Reviews

Nerve Mobilization with Doug Alexander

Reviewed by Andrew Lewarne

This DVD is a must-have for anyone that is serious about any type of manual therapy including massage therapy. It takes you on a no nonsense journey that supplies the anatomy of potential neural dysfunction and treatment techniques for the rehabilitation of that dysfunction. Doug has supplied the map for the upper limb but practitioners will have no difficulty extrapolating from that and applying these techniques wherever they suspect neural entrapment.

I applied the assessment and techniques the same day I viewed the video and with a remarkably good results. There are good reasons for the efficacy of these techniques. First and foremost they are presented in a fashion that allows them to be incorporated within a treatment such that you can assess, treat and reassess without breaking the flow of the work.

 An example in which these assessment and treatment techniques were particularly useful occurred with a new client 3 days ago. She had been preparing for her daughter’s wedding and was concerned about her weight and so hopped on the treadmill with a set of 8lb hand weights. She sensed this might not be the best idea, but had a momentary lapse in judgment. She woke up the next day with left sided numbness in her thumb, pain in her forearm and pain in the lateral upper arm and underneath the shoulder blade. I performed standard assessment including range of motion of the shoulder, neck, glenohumeral joint, elbow and wrist with all the accompanying special tests i.e. Adson’s, Wright’s, etc. These testing protocols gave a general idea of specific structures to treat yet the all too common problem remained; the client will not allow themselves to release enough for truly passive movement testing. Because of this, the exact origin of the pain and/or discomfort is often difficult to assess. The client activates their muscles (even a little bit) and it changes the results just enough for “Location” to be compromised.

The overall direction for the treatment was clear so I decided to wait and apply the tension tests within the treatment. This allowed for me to treat the posterior areas of concern as well as getting her used to my touch. I feel that this allowed the client to build trust and afforded me an opportunity to demonstrate when and where she was holding tension without being aware of the fact.

 By the time we moved to the anterior structures she was ready to allow passive movements to be truly passive, which in turn meant that I could more accurately determine the compromising structures. The combination or stacking of positions that occurs in the Nerve Mobilization assessment protocol showed me that compression occurred in the scalene triangle (no surprise here) and that the Pectoralis Minor was also involved (again no surprise). What did come as surprise was that the strongest reaction came with the compression through the Pronator Teres via supination of the wrist and elbow. This allowed me to identify and treat the most significant muscle as far as the median nerve was concerned!

One of the aspects of these techniques that I appreciate the most is that they can be mixed and matched once you understand the basics of nerve and muscle anatomy along with the action of the various muscles. It is not hard to begin to grade the various structures you are testing i.e. maintaining nerve traction and then reducing the number of stretches to identify which is the most provocative. In other words you can re-check in the opposite direction from your initial testing which allows for a full circle effect in your treatment. I finished my initial set of techniques with a gentle sustained traction of the median nerve.

I spend a lot of time in my practice educating clients and I found it easy to explain the why’s and where for’s of what I was doing. In my experience this always helps because the client becomes engaged in the process. This is often the first time they have been an active and informed participant in their own healthcare.

There are also various spin-off benefits. For example, it is impossible to explain what a lymphatic technique is without going into the role of the lymphatics in our overall health. Most clients have only heard of the lymphatics in combination with “Toxins”, “Cancer”, and “Surgery”. “Lymphatic” is an often confusing and scary term for people, whereas the technique is both calming and soothing. I found the use of such techniques as milking (which was new to me) and nodal pumping supplied an effective and enjoyable alternative to standard fold and hold and dragging techniques.

  Doug also makes the point that you can’t rush assessment and treatment. This is a point that I believe needs to be heard. Too many therapists have told me that they don’t get results fast enough and so they refer out and lose the opportunity to see a treatment plan through to its logical conclusion. There is an old saying in Tai Chi, “It takes 20 years to learn Tai Chi, 25 to learn it quickly.” The same applies to treatment!

I found the glide techniques were an interesting addition especially the reminder work shown for the Radial-Ulnar joint (often over looked in tennis elbow presentations). The work that was demonstrated through the Tunnel of Guyon reminded me very much of the work taught to me by a couple of osteopaths. Indeed, I find that the use of osteopathic listening technique combined with a gentle compression, followed by gentle traction (what the osteopaths call a “decompression”) allows for effective tissue release. In the case of the techniques demonstrated on the DVD, the anchor and gentle bowing techniques achieve very much the same result.

It is not a great leap to see that these techniques and assessments could very easily be applied with active and resisted movements to resolve issues of scar tissue entrapments. Include the addition of hydrotherapy and you have a very valuable set of tools for a wide variety of clientele

My only critique, and it is a small one, is that Doug occasionally lets his voice slip into that therapeutic range that, while soothing, does lull the listener so that some meaning can be lost.

All in all I think this is a valuable addition to any practitioner’s library.

Andrew Lewarne: Registered Massage Therapist, National Strength and Conditioning Association Certified Personal Trainer, Former Examinations Officer of the College of Massage Therapists of Ontario. Andrew works at The Body Wise in Toronto. Click on web site link below to contact him:

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