Friday 10. December 2010

Active Release Techniques – median nerve treatment method

Introduction

There are many different peripheral nerve treatment methods. The technique I am about to describe, is working remarkably better than any other method I’ve tried. Active Release Techniques (ART) is a manual soft tissue method that involves precision in touch, movement and function. Before looking deeper into this subject, some background information is needed.

Active Release Techniques

ART: encourages structural gliding through nerve receptors and longitudinal muscle fibers, breaks down adhesions by intervening in the repetitive injury cycle, releases peripheral nerve entrapments by using specific patient movements and manual tension at the correct cause.

ART-therapists

In order to perform this technique (ART), the practitioner needs to be a licensed ART-upper extremity practitioner. In order to become an ART-therapist, the practitioner needs to have mal-practice insurance. In general, all medical professions working in a private clinic needs to have these insurances in order to be certified to work with patients. Examples of medical professions; chiropractors, physiotherapists, manual therapist, osteopaths, sports med’s., GP’s etc. After the practitioner has completed the 3 basic modules, Upper extremity, Lower extremity and Spine, he or she is licensed as Full Body. The ART-therapist needs to re-cert every year in order to maintain the title.

Recognized as a manual treatment method

ART is recognized by OSHA and the department of labor as a wellness, prevention, or first aid measure. These course modules also provides practitioner with continued graduation credits for chiropractors and manual therapists.

Study

Results: Increase in hamstring flexibility was significantly greater in the dynamic STM group than either the control or classic STM groups with mean (standard deviation) increase in degrees in the HFA measures of 4.7 (4.8), 20.04 (4.8), and 1.3 (3.8), respectively.

Dynamic soft tissue mobilisation increases hamstringflexibility in healthy male subjects. D Hopper, S Deacon, S Das, A Jain, D Riddell, T Hall, K Briffa

Br J Sports Med 2005;39:594–598. doi: 10.1136/bjsm.2004.011981

ART is a method that works with the same principle as the method used in this study. Differences: ART is more specifically directed in the structure(s) involved and the movements performed are active throughout the whole range of motion.

Why ART vs surgical interventions for median nerve entrapments

I am convinced that establishing freedom of nerve gildings by non-surgical means is absolutely the best option for the patient, environment and the society. Therefore I encourage the means of Active Release Techniques in patients present with median nerve entrapments, often misdiagnosed and described as carpal tunnel syndrome.

When the ART-therapist conducts the diagnostic session, he or she is able to determine where the median nerve is pinched. The median nerve can be pinched by several causes, but the most common is by active structures and/or adhesions. It is of high importance that the ART-therapist knows the history of the complaints. Patients where symptoms have gradually set and increased are much more common that acute conditions. Already now, we know that it is more likely that the compression is caused by active structures. The median nerve travels from the neck and all the way out to your fingers. On this pathway, the nerve is guided through 5 structural tunnels. Patients with carpal tunnel symptoms usually have a compression of the median nerve at one or more of these tunnels.

When the ART-therapist has concluded with his or her findings, the treatment session begins. The patient is carefully instructed in what to expect from the treatment session. Before manually releasing the pinched peripheral nerve, the patient is instructed in movement patterns and body positioning. Related muscles, tendons and / or ligaments are treated before releasing the nerve at the entrapment site. It takes at least 3 – 5 repetitions on each area of the structure that needs to be treated. Patients can expect results within the 5 first treatments sessions.

The median nerve is usually pinched by the pronator teres muscle (an active structure), not the transverse carpal ligament. This is a strong, two-headed muscle that twists your forearms inwards. The median nerve runs in between the two heads.

ART treatments are combined with exercises that needs to be carried out with precision. The exercises aim at restoring optimal function by encouraging gildings of the muscle fibers through dynamic stretching in specific orders, combined with dynamic nerve gliding movements.

Prevention

It is very important that the ART-therapist makes sure that the patient is instructed in ways to prevent symptoms to re-establish. The reason for that the nerve gets pinched, causing the symptoms, are mostly due to simultaneous loading / usage of structures involved over a longer period of time (repetitive cycle).