you fell off your bike when you were three. Not to mention the twisted habitual ways we hold ourselves as we sit, stand and sleep. All the daily micro-tears inherent in our patterns of over use. You get the picture. The clinical word for what happens to the nervous system secondary to this trauma is “tethering”. The insulted nerve scars and adheres to surrounding tissue and in the process loses its free-glide nature. Frequently the nerve is scarred down in more than one place.
Back to the person with foot pain. He stood before me reporting minimal heel ache. As soon as I asked him to bring chin to chest, the heel pain screamed out. What? But picture it: chin to chest tenses the spinal cord, asks it to lengthen. That lengthening move tugs on tethered spots along the course of the sciatic and tibial nerve. Chin up---better. Chin down---ouch.
After 1991 I began to evaluate and treat these special patients with neural involvement very differently. There are five key tension tests---sciatic, femoral, ulnar, radial, median--- for assessing the presence and degree of tethering. Treatment and self-care focus on releasing the bind of muscle and fascial restriction all along the route of the nerve---not just where the pain is manifesting!
It is oh too easy to flare symptoms with stretching techniques, both in treatment and self-care. Over the years I’ve seen many unsuspecting folks make themselves worse with stretching. We really need to learn about and respect neural entrapment. When symptoms are long-standing, easily irritable, seemingly unresponsive to logical care--- adverse neural tension is highly suspect.
Assessment by a skilled practitioner can really ease the way. It is often a relief to understand why something has not healed. First step is release of surrounding tissue---hands on treatment translated to roller/ball work. Release is followed up with very light touch dynamic flossing. Flossing is the clinical term for gently moving the nerve through the tissue with a goal of un-tethering. There is a very fine line between moves that flare up symptoms and moves that progress toward healing.
This rant is an invitation for you to reach for help if you see yourself painted here. Back in the day I used to treat 12 patients a day. I look back in wonder at my norm for oh so many decades. The current pace of my clinical practice? One patient a day. It is so perfect. After all these invested years, this slow build of skill and experience and wisdom, it feels wrong to give it up. I love each and every one of you and treasure our time together. Come see me for a physical therapy session and let’s start to unravel this bundle of nerves.
You can begin to explore and tend to the health of your nervous system in community. Bathe in the known delight of “treatment translated to roller/ball work” a couple times this Thanksgiving week:
Friday Nov 29 (yes to the day after Thanksgiving!) Release & Realign at Sierra 2 10:00am. Drop in $20. Enter parking lot off 4th Avenue for back door entry on this holiday hours day.
Letting Go is Sunday Dec 1, three hours to dive in to this pleasure-filled world at Clara Auditorium 1:00pm. Pre-enroll for $50; drop in for $60.
I am so grateful for a body that functions reasonably well and is a great source of pleasure and joy. Here to support you in moving in that direction.
❤️Bella