At a recent The Eclectic Approach to IASTM in Quebec City, there was an interesting case.
I went over several modern manual therapy concepts such as
- rapid increases in ROM, function, or anything objectively measured are neurophysiologic changes
- lightly scraping skin changes the stretch perception, thus decreasing threat
- if someone has full ROM actively and passively to overpressure at end range with all joints tested in a neurodynamic test, you should be able to easily get full ROM after a short, non threatening treatment
It was this last point where I was demonstrating in class how to make someone with a limited and positive median neurodynamic test WNL rapidly. For those with a pre-test of limited/painful, or strong and uncomfortable paraesthesia, this was rapidly modulated with either
- light IASTM along the neural container
- wrapping an EDGE Mobility Band around the area with the most perception of stretch/discomfort
All but one participant of a 14 person class got rapid results. I asked her partner if he did the above two steps. He replied yes and I gave it a shot. My initial findings were
- very lax individual
- full ROM in shoulder ER, abduction, elbow extension, forearm supination, and wrist extension
- very limited wrist extension with median neurodynamic test, with painful paraesthesia at her available range (probably less than 10 degrees, also unable to get to her 20 degrees of elbow hyperextension with all components taken up
I initially tried light IASTM along the neural container, then wrapping both her upper and lower arms and re-testing. Both had no effect. With the above "rule" in mind, namely, having full ROM in all neurodynamic components, I knew she had to be a Rapid Responder. At the limit of her elbow and wrist extension, I backed off and started applying light IASTM in a distal to proximal direction along her forearm to modulate the perception of stretch. I progressed to end range elbow and wrist extension lightly during this time. After this short treatment, we re-tested the median neurodynamic test, and there was full and pain free movement!
Remember, to decrease threat perception, you need to change the perception of stretch during active/passive movement. Lightly stimulating skin during passive movement was enough to change this perception resulting in rapid improvements to a previously painful test. Try this next time normal IASTM and compression wrapping does not get the desired results.
Keeping it Eclectic....