NeuroCentric Approach-Case Report-Abdominal Nerve Impingement Causing Unusual Anterior Thigh and Groin Pain-by guest author, Marc Heller, DC
November 16, 2024
Introduction
In the evolving landscape of physical medicine and rehabilitation (PMR), traditional models of clinical assessment and treatment have often fallen short of addressing the complexities of pain and movement dysfunction. The ordering of the evaluation historically placed a high bias on “mesodermal” structures, owing to our understanding of material properties of bones, muscles, tendons, ligaments and joints.* Physical medicine became adept at pinning fractures and splinting severe sprains and strains. Doctors, chiropractors and physical therapists managed pain and tissue healing of these structures, essentially riding herd over the process by making the patient more comfortable. This patient journey was commonly expected to take anywhere from 6 weeks to 6 months to resolve.
By and large, this process has reduced suffering and improved function for the majority of patients using this “meat and biomechanics” approach. However, a subset of these injuries run off the rails and become chronic. A seemingly simple low back sprain/strain morphs into episodic low back pain, multiple surgeries and earns the terribly damning moniker of “failed back syndrome”. The mild Achilles tendon injury never fully resolves, and the tendon remains grossly misshaped and howls for days with most activity. The public health costs of these incomplete healing processes and syndromes rivals annual expenditures on the most expensive health issues: heart disease and depression.(1,2) The NeuroCentric Approach® (NCA) represents a fundamental shift in how we understand and treat these conditions, by integrating emerging and maturing areas of research from 3 primary domains:
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mechanical sensitivity of peripheral neurology
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pain neuroscience
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geroscience and longevity
What the NeuroCentric Approach® attempts to accomplish is to re-order the PMR clinician to first prioritize the health and well being of a non-“meat-based” tissue strata…neurology. Borrowing from the above tangential lines of research, opens doors to the answers that patients commonly ask:
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What is happening in my body?
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Why did it happen?
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What can be done to make it better now?
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What can be done to keep it from happening again?
Let’s take a peek through a NeuroCentric lens and catch a glimpse of how the integration of this approach can reduce chronicity, improve pain, shorten healing times and reduce healthcare costs. In some cases, we may even be able to see the future, and predict future pain and disability that previously escaped scrutiny. In other cases, we can see that this approach can also confer performance enhancement in athletes who are uninjured and asymptomatic.
What is the NeuroCentric Approach?
The NeuroCentric Approach redefines the way we perceive pain, movement, and aging by acknowledging that the nervous system is not a passive structure but an actively modifiable component of human health. The NCA is not a singular technique but rather a synthesized philosophy—one that recognizes the interconnectedness of the nervous system, musculoskeletal system, and cognitive processing.
By leveraging cutting-edge research and clinical evidence, NCA provides a framework that bridges the gap between biomechanics, neurology, and pain science, offering clinicians a robust, adaptable model for patient care. NCA acknowledges that pain is both a sensory and perceptual experience and that addressing neural sensitivity can unlock new treatment potentials for both acute and chronic conditions.
Core Principles of NCA
- Mechanical Sensitivity of Peripheral Neurology
- The nervous system is dynamic and responsive to mechanical inputs. Neural tension, mobility restrictions, and peripheral sensitization can dramatically affect pain perception and movement.
- Clinical interventions focus on neurodynamics, nerve gliding techniques, and graded exposure to restore optimal function.(3)
- Peripheral sensitization can mimic musculoskeletal disorders, leading to misdiagnoses if clinicians fail to consider neural contributions.(4)
- Peripheral sensitization may predict future injury or hinder healing of surrounding mesodermal structures by altering local motor behavior.
- Pain Neuroscience and Perceptual Processing
- Pain is not merely a symptom but a complex, multifactorial experience modulated by the brain’s interpretation of threat.(5)
- Educating patients on neuroplasticity, pain modulation, and the biopsychosocial model often enhances treatment effectiveness and patient compliance.(6)
- Pain modulation strategies, including graded motor imagery, mirror therapy, and sensory retraining, can be integrated within an NCA framework to alter pain perception and enhance functional outcomes.
- Aging, Longevity, and Neural Plasticity
- The concept of aging has shifted from an inevitability to a modifiable process influenced by epigenetics, lifestyle, and movement.(7)
- Strategies such as targeted exercise, dietary interventions, and cognitive training can enhance neuroplasticity and mitigate age-related neural decline.
- Epigenetic mechanisms can be influenced through nutrition, stress management, exercise, and sleep optimization, all of which play a role in neuroplasticity and neural sensitivity. (8)
- Many of these epigenetic influences modulate the experience of pain at the cognitive level as well as the expression of nociception at the tissue level.(9)
How NCA Integrates with Established Models
The NeuroCentric Approach builds upon the work of pioneering researchers:
- Stuart McGill’s spinal biomechanics informs our understanding of mechanical.
- Dynamic Neuromuscular Stabilization (DNS) refines motor control principles, integrating developmental kinesiology.
- Robin McKenzie’s mechanical diagnosis and therapy (MDT) enhances patient-driven solutions for spinal health.
- Michael Shacklock’s framework of neurodynamics provides practical applications for assessing and treating peripheral nerve-related dysfunctions.
Unlike conventional rehabilitation models that compartmentalize treatment approaches, NCA creates a unified structure where these methodologies work synergistically. This integration ensures that clinicians consider both structural and neural contributions to pain and dysfunction, leading to more targeted and efficient treatments.
Clinical Applications of NCA
The NeuroCentric Approach is highly adaptable across various patient populations, from elite athletes to individuals with chronic pain. Clinicians applying NCA can expect:
- Enhanced diagnostic accuracy by assessing the nervous system’s role in musculoskeletal dysfunction.
- More effective interventions through tailored neurodynamic treatments and graded exposure techniques.
- Improved patient engagement by reframing pain as a manageable, neurobiological process rather than a purely structural issue.
In the context of sports rehabilitation, for example, considering the role of neural tension in movement efficiency can help address hidden contributors to performance deficits. Similarly, in chronic pain populations, integrating neuroplasticity-based interventions can lead to long-term functional improvements, even in cases where structural damage has been ruled out as the primary pain generator.
The Future of Rehabilitation: Why NCA Matters
Healthcare is shifting toward more integrative, patient-centered approaches. The NeuroCentric Approach not only aligns with this movement but provides a concrete framework for redefining clinical success. By embracing neuroplasticity, mechanical sensitivity, and longevity principles, clinicians can unlock new avenues for treatment and rehabilitation.
Traditional rehabilitation models often rely on structural diagnoses as the primary determinant of treatment approaches. However, research increasingly supports the notion that pain and movement dysfunction are often driven by neurological adaptations rather than pure structural pathology. The NeuroCentric Approach embraces this paradigm shift, equipping clinicians with the tools to target neural contributions to pain and mobility impairments.
Moreover, as research continues to advance in areas such as brain mapping, neuroplasticity, and motor learning, the NeuroCentric Approach provides an adaptable framework for integrating these findings into everyday clinical practice. This ensures that rehabilitation strategies remain progressive, evidence-based, and patient-specific.
NeuroCentric Approach is Trending
The NeuroCentric Approach represents a necessary evolution in physical medicine—one rooted in evidence-based practice and a holistic understanding of the human body. By integrating pain neuroscience, mechanical neurodynamics, and longevity science, NCA offers a forward-thinking, adaptable model that empowers clinicians to optimize patient care and long-term health.
As the fields of physical medicine, rehabilitation, and neuroscience continue to evolve, clinicians must adopt models that reflect our growing understanding of neural sensitivity, pain processing, and movement efficiency. The NeuroCentric Approach not only aligns with this emerging paradigm but provides actionable, research-supported strategies that clinicians can implement immediately in their practices.
As we explore what the NeuroCentric Approach does…and doesn’t, do, an old joke sheds some light (pun intended).
A man walking home in the night sees another person searching the ground beneath a streetlight. He asks the person what he’s looking for and learns that the person is looking for their keys. “Where did you last see your keys?” he asks. The person points up the street and says “About a block back there.” The man asks the obvious question, “If you last saw them a block away, why aren’t you looking there?” “Because the light is so much better here,” the person says.
When a person has a musculoskeletal pain presentation in clinic, the cause is not always irritable neurology. But if the patient’s condition is caused by irritable neurology and the clinician doesn’t look for it…they will not find it.
For more information, please check out these links:
Stuart McGill, PhD-find books, and coursework at https://www.backfitpro.com/
Dynamic Neuromuscular Stabilization (DNS)-find books, and coursework at https://www.rehabps.com/
Robin McKenzie, PT- find books, and coursework at https://mckenzieinstitute.org/
Michael Shacklock, PT, PhD- find books, and coursework at https://neurodynamicsolutions.com/
References
- Dagenais, J. Caro, S. Haldeman. A systematic review of low back pain cost of illness studies in the United States and internationally Spine J, 8 (2008), pp. 8–20
- Ahmad Z, Parkar A, Shepherd J, Rushton N. Revolving doors of tendinopathy: definition, pathogenesis and treatment. Postgrad Med J. 2020 Feb;96(1132):94-101. doi: 10.1136/postgradmedj-2019-136786. Epub 2019 Nov 22. PMID: 31757873.
- Ellis RF, Hing WA. Neural mobilization: a systematic review of randomized controlled trials with an analysis of therapeutic efficacy. J Man Manip Ther. 2008;16(1):8-22. doi: 10.1179/106698108790818594. PMID: 19119380; PMCID: PMC2565076.
- Bove GM. Partial mixed neuropathy of the fourth lumbar spinal nerve misdiagnosed as "shin splints.". J Can Chiropr Assoc. 2023 Aug;67(2):186-193. PMID: 37840581; PMCID: PMC10575327.
- Visser EJ, Davies S. Expanding Melzack's pain neuromatrix. The Threat Matrix: a super-system for managing polymodal threats. Pain Pract. 2010 Mar-Apr;10(2):163. doi: 10.1111/j.1533-2500.2009.00348.x. PMID: 20415732.
- O'Hagan ET, Cashin AG, Traeger AC, McAuley JH. Person-centred education and advice for people with low back pain: Making the best of what we know. Braz J Phys Ther. 2023 Jan-Feb;27(1):100478. doi: 10.1016/j.bjpt.2022.100478. Epub 2022 Dec 22. PMID: 36657216; PMCID: PMC9868342.
- Pal S, Tyler JK. Epigenetics and aging. Sci Adv. 2016 Jul 29;2(7):e1600584. doi: 10.1126/sciadv.1600584. PMID: 27482540; PMCID: PMC4966880.
- Gyorkos A, Baker MH, Miutz LN, Lown DA, Jones MA, Houghton-Rahrig LD. Carbohydrate-restricted Diet and Exercise Increase Brain-derived Neurotrophic Factor and Cognitive Function: A Randomized Crossover Trial. Cureus. 2019 Sep 9;11(9):e5604. doi: 10.7759/cureus.5604. PMID: 31700717; PMCID: PMC6822553.
- Cheng C, Wu Y, Huang Y, Xue Q, Wang Y, Liao F, Wang X, Miao C. Epigenetic modification and exosome effects on autophagy in osteoarthritis. Biochem Pharmacol. 2023 Dec;218:115930. doi: 10.1016/j.bcp.2023.115930. Epub 2023 Nov 17. Erratum in: Biochem Pharmacol. 2024 Aug;226:116225. doi: 10.1016/j.bcp.2024.116225. PMID: 37979704.
Notes:
*In embryological terminology, 3 primary germ lines are described: mesoderm, endoderm and ectoderm. Mesodermal structures include bones, ligaments, tendons and joints. Endodermal structures include many internal organs. Ectodermal structures include skin and neural tissues.
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