Physical Therapy

&  Wellness Center, Inc.

7800 Red Road. Suite 105. South Miami, FL 33143

Still having Neck, Back or radiating Pain?

Or all of the above?
You may be experiencing Neural Tension.

Nerve Mechanics or Neurodynamics

Nerve mechanics, also known as neurodynamics, is the study of the mechanical properties of nerves – how they stretch, move, glide, and cause pain as the body moves. Science has made some exciting leaps forward in this area in the last twenty years. Amazingly, this work is unknown to many doctors, physical therapists, fitness instructors, personal trainers and massage therapists. This is unfortunate because nerve mechanics are easily understandable and help explain and treat many painful conditions.

Nerves are built for movement

As you move around, nerves need to slide, bend, elongate and withstand compression to allow for pain free movement. Fortunately, they are very well adapted for this task.  What if we apply tension from both ends of a nerve at the same time? The nerve would simply have to elongate, stretching just like a bungee cord. During this process the nerve gets thinner.

Movement of the nerves is healthy

The movements of the nerves – bending, sliding, compressing and stretching – are completely normal and healthy under normal circumstances. In fact, proper nerve function depends on movement; alternating tension, compression and relaxation assist circulation and reduce the nerve’s inner viscosity. In other words, motion is lotion for the nerves, just as it is for all the other parts of the body. However, as you might have guessed, once the nerves become sensitive, moving can cause irritation and pain. In fact, many painful conditions that you may have thought were caused by a sore muscle or tendon, such as carpal tunnel, plantar fasciaitis, bursitis, tendonitis, radiating pain, a pulled hamstring,  etc., may actually be caused by sensitive, compressed or inflamed nerves.

Can I make my Sensitive Nerves stop Hurting?

Making sensitive nerves healthy again

Without getting into a bunch of complicated anatomy, discussing how to minimize tension or  properly slide certain nerves, here’s a general recipe for recovering pain free movement in any part of your body, including your nerves:  Move as much as you can in the direction of where you want to go without causing pain, wait for the body to make a favorable adaptation, and then try to move more next time. If you can keep this up, eventually you will recover your normal movement pain free.

Is Flexibility important?

Flexibility usually means the extent of a joint’s range of motion. In other words, flexibility describes how far you can move a joint – its range of motion from point A to point B.  It says nothing about the quality of movement between these two points. The quality of the movement is defined by other terms such as stiffness, speed, strength, mobility, accuracy and coordination. So how much flexibility is enough? Unless you are a dancer, martial artist or gymnast, chances are you have just enough flexibility suitable for your lifestyle. But isn’t more flexibility better, all things equal? Not really. More flexibility is not necessarily good, because it tends to reduce stability, which is very important. This doesn’t mean that tightness is always better, it just means that there exists a tradeoff between flexibility and stability.

What is Thoracic Outlet Syndrome?

Thoracic outlet syndrome (TOS) is a syndrome involving compression at the thoracic inlet, resulting from excess pressure placed on a neurovascular bundle passing between the anterior scalene and middle scalene muscles. But what is the thoracic inlet and the neurovascular bundle. The thoracic inlet is the space between the neck, clavicle (collar bone), upper chest and the upper shoulder. The neurovascular bundle in the shoulder is the bundle of arteries, veins, lymphatic tissue and nerves that innervates and supplies the upper limb, pass through the thoracic inlet.

How come I was diagnosed with TOS when I came to the Physical Therapy office with a complain of shoulder pain, arm weakness or numbness of my hand?

Symptoms of TOS may include neck pain, shoulder pain, arm pain, changed sensation and feeling in the neck or arms, numbness, muscle weakness, muscle atrophy (shrinking), heavy feeling in the arm, discoloration of the arm, swelling, and/or arm fatigue. Testing can determine that your symptoms are not associated to common orthopedic conditions like deficits of the rotator cuff, bursitis or tendonitis, but rather related to compression of the nerves and/or arteries that leads to TOS.

Can I alleviate the pain and loss of strength associated with TOS?

The answer is YES! Since, 95% of the cases are associated to compression of components of the brachial plexus nerves, you will be most likely be referred to Physical Therapy. Physical Therapy options for TOS, include a stretching and flexibility program and strengthening of the neck, shoulder, scapular stabilizers, arm, and core. Your physical therapist will teach you about proper posture, ergonomics and positioning at work, while driving, sleeping, and completing tasks at home. Relaxation techniques and breathing awareness can also promote pain relief. Very rarely does a bone anomaly needs to be repaired surgically. Medications are used to ease the pain and decrease the inflammation associated with the compression of the neurovascular bundle.

Let's learn more about the causes, classification and

diagnosis of Thoracic Outlet Syndrome.

Causes of Thoracic Outlet syndrome:

1. Congenital Abnormalities: including a rib originating from lower cervical spine vs. thoracic spine, prolonged transverse process of the cervical or thoracic vertebrae, muscular abnormalities  (e.g., in the scalenus anterior muscle, a sickle-shaped scalenus medius) or fibrous connective tissue anomalies.

2. Trauma: like whiplash injuries, repetitive strain to the area due to compression from overhead activities (i.e., lifting heavy weights at the gym) or compression from carrying heavy objects on the shoulder (i.e., heavy briefcase).

3. Rarer acquired causes include tumors, hyperostosis, and osteomyelitis (an infection to the bones around the thoracic inlet).

Classification of TOS

TOS can involve all three types of compression to various degrees. Neurogenic TOS includes disorders produced by compression of components of the brachial plexus nerves and it accounts for 95% of all cases. Isolated arterial TOS, caused by the compression of the subclavian artery or venous TOS, due to compression of the subclavian vein, are rare.

TOS can also be classified by the location of the obstruction:

1.  Anterior scalene syndrome (compression on brachial plexus and/or subclavian artery caused by scalene muscle growth or guarding) – diagnosed by using Adson's sign with patient's head turned outward.

2. Cervical rib syndrome (compression on brachial plexus and/or subclavian artery caused by bone growth at the lower cervical region) – diagnosed by using Adson's sign with patient's head turned inward.

3. Costoclavicular syndrome (narrowing between the clavicle and the first rib) – diagnosed with the costoclavicular maneuver. This, at times, may require surgical repair of the bone anomaly.

Diagnosis of  TOS

Orthopedic special tests/maneuvers: these can be performed by your doctor or physical therapists and are tests that you the neurovascular bundle in tension and you may experience changes in the pulse (being palpated by the examiner) and/or pain, numbness or tingling.
Doppler arteriography: may be performed to rule in vascular TOS.

Imaging scans like x-rays and special MRIs may be useful to study the skeletal structure and integrity of the brachial plexus.

                 But isn’t stretching a good way to prevent injury and pain?

Most movements in sports and life do not require any more flexibility than you already have. To make these movements more coordinated and pain free, work on improving quality of movement, not quantity.