Manual Therapy for the Peripheral Nerves

277 Pages·2007·14.76 MB·English

Manual Therapy for
the Peripheral Nerves
Every nerve must be free to act and do its part.
A.T. Still
Commissioning Editor: Sarena Wolfaard
Development Editors: Claire Wilson and Claire Bonnett
Project Manager: Anne Dickie
Designer: Sarah Russell
Illustration Manager: Merlyn Harvey
Illustrator: Hardlines
Manual Therapy for
the Peripheral Nerves
Jean-Pierre Barral
Osteopathe DO (UK)
Member of the Registre des Osteopathies de France
Diplomed from the European School of Osteopathy of Maidstone (UK)
Faculty of Medicine of Paris - North, Department of Manual Medicine and Osteopathy
Alain Croibier
Osteopathe DO, MRO (F)
Member of the Registre des Osteopathies de France
Member of the Academie d'Osteopathie de France
Lecturer in visceral manipulation and osteopathic diagnosis at the osteopathic college, A.T. Still Academy,
Lyon, France
Foreword by
Gail Wetzler
Registered Physical Therapist
Certified Visceral Manipulation and Neuro Manipulation Instructor
Director of the Visceral and Neuro Manipulation Curriculum
EDINBURGH LONDON NEW YORK OXFORD PHILADELPHIA ST LOUIS SYDNEY TORONTO 2007
CHURCHILL
LIVINGSTONE
ELSEVIER
An imprint of Elsevier Limited
2007, English translation - The Upledger Enterprises. Published by Elsevier
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2004, French edition - Elsevier SAS, Paris.
The right of Jean-Pierre Barral and Alain Croibier to be identified as authors of
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First published 2007
Reprinted 2008
ISBN: 978 0 4431 0307 0
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Notice
Neither the Publisher nor the Authors assume any responsibility for any loss
or injury and/or damage to persons or property arising out of or related to
any use of the material contained in this book. It is the responsibility of the
treating practitioner, relying on independent expertise and knowledge of the
patient, to determine the best treatment and method of application for the
patient.
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Contents
Acknowledgments xiii
Preface xv
Foreword xvii
1. Anatomy and physiology of the peripheral nervous system 1
1.1 Nerves of the peripheral nervous system 1
1.2 Spinal nerves 1
1.2.1 General 1
1.2.2 Typical structure 2
1.2.3 Nerve plexus 4
1.3 Innervation region of the nerves 6
1.3.1 Embryology of the peripheral nervous system 6
1.3.2 Sensory supply region - dermatomes 7
1.3.3 Motor supply region - myotomes 9
1.3.4 Neurovisceral supply region 10
1.4 Nerve fibers and nerve sheaths 10
1.4.1 Neurons 10
1.4.2 Peripheral nerve fibers 13
1.4.3 Nerve sheaths 13
1.4.4 Nerve fibers 15
1.5 Connective tissue structure of the peripheral nerves 19
1.5.1 Structure of a peripheral nerve 19
1.5.2 Classification of the connective tissue 19
1.5.3 Connective tissue ratio 22
1.6 Vessel supply 23
1.6.1 General structure 23
1.6.2 Nerve arteries 23
1.6.3 Nerve veins 25
Contents
1.7 Innervation 25
1.7.1 Nerve supply 25
1.7.2 Nervi nervorum 26
1.7.3 Sympathetic nerve fibers 26
1.8 Axonal transport 26
1.8.1 Nerve conduction 26
1.8.2 Physiology 27
1.8.3 Orthograde (orthodromic) axonal transport 27
1.8.4 Retrograde (antidromic) axonal transport 27
1.8.5 Importance of the myelination 28
2. Mechanical-functional interferences of the peripheral nerves 29
2.1 Mechanical characteristics 29
2.1.1 Resistance 29
2.1.2 Visco-resilience/viscoelasticity 29
2.2 Nerve damage classifications 29
2.2.1 Classification according to Seddon 30
2.2.2 Classification according to Sunderland 30
2.3 Traumatic lesions 30
2.3.1 Demyelination 31
2.3.2 Interruption of the axon continuity 31
2.4 Lesions through compression 31
2.4.1 Effects on the Schwann's cells 31
2.4.2 Effects on the axons 31
2.5 Bottleneck or compression syndromes 32
2.5.1 Definition 32
2.5.2 Etiology 32
2.5.3 Pathogenesis 33
2.5.4 Clinical picture 35
2.5.5 Electrophysiological examination 37
2.5.6 Complementary examinations 37
2.5.7 Therapy 37
3. Functional pathology of peripheral nerves 39
3.1 Functional neuropathology 39
vi 3.2 Connective tissue functions 40
Contents
3.2.1 Trophism 40
3.2.2 Mechanical and biochemical protection 40
3.2.3 Informative role 41
3.3 Nutrition and metabolism of the peripheral nerves 41
3.3.1 Metabolic requirements 41
3.3.2 Intraneural microvascularization 41
3.3.3 Effect of traumas on the vessels 43
3.4 Mechanical characteristics of the nerve tissue 45
3.4.1 Mechanical characteristics 45
3.4.2 Mechanical characteristics of peripheral nerves 47
3.4.3 Mechanical-functional balance of the nervous system 51
3.5 Neurophysiology 52
3.5.1 Basic substance (matrix) of the nerve cells 52
3.5.2 Proprioception 54
3.5.3 Nociception and pain 61
3.5.4 Visceral connections 62
3.6 Electromagnetic characteristics 63
3.6.1 Dualism of the nervous system 64
3.6.2 Lesion current and tissue repair 65
3.6.3 Role of the perineural system 66
3.7 Neuro-psycho-emotional connection 66
3.7.1 Information comparison 66
3.7.2 Storage of information 66
3.7.3 Case study 67
3.7.4 Nothing is forgotten 67
4. Treatment of the peripheral nerves - methods of treatment 69
4.1 Basic principles 69
4.2 Palpation 70
4.2.1 Nerves 70
4.2.2 Other structures 71
4.3 Manual evaluation 72
4.3.1 Palpation 72
4.3.2 Listening techniques 72
4.3.3 Mechanical function tests 73
4.3.4 Summary 74 vii
Contents
4.4 Effects of manual therapy 74
4.4.1 Basic rules 74
4.4.2 Effects on the nerves 75
4.4.3 Effect on the whole organism 77
4.5 Indications 80
4.5.1 For the nervous system 80
4.5.2 For the osteoarticular system (from nerve branches to one or more joints) 80
4.5.3 For the vascular system 80
4.5.4 For the visceral system 81
4.6 Contraindications 81
4.6.1 Contraindications and warning signals 81
4.6.2 Restrictions and exclusion criteria 81
4.6.3 Neuropathy 82
4.6.4 Shingles (herpes zoster) 84
4.7 Treatment techniques for peripheral nerves 85
4.7.1 Treatment rules 85
4.7.2 Skin branches of peripheral nerves 87
4.7.3 Reflexogenic hierarchy 87
4.7.4 Combined treatment 87
5. The cervical plexus and its branches 89
5.1 Cervical plexus 89
5.1.1 Anatomical overview 89
5.1.2 Treatment of the cervical plexus 92
5.2 Phrenic nerve 96
5.2.1 Anatomical overview 96
5.2.2 Treatment of the phrenic nerve 99
6. The brachial plexus and its branches 105
6.1 Brachial plexus 105
6.1.1 Anatomical overview 105
6.1.2 Compression sites 110
6.1.3 Treatment of the brachial plexus 111
6.2 Accessory nerve (Xlth cranial nerve) 119
6.2.1 Anatomical overview 120
6.2.2 Treatment of the accessory nerve 120
viii