‘Neurological tightness’ vs. ‘Mechanical tension’: an important distinction for soft tissue management
In the past few weeks we have been focusing on using assessment skills to determine not only the location of the pathology, but also to better define the lesion in order that we are able to select the treatment tool/modality most appropriate to achieve our goal (of course the goal is defined by the aberrant histology present).
The video below show a case of a 23-year old elite hockey player who presented 1.5 months after a second reconstruction surgery for his chronic anterior dislocations (BTW – for those following me on twitter, this is the case that I have been consistently updating you on with video analysis and pictures – @DrAndreoSpina) Due to the condition of the capsule after he tore through the original repair, the surgeon decided to use a cadaveric achilles tendon (allograft) to reinforce the capsule. As the patient was still in the US shortly after surgery, he began ‘standard’ rehabilitation procedures with a therapist for the first 1.5 month which included the standard modalities, soft tissue “release” which, as per the patient, lead to no improvement in ROM. Before starting I had a lengthy discussing with the surgeon who confirmed that ROM had not improved and that at the end of the 2-3 months I have with him (before he goes back to school) he doesn’t expect any significant 
ROM improvements.
As you can see in the figure which demonstrates 0-5 days of progressive adaptation (in flexion only)…my prognosis is much more ‘inspired’ than the surgeons. What is important to note is NOT simply the improved ROM (which is ACTIVE btw…I care very little for passive/useless ranges), rather that is was done thus far USING ABSOLUTELY NO SOFT TISSUE RELEASE/THERAPY or MOBILIZATION. This progression what via the utilization of PAILs & RAILs rehab only. Why the decision to exclude soft tissue and/or mobilizations to this point…watch the video for the answers.
BTW – Differentiating Neurological tightness vs. Mechanical tension is one of the main focus at the F.R. Release® seminars (and the concept is elaborated on greatly).
Take home points:
1. If you cannot achieve an end range of motion, you must decide what the barrier is…nervous system guarding, or actual fibrotic development.
2. Once number one is determined, only then can the appropriate tool be selected for the job.
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interesting post Dr Spina. It certainly got me thinking cos in college we only learned abt muscle guarding and if we follow the massage therapists’ approach it’s something like break the adhesions or wait for the tightness to melt… If you had not mentioned the role of the nervous system, my automatic reaction would be to break the adhesions or try something like MET/PIR and let the GTO reset…
Can you please share some literature/ sources where I can read further abt the role of nervous system in perpetuating/causing this phenomenon
Thank you.
Thanks for the feedback/comment
Unfortunately there isn’t the ONE article that will lead you to this conclusion…it is a combination of histological/physiological research combined with lots….and lots of clinical trial and error. I have made the mistake of attacking cases such as this one with soft tissue work prematurely and have made mental note of the inability to alter the muscular tone. However when using techniques to ‘access’ the nervous system, the results were much, much more efficient (which is then followed up by using FR release to deal with the mechanical components). Through my experience, there is usually a neurological component, and a mechanical component to each condition…all that changes is the ratio of each. If one component is dealt with but not the other = incomplete resolution/chronicity/recurrence, etc.
Try this paper to start…hopefully you can follow their literature trail (references) to the same conclusion:
“Gradual increment/decrement of isometric force modulates soleus stretch
reflex response in humans” by Kimura et al in Neuroscience Letters 347 (2003) 25–28.
‘Neurological stiffness is palpated during muscle relaxed status; while mechanical stiffness
can only be palpated during muscle activated.’
It would be more clear and simple if only palpate the muscle when it is at rest. When muscle activated by the nerve, nothing can be palpated except scars which is nothing the physician can do [except butchers instead of trained medical professionals. ]
Do not chase the muscle tightness/stiffness, go with the nerve!
Do not chase the pain, go with the nerve!
simple is the beauty.
Jerry Nie, RMT.
Hi Jerry
There are various problems with this comment…
1. The point of the post is that static palpation only provides information regarding the neurological status of the system….passive movement assessment is therefore needed in order to discover aberrant fibrosis. There are usually two problems for each ‘condition’ …a neurological one, and a mechanical one.
2. Scars??? “nothing can be palpated except scars which is nothing the physician can do [except butchers instead of trained medical professionals. ]”…I don’t know where to begin here. The MAIN GOAL of soft tissue application historically has been focused on the removal of aberrant fibrosis restricting relative tissue motion. To say that there is “nothing the physician can do” contradicts thousands of years of soft tissue work…teachings from any and all educational institutions…and research.
3. “Neurological stiffness is palpated during muscle relaxed status”…true, however then you say “Do not chase the muscle tightness/stiffness, go with the nerve”…so are you massaging nerves???
4. Nothing is simple unless it is oversimplified
Hi DrAndreo,
when I post the comment, my mind preoccupied by those practice that focus on ‘break the scar tissue’ which is popular. my observation and learning just showed me the opposite – focus on the ‘functioning’ muscles which innervated by inhabited nerves – I think that is what you actually teach us. I would massage the ‘scar’ only for metabolic reason.
The clinic example is to treat the rotator cuff when external rotation ROM reduced and cause pain; some ‘traditional’ physicians use friction,strech and ‘deep tissue’ on the anterior of G-H joint to ‘break the scar’; my approach is to stimulated the suprascapular nerve and the infraspinous nerve by acupuncture or manually massage related tissue to stimulate the nerve – this explains what ‘chasing the nerve’ means. This approach is much gentle, effective and ‘functional’ – closer to what you do.
I manipulated the tissue, is aimed on the nerve, and the nerve will innervate the tissue.
Finally, I do massage nerves: over the body and don’t know how to avoid them; actually every tissue manipulation, joint movement is some kind of the nerve manipulation. isn’t it interesting?
thanks.
jerry nie , RMT
Hi Jerry
Although I see your point….the point of my post was that there are usually 2 components to every condition, a neurological one, and a mechanical one (the latter is often caused by the first, but not always). With the approached that you discuss, you will be missing a significant component of each condition.
My general point is that practitioners must select the appropriate tool for the job. To say that “I always use this or that” indicates that their decision making process is unaffected by their assessment findings. Thus the histology of the condition is not considered…and thus treatment selection is always the same. The appropriate tool for the appropriate job is always the best approach.
Hi, Dr.Andreo:
I got your point too. Thank you for remind me to be thorough. This topic is done, let’s move to the next one:
what are the difference among those ‘catching’?
1.Trigenics – Functional Neurology
2.Neuromodulation
3.Functioning Anatomy /Functioning Release ?
Thanks
jerry nie, RMT
Hi Jerry…as always thanks for your questions and comments
I am not sure that I understand this question however…are you asking what the difference is between these methods?
Hi Jerry
I can’t really speak for the other two techniques as I have not had enough exposure to either of them. I can say however that one of the main things that sets the Functional Range Release system apart is that it is a complete system whereby certified practitioners learn various techniques of assessment, treatment, rehabilitation, and conditioning. We pride ourselves on having developed a complete curriculum for manual care.
thanks Dr.Andreo, manual work is diversified and best wish for you. any palpation book you think is valuable for experienced practitioners?
Hi Jerry
I don’t know that I feel any palpation book that I have seen to be particularly useful…This is one of the reasons I began to teach palpation in seminars. As an aside, I find that the more experienced the practitioner…the more they require a refresher seminar in palpation!!