order for treating nerves

[stevept]

Hi, and again thank you so much for your great job Diane :clap2: :clap2:

Is there any order of treatmnet when you have several nerves to treat ?
I mean do you treat the most proximal ones then the distal ones ?
For example, if i want to treat the sural nerve and the plantar nerves which one comes first ? (heel pain)

Hope i make myself clear

[Diane]

Hi stevept,

You are most welcome.

No, there is no particular order. Keep all of them in mind and treat the one that seems to be the crankiest first. Then upstream from that one. Or else start upstream and move downstream. Learn to feel then treat how you feel. Every system will be a bit different, so be versatile.

[stevept]

Treating the crankiest first sounds logical. Thanks.

My next questions :
1) During a stretch the patient felt pain cycling up and down i.e. inrease and decrease and so on (one cycle= 5-10 seconds or so). I was treating the superior cluneal nerve.
What do you think?
Does your patients report this at times ? (i suppose so)

2) After "DNMing" the femoral and the obturator nerves, the painful spot did not feel sore any more when palpating but the pain was still here when walking.
This patient has had an anterior hip/groin pain since 2 years after she fell on her ipsilateral buttock.
Do you think that repeating the same stretches again would solve the problem?
Its looks like a good indication for neuro-tapping ?

[Diane]

1) During a stretch the patient felt pain cycling up and down i.e. inrease and decrease and so on (one cycle= 5-10 seconds or so). I was treating the superior cluneal nerve.
What do you think?
Does your patients report this at times ? (i suppose so) I think it could be a cluneal or a twig from one. I haven't had that specific complaint, but it's not outside the realm of possibility.

2) After "DNMing" the femoral and the obturator nerves, the painful spot did not feel sore any more when palpating but the pain was still here when walking.
This patient has had an anterior hip/groin pain since 2 years after she fell on her ipsilateral buttock.
Do you think that repeating the same stretches again would solve the problem?
Its looks like a good indication for neuro-tapping ? I would move onto other nerves in the area. I would "widen the circle" and treat nerves that feed into the zone, from either upstream or downstream. Don't forget to check saphenous by the knee.

Sure, you could try taping. I would put tape on the back of the hip/pelvis, outside and front of the thigh.

[stevept]

Hi,
I tried DNMing several nerves in the area and lower limb, she felt no more pain moving, or walking but a little when bending forward.
When i saw her four days ago the pain was almost back at the same level.
I'll see her tomorrow and ask for feedback.
Maybe I'll tape this time.

[Diane]

Have you asked her if she's an habitual one-sided leg crosser?

[bernard]

Steve,

Post also your subject in the French section. It will be hepfull for the "Français".

ps: Commence à un niveau plus global pour pacifier le corps ensuite regarder ce qui reste. :lightbulb

[kongen]

Diane,

Would you care to describe your reasoning behind the habitual one-sided leg crosser? I'm one myself, always crossing my right leg over my left. Trying to cross the left over the right is restricted and awkard. I also have limited hip internal rotation on the left. I've been doing some MET into the restricion (capsular pattern) and training of abductors/internal rotators lately which seems to improve the range.

Anders.

[Diane]

I'll explain it how I see it.. in a word, adaptation.

But no one has a very clear idea of exactly what is meant by that.
The way I explain it to patients, I show them the picture in Butler's book of the ulnar nerve, bent at the elbow. It's a simple picture of a tube (the nerve) fed by two arteries, one along the top and the other along the bottom, each with feeder vessels pugged in every couple inches or so along the way.

The vessel along the top has open feeder vessels, on the slack, plump, no tension on them. The vessel underneath is pulled, its feeder vessels are stretched, they could well be empty or nearly. The nerve itself is getting all sorts of oxygenation along its top side, but its bottom side is not. It stands to reason, at least to me, that an habitual posture will do this to any nerve at all, feed it on one side but not the other - of each nerve - until the danger signals start to overwhelm the system and something gives. In your case, you do not have pain (not yet anyway) but you certainly have adaptation. Which to me, is what the brain does in its initial stages of trying to cope with hypoxia in any of its tendrils. It fights to keep from having to give you "pain" and is busy downregulating for you.. right into "stiffness".

This is all fine, but one day you will move in a way that you didn't know you can't anymore, and your brain will get a BIG danger signal that will exceed its capacity to downregulate, depending on context. They you will have pain to deal with, perhaps in the back. You will go to see a therapist (hopefully one who has obsessed about the nervous system for years :)) and she will look at you standing, get you to stand on one leg, then the other, will note your body parts' relationship to each other, will maybe check one of your calves for a dint, just to make sure, then ask you, Anders, do you always sit with your right leg crossed over your left, never the other way? And you'll say what you just said above, whereupon the therapist will talk to you as I am just now, and show you pictures of nerves in the pelvis this could be affecting, in the low back, in the hips..

The thing is, it doesn't have to be a "big" nerve entrapped/hypoxic to make a big noise. Remember the "tipping point" danger signal in is usually not in any sort of proportion to the pain signal out. Remember also that sensory nerves are the first to signal hypoxic stress according to the Tunnel Syndrome (http://www.somasimple.com/forums/showpost.php?p=24914&postcount=14) book. Tunnel compromise does not require major changes in space to dramatically alter function.4 Inflammatory changes resulting in slight connective tissue thickening of tendon or nerve sheaths can compress a nerve or its vascular supply. Ischemic events initially affect sensory nerve fibers.5 If the ischemia continues, motor fibers begin to be damaged. Edema secondary to the hormonal changes associated with pregnancy, birth control pills, menopause, and hypothyroidism has been thought to cause tunnel compression. Dynamic changes of a tunnel during daily activity can create traction or compression of a nerve if slight anatomical variations exist. The variations become important because the nerve has restricted mobility between its origin and its course through the tunnel. Nerve damage ranges from temporary and reversible to complete loss of function with or without the chance of regeneration.34