Let us not forget the nerve

Lets not forget the nerve…..!
You do not need to be getting pins and needles, numbness, lancinating or burning pain for a diagnosis of neural problems to be made. In fact, within a good percentage of my clinical population, this is not reported as the primary feature of what turns out to be nerve dysfunction.
Amongst health care professionals the way in which the nerve moves is called neural dynamics, and thus if it is not working properly…adverse neural dynamics (AND). This diagnosis can easily be forgotten with the tendancy to fall back to more traditional structures like ligaments, muscles or cartilage being given the blame for your pain.
This is particularly pertinent in my mind due to the number of patients who seem to have gone through the mill, often having had multiple operations, only to establish that their pain is no better, and clearly had very little, if anything at all, to do with the structures that have been operated on. This can then become a very slippery slope, with often more surgery being undertaken to try and sort out a mechanical problem (often within a joint) that the MRI shows to be abnormal structure (lets not get started on MRI’s, the greatest gift and possibly one of the biggest curses every to grace modern medicine), when actually this is not the generator of pain. The problem remains unresolved with the patient often being left very frustrated, weak following the pain and rest post surgery, and not any better.
Testing the dynamics of the nerve is not complicated, but does require specific questioning and careful handling. It should be able to reproduce your symptoms, and should be modifiable with techniques to change the pull on the nerve. This might include taping, manually lifting the tissue that is above or below the restriction, or manipulation of any one of a number of interfaces through which the nerve passes.
Now I’m not saying this represents all problems, and in fact I would go so far as to say that this represents only a very few cases. But, it is a source of symptoms that should be identified early and effectively managed to save time, money and sometimes significant frustration and heartache.

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