← All articles
Nervous system & health
How I work with your concern: dysfunction, a solution and integration
You raise your arm – and the movement feels effortful, unsteady or painful. How do I approach this? In my work with Angewandte Neurofunktion, I start with what you find difficult in everyday life. From there, I look for a function that may be involved, test a suitable solution, integrate the connection we have found and then compare your movement again. A possible shoulder example makes this process easier to understand.
1. Identify a dysfunction, test a solution, integrate
First, you show me your arm movement. How far can you move? Where does it become effortful? When does pain occur? We establish the starting point so that we can compare the same task later.
Several functions need to work together for a movement. Joints allow and guide the movement, muscles regulate force, and sensory receptors report position, stretch and tension. The nervous system coordinates these tasks.
What does functional impairment mean here?A function is something your body does: for example, contracting a muscle, coordinating a movement or directing your gaze towards a target. In this context, a functional impairment means that a particular function, or the way functions work together, is impaired under certain conditions.
The condition of a structure and how well it functions are related questions. Even if an existing finding does not adequately explain your symptoms, I look for a functional connection that we can follow. We take existing medical findings and treatments into account.
To do this, we break the difficult movement down into individual aspects. Which information involved in the movement might contribute to what you have noticed? The choice of an assessment follows from your concern and the results so far.
In some assessment pathways, I use an indicator muscle as a test indicator. You hold a defined position against resistance that I adjust to you. First, I check that its initial response is stable. The indicator muscle does not have to be near the painful shoulder: it helps me test a functional connection relevant to your concern.
In this possible example, I reproduce a skin stretch at the shoulder. Its direction comes from your arm movement: when you raise your arm through the restricted movement, the skin is pulled in that particular direction. By gently shifting the skin, we therefore test information that actually arises during the movement you find difficult.
Suppose the previously stable indicator muscle repeatedly gives way after this stimulus, but holds steadily without it. Within the functional assessment pathway being used, I describe this reproducible abnormal response as a dysfunction of the connection being tested. Next, I look for additional information that allows the muscle to hold steadily again despite the skin stimulus.
In our example, contact at the upper neck helps. The original skin stimulus stays the same for comparison; with the solution contact, the indicator muscle holds steadily again. We have now found a working combination that we can use for the next step.
What does integration mean?In my working model, I describe integration as “storing” the functioning connection we have found within the network. Afterwards, the additional solution should no longer be needed. There are different integration pathways; I select a suitable pathway and integration stimulus for the individual.
After integration, I apply the same skin stimulus again – without the additional solution contact. I test the same indicator muscle under the original conditions. In this example, it now continues to hold steadily.
Then you raise your arm again. Is the movement easier or can you move further? What changes in effort and pain? Through the indicator muscle, we have followed a connection that may be relevant to raising your arm. By returning to your original movement, we check how working with that connection affects your concern.
2. What may be involved in raising your arm
The skin stimulus is one possible factor. Depending on your concern, I also consider tendons, joints and muscle activation. These aspects help us ask a more precise question and choose suitable assessments.
Skin: It moves and stretches as you raise your arm. It is a large sensory organ and supplies information about touch and mechanical changes. A scar may also be relevant in this context. In the assessment pathway shown here, I gently reproduce the direction of pull from the restricted movement and compare the holding response.
Tendons: They transmit muscle force to the bone. Receptors at the muscle–tendon junction report tension back to the nervous system. Depending on the question, I also include tendon reflexes. Another possible example: after eliciting the biceps tendon reflex, a previously stable indicator muscle in the leg repeatedly gives way. We then follow this unusual connection further and look for a suitable solution.
Joints: Their position and mobility influence how the arm can be guided. The joint capsule and ligaments also provide sensory feedback, particularly at the limits of movement. I assess the role of this information in relation to the specific restriction.
Muscle activation: Can the muscles involved activate appropriately, regulate their force and work together? Movement requires these tasks to be coordinated. The assessment focuses on where this coordination appears to be difficult.
Your concern and the responses so far determine which factor I assess first and how we proceed. Vision, balance, head–body coordination, breathing or mental aspects may offer further directions to explore. They are included when they lead to a specific question about your situation.
3. From the solution contact to a suitable function
Why might contact at the upper neck offer a solution in the shoulder example? The location has a functional relevance. Small, deep neck muscles are among the structures attached around the transverse processes of the first cervical vertebra, C1, also called the atlas.
These muscles provide fine control of head stability. Their sensory receptors supply feedback about head position. These include muscle spindles, which report changes in muscle length. For a steady gaze, head posture and eye control need to work well together. Information from this region is therefore also important for eye–head coordination.
I choose this contact area because of this sensory and motor connection. In the NeuroFI model, the contact is associated with the mesencephalon, or midbrain. The original skin stretch at the shoulder and this additional solution contact serve different purposes in the process.
It may be useful to test whether the solution contact we have found can be replaced by a related function. We move from the identified contact to the structure associated with it in the model, and from there to a suitable function.
Contact → structure → functionIn this example: solution contact at C1 → association with the midbrain in the NeuroFI model → convergence as a possible related function. Convergence means directing both eyes towards a nearby target. The midbrain is involved in controlling it.
If I choose this pathway, the solution contact is removed and the eye function is added. We keep the original skin stimulus. In this example, the indicator muscle also holds steadily with this combination. We can then continue working through the function we have tested.
Replacing the contact with a function is one possible way of exploring further. It is not automatically part of every appointment. After integration, the same comparison follows here too: the original skin stimulus without an additional solution, then raising the arm again.
4. Why additional information might change the response
One possible explanation concerns timing within the nervous system. A neurophysiological reference point is corticomuscular coherence, also called corticomotor coherence. Here, particular rhythmic components of electrical signals from the cerebral cortex and muscles are coupled within a certain frequency range and maintain a stable timing relationship.
The idea is that when information arrives also matters for how it is processed. Groups of nerve cells vary in their receptiveness over the course of their rhythm. An input may be processed more effectively during suitable phases. This kind of timing coordination may support signal transmission that is as reliable and undisturbed as possible.
The working hypothesis for our shoulder example is this: initially, the skin information is processed in an unhelpful way; the indicator muscle gives way in the test. The additional contact introduces further sensory information related to head position, neck stability and gaze coordination. In the NeuroFI model, this brings in the association with the midbrain. This additional input might change the coordination so that the indicator muscle holds steadily again despite the skin stimulus.
The practical comparison remains specific: the original stimulus, the stimulus with a solution, and, after integration, the same stimulus without an additional solution. Your movement follows. In this example, the indicator muscle stays stable after integration; we use raising your arm to compare what has changed for you.
How we take the further course into account
If a response remains unusual or unclear, I continue to check which part of the process needs more attention. We also consider what happens in everyday life. If symptoms return, another or a higher-level control connection may be involved that was not addressed during the first appointment.
Depending on the result, I might consider functional connections relating to the supply of the motor cortex, modulation functions of the cerebellum or mental aspects. A conflict at work is one example of a mental aspect: if pain returns in that context, we include the situation and the associated responses in the further assessment.
Suitable exercises may support the work done during the appointment. They follow from the connection we have found and your everyday life. Your concern remains the reference point: what influences the function, which solution fits, and how does this change your movement or symptoms?
Let's talk about your concernWould you like to find out how I could work with your concern? In a free initial telephone consultation, we discuss your situation and a suitable next step. The work with manual contacts described here takes place in person in Vilshofen.