Neurological tightness is a common finding in the clinical setting. Depending on the circumstances, I, as a practitioner, have to make a clinical decision as to what treatment strategy is prudent: go at it and completely overhaul the nervous system, open up just a little, or leave it be.
I’m not quite sure what other practitioners do for cases of neurological tightness and how they assess it. In truth, I don’t think most practitioners have an assessment that specifically tests for it. When recently shadowing another medical professional’s session with a patient, I can say that they broadly classify compensations and neuromuscular “issues” in larger areas such as “slings,” but I’m not sure how they came to that conclusion. Further, the physical therapists working there “release” this tightness using percussion tools like shockwave therapy, Theraguns, and ill-cued eccentrics. It was just an observation, not a slight at the clinic or its therapists.
As a manual therapist specializing in the Functional Range System, I use a much more specific method of assessment and management of neurological tightness—my hands and my training. I use these tools to feel either how the tissue behaves under my hands or how the nervous system behaves under my hands. I am feeling for either mechanical tension or neurological tightness—normal behaviors or abnormal.
I have a case of a client who underwent a cervical fusion (x-ray image above). In the image, you can see there is a plate screwed into several segments of the cervical spine, rendering them immovable from here on out.
Because these four vertebrae have a screw in them and are attached to a plate, they are now a single “joint.” A simple analogy to think of is that the nervous system had 7 employees in the office and is now down to 3, and the nervous system needs to make adjustments to accommodate the new circumstances.
Now, as their therapist, I know that these segments will not move, and movement will occur above and below the neck hardware. I also know that when my fingertips are palpating the deep structures of the anterior neck (longus colli) and posterior neck (multifidus), I will find abnormal behaviors.
It is fascinating to feel the nervous system work. In that, I can feel the nervous system setting the boundaries of the cervical spine, learning and mapping the new “stuff” it has to work with. I can feel the neurological tightness engage at the new outer ranges of motion.
It is no longer the neck it had 60 years prior; it is a new neck with new constraints and limitations. As I move their neck through space, I can feel the boundaries and outer limits of the new spine. The nervous system setting the tightness to new ranges of motion, of which I am helping it map in-time by moving their neck and head and having them do the same motions actively. I am passively moving each segment of their spine in as many degrees of freedom as the nervous system allows and having the client replicate the same ranges on their own.
This case is a great example of when I would NOT get rid of neurological tightness and probably could not. The CNS is defining its new joints within itself. It is learning where it can and cannot go; the neurological tightness is the fence boundary.
It is important to recognize that we can push against the boundaries, but there are limits we must not exceed. My job is to make my own map of these and other boundaries and treat and train what I can within them. We can work within these boundaries, but the hardware, in this case, has set the limits.
Manual therapy treatments include improving joint and capsular workspace in the moving joints, using Functional Range Release to improve connective tissue architecture, improving the load-bearing capacity of the deep neck, and always being cognizant of our boundaries and limitations.
It is important to understand when, where, and why to intervene at the neurological level. Without a proper assessment, treatment, and training, this client may develop compensations that are mistakenly symptomized and treated with a percussion device, inadvertently decreasing the neurological tone just enough for them to get re-injured. We’ve all seen someone using the gun on their shoulders, pecs, and traps and then bench pressing. That tightness is there for a reason. Don’t tear the fence down without fully understanding why the fence is there in the first place (Chesterton’s Fence).