Did you know nerves can be quite thick structures lying alongside muscles and tendons thorough the arms, legs and trunk? Over the weekend I will be lecturing and teaching my fellow physiotherapists about them for the Australian Physiotherapy Association. Treating nerves and the pains from them (neural mobilisation) is something that has interested me throughout my career, and the techniques were developed by Australian physiotherapists. ​

These ‘peripheral’ nerves are like flexible telescopes that can coil up, stretch out, slip, slide and change their shape to adapt to movement. Their internal make up and architecture allows this amazing flexibility and adaptability. So what can go wrong?
Nerves transport messages but also a variety of substances to muscles, joints, skin and every organ in the body. They can also be a source of pain themselves, just like any other body part. When their health is altered by injury, pressure, lack of oxygen or inflammation, they become less tolerant to flexing and sensitive to movement and pressure.

​This scenario is seen in some musculoskeletal problems, such as sciatic (back and leg) pain, nerve root problems,  carpal tunnel and tarsal tunnel. We can help by providing movement to unload or protect the nerve, relieve aggravation, progressing towards normal nerve sliding  and recovery.
​
Systematic Review Research findings have shown efficacy in this for plantar heel pain, neck and low back / sciatic pain [1-2]. Other benefits have been associated with these techniques, but more research will be needed.
 
What do these techniques do? Aside from relief of pain, effects on swelling, inflammation and tenderness, there is a benefit on flexibility. Often what is felt by people as muscle tightness is actually the muscle tensing to protect the sensitive nerve. This may be a good thing but may suggest an unhealthy nerve that requires careful handling and treatment. Laboratory research findings suggest there may be positive anti-inflammatory effects as well and this is undergoing more research.

Everyone moves to a different version of normal. Normal movements vary between us. If you are in pain, we recommend you consult with a physiotherapist or other health professional for guidance and recovery. This blog piece highlights research, stimulates thought, and does not replace consultation and treatment.

For many years the mantra “Lift from your knees and not your back” has never been questioned. This belief was largely based off research into low back disc pressure conducted in the 80’s in Scandinavia which concluded the safest way to lift anything was to maintain a neutral spine and use the strength of your lower limbs.  (Brox, 2018)

However, new light has been offered that contradicts the long-standing belief that lifting through your knees and keeping a straight back is always the right thing to do. The unlikely catalyst of this view arises from Scandinavian research into Lumberjacks (Brox, 2018).  

The back is “articulated hydraulic log” made up of strong parts, discs, joints, ligaments, muscles and bones. They are designed to stay nourished and strong with the right amount of movement. If we do too much, or do too little, you are out of the ‘Goldilocks’ zone and these parts aren’t so strong. Yes, age does have an effect as well, but that is another story, again exercise has benefits for us all here.

If you feel well and healthy about your back, lifting technique should be seen as not one, but many different and normal ways you can lift and decided by the effort to lift you think is required to do so.

Research into different lifting styles in people with disc-back-pain showed those given the option to bend their back in normal everyday activities including normal lifting did slightly better than a group with an operated fused back. Good news but why?

Guarding and stiffening up the back is a high load task, great for lifting weights, but not for simply picking something off the floor. This is because avoidance to relax and bend can lead to overloading the back components with unhealthy amounts of friction on our joints.  

Yes, it is important to consider that you need to keep heavy objects close to your body when lifting to reduce long levers, but maybe keeping a straight spine is not essential for lighter objects. And yes, more research is needed.

In late September I visited glorious Sydney and enjoyed, Wendy Whiteley’s Secret Garden, just north of the Harbour Bridge. I also went to attend the annual scientific meeting of the Australian & New Zealand Academy of Orofacial Pain (ANZAOP). This group of health professionals and scientists meet annually, and this year research was presented on muscles and jaw pain. This included Oral Medicine Specialist Professor Daniele Manfredini from Università degli Studi di Siena (unisi.it), with a wealth of knowledge in this area.

Daytime clenching is common, and this includes bracing the jaw, not necessarily with tooth contact. This habit is a source of muscular pain that may over load the teeth, causing excessive wear, overwork the muscles, causing headache and neck pain. The temporomandibular joint can also be overloaded causing pain, clicking or locking.

Reviewing the research, the best approaches are combined ones, based on individual assessment findings. This includes:

• Physiotherapy (as effective as Botox) in pain relief and mouth opening distance. (Guarda-Nardini et al., 2012)
• Education to control and limit day time bracing. Set your self a reminder or use an app.
• Medication as needed. Masking the pain is good as it unmasks faulty muscle patterns and allows retraining to take place.
• Psychology and counselling
• Botox, where needed. This remains controversial in the research arena.

​The take home? Be aware of how you hold your jaw, or brace it during the day. This is a powerful tool to get relief and to retrain the chewing muscles of the jaw. With education, you can become your own physiotherapist.

…..One more take home. My case presentation was received and met the requirements to become a ANZAOP member. Good to be involved!

Have a great weekend.

Jayce Gilbert