Neural Mobilisations

Introduction

Neural mobilisations (also called neurodynamics or nerve gliding techniques) are physiotherapy techniques used to improve the movement and health of the nervous system.

Your nerves are not fixed cables. They are designed to slide, glide, stretch, and adapt as you move. When a nerve becomes irritated, compressed, or sensitised, this normal movement can be reduced, leading to pain, pins-and-needles, burning sensations, or weakness.

Neural mobilisation techniques gently and progressively restore normal nerve movement by guiding the nerve through specific positions. The goal is not to stretch the nerve aggressively, but to improve its ability to tolerate movement and load again, often used alongside back pain treatment where sciatica is present, or for nerve-related wrist and hand symptoms.

At Peak Physiotherapy in Mayville, we offer neural mobilisation to patients from The Moot, Wonderboom, Les Marais, and Rietfontein, as well as further afield across Pretoria, as part of a broader assessment and treatment plan.

Where Did Neural Mobilisation Originate?

The idea that nerves themselves could be a source of pain and movement restriction, not just a pathway carrying signals from elsewhere, developed gradually through the 20th century. Early foundational work came from researchers like Alf Breig, who studied the functional anatomy of nerve movement, and Gregory Grieve, whose 1970 paper is often credited as the first peer-reviewed publication specifically addressing this area.

The modern clinical approach was substantially developed and systematised by physiotherapists David Butler and Michael Shacklock through the late 1980s to mid-2000s. Butler's 1991 book, Mobilisation of the Nervous System, and Shacklock's 2005 text, Clinical Neurodynamics, remain foundational texts in how neurodynamics is taught and practised internationally today.

The specific distinction between "slider" and "tensioner" techniques, covered in more detail below, was formally analysed in research published by Michel Coppieters and David Butler in 2007, refining understanding of how these different movement patterns affect the nerve differently.

How Neural Mobilisation Works

Nerves are designed to tolerate movement, gliding smoothly relative to the surrounding tissue as you move your body through everyday activities. When a nerve becomes irritated, whether from compression, inflammation, or reduced movement following injury or surgery, it can become mechanically sensitive, meaning normal movement starts to provoke symptoms that wouldn't previously have caused any issue.

Neural mobilisation works by carefully and progressively reintroducing movement to the nerve and its surrounding structures, gradually improving its tolerance to mechanical load rather than trying to force a quick change.

Types of Neural Mobilisation Techniques

Neural mobilisation techniques fall into two broad categories, and the choice between them depends on your specific presentation and how sensitive the nerve currently is.

Sliders (gliding techniques) move the nerve relative to surrounding tissue without significantly increasing overall tension on the nerve. One end of the nerve pathway is lengthened while the other is shortened, creating a gliding motion. Sliders are generally gentler and often used earlier in treatment, or when a nerve is particularly irritable.

Tensioners apply a more direct stretch to the nerve by lengthening the nerve pathway at both ends simultaneously. This creates more tension through the nerve itself, and is generally introduced later in treatment, once the nerve tolerates movement well and a more direct loading approach is appropriate.

Your physiotherapist selects which approach, and how progressively to apply it, based on your assessment, not a fixed protocol applied to everyone.

Evidence & Research Support

Research on neural mobilisation generally supports its use for conditions involving nerve mechanosensitivity, such as cervical radiculopathy and sciatic nerve irritation, particularly when combined with broader exercise-based rehabilitation rather than used alone.

Systematic reviews have found that neural mobilisation can contribute to reduced pain and improved function in conditions like carpal tunnel syndrome and lumbar radiculopathy with sciatica, though study quality and technique application vary considerably across the research, making it difficult to draw firm conclusions about the size of the effect for any single condition.

As with other manual techniques, individual response varies significantly. Some patients notice a clear reduction in nerve-related symptoms within a few sessions; others need a longer, more gradual course. This is part of why neural mobilisation is applied as one component of a broader treatment plan, adjusted based on how your specific presentation responds, rather than a fixed course applied identically to everyone.

Benefits in Physiotherapy

When appropriate for your presentation, neural mobilisation offers several benefits within your broader treatment plan:

• Reduction of nerve-related pain: helps calm irritated nerves contributing to burning, shooting, or sharp pain
• Improved mobility and flexibility: restores normal nerve movement during daily and sporting activities
• Reduced pins-and-needles or numbness: improves nerve tolerance to different postures
• Better movement confidence: helps patients move without fear of triggering shooting symptoms
• Improved function: allows better participation in strengthening and exercise programmes

What to Expect During a Session

Neural mobilisation is applied as part of your broader physiotherapy session, following an assessment that identifies whether nerve irritation is genuinely contributing to your symptoms.

• Your physiotherapist will guide your limb or body through specific positions and movements designed to glide or tension the affected nerve
• You may feel mild symptom reproduction, such as tingling or a pulling sensation, which should stay controlled and tolerable throughout
• Movement is applied gently and progressively, never forced, and adjusted based on your response
• You'll often be given specific nerve-gliding exercises to continue safely at home between sessions

Conditions & Clinical Uses

Your physiotherapist in Pretoria, The Moot, or Mayville will always assess whether nerve-related symptoms are contributing to your pain. Common uses include:

How Neural Mobilisation Fits into Your Treatment Plan

Neural mobilisation on its own doesn't address the underlying cause of nerve irritation, whether that's a disc, a tight muscle, or reduced movement following surgery. That's why it's applied within a physiotherapy session that includes:

• A physical assessment to confirm whether nerve irritation is genuinely contributing to your symptoms
• Treatment of the underlying cause, such as joint mobilisations or dry needling where relevant
• Exercise prescription to build strength and control around the affected area
• Home nerve-gliding exercises to support progress between sessions

Neural mobilisation adds a specific tool for nerve-related symptoms. The rest of the session addresses everything else.