|
The Therapeutic
Value of Neural Manipulation |
Neural
Manipulation as developed by Jean-Pierre Barral, DO, MRO(F), PT and
Alain Croibier, DO, MRO(F) examines mechanical relationships between the
cranium/spine hard frame to the dural and neural elements. It provides
assessment and treatment approaches to address restrictions of the dural and
neural components not commonly focused on with musculoskeletal symptoms.
Neural Manipulation identifies and releases local nerve restrictions while
at the same time examines the effect these local fixations have on the rest
of the body, and by accessing this relationship, resolves the more
comprehensive (global) dysfunctional patterns.
A nerve only functions correctly when it is able to move feely within its
surrounding structures. The modality of Neural Manipulation facilitates
nerve conductivity and intraneural blood supply for local and systemic
responsiveness. By understanding the detailed anatomy of the neural
manipulation, one can clearly see the potential for pathological change when
nerves are restricted.
Manual therapy, as it applies to the treatment of nerves, follows the
standard principles of mobility and function. For optimal function nerves
must be able to move freely within its surroundings. This freedom of
movement is essential for:
• nerve conduction
• electromagnetic conduction
• intraneural blood supply
• intraneural nerve supply
• local and systemic responsiveness
Neural Fixation
When a nerve is fixed, it typically looses its ability to glide and/or
stretch in length. The intra- or peri-neural pressure dramatically
increases, at the same time there are changes in consistency. The nerve
pathway shows functional interferences (blood supply or electric and/or
electromagnetic conductivity).
With fixation smaller nerve sections can harden. They feel like buds and are
very sensitive or painful to the touch. Such "Nerve Buds" are an indication
of an intraneural interference, an overload of physiological pressure points
or a local fibrosis. Nerve buds can be released very quickly, sometimes
within one therapy session.
Palpation of the skin branches of peripheral nerves can be useful for
evaluative, as well for therapeutic considerations. When evaluating the skin
branches, if they are sensitive or painful to pressure, typically there is a
fixation of the deeper nerve branches.
Neural Manipulation and its Influence on Organs
Visceral Manipulation techniques can affect the movement apparatus and vice
versa. It is important to note that the release of sensitive nerve buds can
have a favorable effect on the functioning of the corresponding visceral
organs. Neural Manipulation is involved in all body functions and without
neural control certain visceral activity cannot be maintained. The
stimulation of nerves is processed centrally and reported back to the body
as feedback. This sequence of responses functions providing no interference
(fixation) is present.
Whether the structures involved include joints, fascia, viscera, brain and
peripheral nerves, or emotional centers, proper evaluation is essential for
good therapeutic results. The treatment of a normal nerve section (without
fixation) has no adverse effect, however a local nerve irritation can
result.
Generally, one thinks of a trauma as a severe injury that causes damage.
This definition encompasses different gradients of external forces acting on
the body. For example, not every joint trauma leads to a fracture or
dislocation, which is verifiable by x-ray. From a medical standpoint,
patients are often considered to be perfectly healthy, even though they are
not at all the same as they were before sustaining a trauma. The same is
generally true for the neural manipulation and the nerves. Traumatic nerve
lesions typically do not result in a recognizable, well defined, clinical
picture. Instead a broad spectrum of disturbances can be found. Because of
their inconsistency and lack of evidence (with conventional examination
methods and imaging procedures) symptoms are often overlooked.
Often functional nerve lesions develop after neurotropic diseases (like
herpes zoster) or as a result of posture imbalances. More frequently they
derive from mechanical forces and energies: friction, pressure (compression)
or traction forces (stretch), all of which affect the nerves. To bring about
lesions, a trauma does not have to be severe. Often, it is a matter of
repetitive micro-traumas. For example, a non-physiological movement, a
harmless sprain, faulty posture or muscle contractions. Pathological
processes can take place intra- and extraneurally.
Intraneurally the trauma affects distinct nerve structures:
• demyelination, neurinoma, hypoxia of certain fibers (in the conducting
nerve tissues),
• epineural scarring, perifascicular edema, fibrosis, irritation of the
arachnoid space or the dura mater (in the neural connective tissue).
These categories of pathology are rarely found in isolation. Clinically we
typically find several together. Extraneural disturbances are caused chiefly
by a narrowing of the spinal canal. Trauma can also impact the "nerve bud"
or a functional intersection of the nerve tissue. For example, a nerve or
epidural hematoma, an epineural tissue fixation, a dura adhesion in the
spinal canal, as well as pressure caused by bone or muscle swelling can
result.
Intra- and extraneural function disturbances often occur in tandem. In our
opinion, they are closely connected with a neural fixation dysfunction
and/or are even the cause of it. Our aim is to treat this kind of fixation
with manual techniques or at least to minimize their negative results.
How Does Neural Manipulation Help You?
With interferences in certain body zones, the respective spinal cord and/or
brain structures may also be irritated. A peripheral nerve treatment can
influence these so-called facilitated areas and therefore promote a common
or systemic effect. Manual treatments are basically effective due to the
mechanical effects that cause neural stimuli, which can be transmitted at a
local or central level. Manual neural manipulation changes intra- and
extraneural pressure, improves sympathetic function to blood vessels due to
the auto-innervation of the sympathetic gangli and sympathetic innervation
of peri-neural connective tissues both of which are affected with treatment
of fixations in the nerve sheaths.
How is Neural Manipulation Performed?
Treatment to nerves is through precise applied pressure. The tension of the
perineurium and all other neural connective tissues is transmitted down to
the root sheaths, so the distal contact has a central effect mechanically
and reflexogenically.
For more information regarding Neural Manipulation, how it can benefit your
patients, and training seminars, please go to
Barralinstitute.com.
Last revised: March 29, 2012
by Barbara LeVan, PT, BI-D
Barbara
LeVan, PT, BI-D is an alumni of the University of Maryland and was
awarded her degree in Physical therapy from the University of
Pittsburgh in 1977. She began her clinical work in a comprehensive
rehabilitation setting while acting as Clinical Field Instructor for
the University of Pittsburgh. She continued post graduate studies in
orthopaedic and manual therapy while working in sports clinics and
out-patient orthopaedic hospital based settings until opening her
private practice in Wilmington, Vermont in 1989. Barbara has
continued her clinical education through courses in varying
approaches to joint and soft tissue manipulation such as
Barral Visceral Manipulation, Neural Manipulation, New
Manual Articular Approach and Visceral Vascular
Manipulation. She has also studied Muscle Energy,
CranioSacral Therapy and Cranial Fluid Dynamics, Zero
Balancing, Spirituality and Healing, and Energy Mirrors. She
is a Barral Institute Diplomate and an Advanced Certified
Practitioner of Process Acupressure. Barbara became a
Teaching Assistant for Visceral Manipulation in 1993, then
joining the teaching team as a Visceral Manipulation Teacher
for the Barral Institute in 2006. She began teaching in the
Neural Manipulation curriculum for the Barral Institute in
2008. Barbara manages Physical Therapy Plus, LLC in
Wilmington, Vermont providing care to children and adults
utilizing a wholistic integrative model. 
