Calming therapeutic neuroscience narrative 2. “Zings and zaps from nerves”.
There are many odd pains and sensations that people experience where the strangeness may evoke more stress and maybe even more pain. A fairly common one is where damaged peripheral nerves “fire” at odd times. This is a feature of abnormal impulse generation in nerves, researched extensively by Patrick Wall, Marshall Devor and colleagues.
It seems to happen when a nerve is mechanically stretched or pinched though not every time, which makes it more stressful when it happens. A common one is when a person puts their neck back and they get a shock like zing. Sometimes people get a zap in the front of their hip when they walk and clinicians who examine the physical health of nerves in patients will be aware of the occasional sharp zings when they perform assessment techniques such as a Straight Leg Raise or Upper Limb Neurodynamic Test.
No one likes zings and zaps and if it happens a few times, it is only natural that the person will avoid that movement and change their posture. In most cases, zings and zaps are not serious indicators of disease or serious trauma and with some explanation and some exercise of neighbouring tissues, the zings and zaps may well just go.
“It’s just your body reporting in” may help some.
David Butler
Friday, January 11, 2008
In the early days of neurodynamics, we devised techniques called sliders and tensioners. This was based on the principle that the nervous system is a mechanically continuous structure throughout the body and a clinical search for non-aggressive neural mobilising techniques.
Fig 14.5 From Butler DS 2000 The Sensitive Nervous System, Noigroup, Adelaide
A tensioner is when the nervous system is pulled from both ends. For example, in the slump test, when neck flexion and knee extension, both of which physically load neural tissues are performed together, we refer to this as a tensioner, (i.e. “pulling from both ends”). If the knee is extended and the neck extended at the same time, we refer to this as a slider. The slider is much less aggressive technique. Some people refer to the slider technique as “flossing” as in dental flossing.
Michel Coppieters and I published a paper on this in Manual Therapy, titled- “Do sliders slide and tensioners tension?”. This upper limb cadaveric study on the median and ulnar nerves showed that a slider technique (eg elbow extension with wrist flexion) created much more nerve sliding than a tensioner technique and in comparison, hardly strained the nerves. The suggestion is that mobilising techniques for neuropathic pain states involving peripheral nerves can be made more specific. The gentle but marked sliding of nerves may be extremely therapeutic in aiding early restoration of nerve gliding surfaces and pathways post trauma, and assisting dispersal of inflammatory exudate in gliding pathways.
David Butler
Wednesday, August 15, 2007
For today’s Flashback Friday, I thought these two posts worked nicely together and provided a reminder that the brain, while rightly the focus of a lot of current pain research, is but part of a larger, complex and dynamic system; a system that is mechanically continuous and slides, glides, moves and stretches as we do.
Like so many others, I was introduced to the idea of slippery, sliding nerves, up-regualtion of mechano- and adreno- sensitive ion channels, Abnormal Impulse Generating Sites (AIGSs) and zings and zaps by reading The Sensitive Nervous System by David Butler. The book provided explanations, stories and metaphors for previously unexplainable phenomena and introduced me to the idea of therapeutic narrative with some “neuroscience nuggets”. There was also the most detailed explanation of this idea of mobilising the nervous system within a modern pain science framework. Recently a post at the Student Physio blog asked the question “What 3 books, papers or articles would you recommend every student physiotherapist should read?” and The Sensitive Nervous System was one of these (along with Explain Pain).
The ideas in these posts; neuroscience education, de-threatening pain experiences (especially the weird ones) and healthy movement with an eye to sliding and gliding our nervous system, as relevant today as when they were originally shared six years ago, embody much of the key essence of NOI of seeding ‘healthy notions of self through neuroscience knowledge’ underpinned by critical conceptual change issues including “Injury or disease does not mean that you feel pain”, “the nervous system moves and stretches as we move” and “knowledge and movement are the greatest pain and stress liberators.”
Seen anyone with zingy, zappy nerves lately? Are you using any nervous system mobilising techniques? Let us know in the comments.
– Tim Cocks
Coppieters MW, Butler DS (2007). Do ‘sliders’ slide and ‘tensioners’ tension? An analysis of neurodynamic techniques and considerations regarding their application. Manual Therapy; 13(3): 213–221.
Useful Links
Bodily Relearning, Boyd BS
Neurodynamic techniques Handbook & Videos, Butler DS
The Sensitive Nervous System, Butler DS
Noigroup courses cover neuroscience education, neurodynamics, mobilisation of the nervous system and more. Check out the course schedule for a date and location near you.
Nice flashback Tim – thanks.
This flashback prompts a few thoughts:
It makes me aware of how trendy the brain is as a research target. Very few groups now research the peripheral nervous system. We really don’t know much for example about dorsal root ganglia – the “minibrains” of the nervous system.
The post brings up the important and often forgotten principle of the “physicality of the pain mechanism”. For example nociception is clearly tied up with physical issues in the tissues at the nerve ends, the peripheral nervous system is a highly complex mechanical structure from the sliding of myelin wrapping,, neurones bending and folding to complex brachial plexus mechanics. The central nervous system is also a very physical structure – cord neurones fold, CSF must move for optimal CNS cell nutrition, dura is incredibly strong – but more on that in forthcoming blogs.
Overall, while movement is frequently linked to symptoms, movement is like any other brain output – in the right context, it can be transformative as well.
David
I agree David that we must not, indeed cannot ignore “The issues in the tissues” where all is focused on the brain. Otherwise we are slipping back to key whole vision and not embracing the whole picture. In this generation of “Hands Off” philosophies the vehicle of the brain, the body is being neglected……Whether our neurodynamic techniques are bringing about physical and/or representational changes is irrelevant. The importance is whether the brain, or better said consciousness is convinced. Hence the importance of a smile and a colourful shirt ………Let’s continue adding to and drawing on our growing knowledge and not fall into the trap of disgarding old toys for new…..