Neural Tension Vs. Muscle Strain

5/26/2015

For this week's post, I'd like to pose more of a question or consideration, instead of the usual content. As many of you know, I have written about cases several times in the past about examining and treating chronic "strains." In the outpatient setting, odds are you will frequently be presented with cases where the patient reports straining a muscle months/years ago and never fully recovering. In prolonged cases like these, the connective tissue typically has healed, or at least should no longer be responsible for the pain. At this point, the nervous system is typically the culprit for any remaining pain/limitation. This can be examined and treated with any of the techniques usually utilized for the neuromuscular system.

While this can readily be applied in patient presenting with chronic strains, I have recently been wondering if it is applicable to those with more acute injuries as well. With pain being a perception in the manifestation of the nervous system, should we expect there to be a significant difference in the acute setting. I'm not sure. I rarely am presented with patients complaining of an acute strain. Typically, people get hurt, then rest until it is better, or at least do some form of self-management. Occasionally, I have people come in for a free screen, where I do an assessment and provide a little treatment, along with my recommendation on how to manage the injury. I have had a few people come in with strain presentations, but show some improvement with repeated motions. Unfortunately, these clients don't typically follow-up, but there is still an improvement on display. I also often wonder how this could potentially apply to someone "risk" for a strain. If someone has a lot of neural tension limiting mobility, would a repeated motion or nerve glides decrease that risk? What are your thoughts and experiences on this?

-Chris

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Mini-Case: The Questionable Calf Strain

Self-Management of Sciatic Nerve Pain

3 Comments

Robbie Horstman

5/27/2015 08:41:23 am

Hey Chris -

I talked to you on the phone about this one a while ago. Back last November when I started training for Boston I was having a lot of calf tightness that was rather diffuse. Additionally, my gastroc was significantly tender to the touch and apparently hypertonic. After about 3 weeks of dealing with it, I finally did what I would do if I were assessing a patient and looked at my lumbar spine, finding R sideglide to be significantly limited vs. the L. I started with repeated R side glides in standing (R sided complaint). The first day, I was able to run painfree for the first time in weeks - I had to keep performing them 3-5x per day for the next two weeks or so, but was able to wean off. For good measure, I also threw in some press ups and some R road kill press ups after the sideglides. I think this example is exactly in line with what you're talking about - a relatively acute issue that presents in some ways like a muscle strain.

Mary Kimberlin

5/30/2015 02:58:32 am

Do you know anybody in Dallas trained in this?

keith mccarroll link

5/30/2015 09:25:15 am

I was taking the Explain Pain course from Bob Johnson earlier this month and the patient he presented was having left sided back pain and sciatica type symptoms. Initially the pt said he had no previous issues, but when Bob dug deeper the guy had had some left cervical shoulder stuff and i believe left knee. Nothing serious but stuff that kind of came and went. Afterward Bob talked about that this pt's nervous system had been "bubbling up" for a while on the left side and presented as a left sided lumbar situation because of sustained flexion (patient driving long distances for work) rotation (1st rounds of golf for the season) and psychosocial stresses mixed in. Maybe looking at those other parts of the history deeper would help, especially if the "strain" doesn't have a typical muscle pull presentation. He theorized that many people have a sensitized nervous system that kind of gives people these minor come and go things until it was mixed with bigger physical and/or biopsychosocial issues and then something would come but no go as easily.

I would think if this is the case, and the presentation is not typical explosive muscle strain, and some of those history things that might not seem directly related are there, treating it from a neural standpoint may prevent an acute issue from lingering to long.

Neural Tension Vs. Muscle Strain

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