What is Neural Manipulation?

The Therapeutic Value of Neural Manipulation

French Osteopath Alain Croibier collaborated with Jean-Pierre Barral to develop Neural Manipulation. The courses are based on clinical techniques personally developed by Jean-Pierre Barral combined with Alain Croibier’s scientific information. Comparative studies found Neural Manipulation beneficial for various disorders such as:

  • Lower Back Pain & Sciatica

  • Headaches & Migraines

  • Carpal Tunnel Syndrome

  • Joint Pain

  • Digestive Disorders

  • Post-operative Scar Tissue Pain

  • Swallowing Dysfunctions

  • Thoracic Outlet Syndrome

  • Whiplash Injuries

  • Birth Injuries

  • Neuralgia & Neuritis

  • Tendinitis

  • Sprains & Traumatic Lesions

  • Concussion & Traumatic Brain Injuries

    and More……..

Neural Manipulation examines mechanical relationships between the cranium/spine hard frame to the dura and neural elements. It provides assessment and treatment approaches to address restrictions of the dural and neural components not commonly focused on with musculoskeletal symptoms. Neural Manipulation identifies and releases local nerve restrictions while at the same time examines the effect these local fixations have on the rest of the body, and by accessing this relationship, resolves the more comprehensive (global) dysfunctional patterns.

A nerve only functions correctly when it is able to move feely within its surrounding structures. The modality of Neural Manipulation facilitates nerve conductivity and intraneural blood supply for local and systemic responsiveness. By understanding the detailed anatomy of the neural manipulation, one can clearly see the potential for pathological change when nerves are restricted.

Manual therapy, as it applies to the treatment of nerves, follows the standard principles of mobility and function. For optimal function nerves must be able to move freely within its surroundings. This freedom of movement is essential for:

  • nerve conduction
  • electromagnetic conduction
  • intraneural blood supply
  • intraneural nerve supply
  • local and systemic responsiveness

Neural Fixation

When a nerve is fixed, it typically looses its ability to glide and/or stretch in length. The intra- or peri-neural pressure dramatically increases, at the same time there are changes in consistency. The nerve pathway shows functional interferences (blood supply or electric and/or electromagnetic conductivity).

With fixation smaller nerve sections can harden. They feel like buds and are very sensitive or painful to the touch. Such “Nerve Buds” are an indication of an intraneural interference, an overload of physiological pressure points or a local fibrosis. Nerve buds can be released very quickly, sometimes within one therapy session.

Palpation of the skin branches of peripheral nerves can be useful for evaluative, as well for therapeutic considerations. When evaluating the skin branches, if they are sensitive or painful to pressure, typically there is a fixation of the deeper nerve branches.

Neural Manipulation and its Influence on Organs

Visceral Manipulation techniques can affect the movement apparatus and vice versa. It is important to note that the release of sensitive nerve buds can have a favorable effect on the functioning of the corresponding visceral organs. The neural manipulation is involved in all body functions and without neural control certain visceral activity cannot be maintained. The stimulation of nerves is processed centrally and reported back to the body as feedback. This sequence of responses functions providing no interference (fixation) is present.

Whether the structures involved include joints, fascia, viscera, brain and peripheral nerves, or emotional centers, proper evaluation is essential for good therapeutic results. The treatment of a normal nerve section (without fixation) has no adverse effect, however a local nerve irritation can result.

Generally, one thinks of a trauma as a severe injury that causes damage. This definition encompasses different gradients of external forces acting on the body. For example, not every joint trauma leads to a fracture or dislocation, which is verifiable by x-ray. From a medical standpoint, patients are often considered to be perfectly healthy, even though they are not at all the same as they were before sustaining a trauma. The same is generally true for the neural manipulation and the nerves. Traumatic nerve lesions typically do not result in a recognizable, well defined, clinical picture. Instead a broad spectrum of disturbances can be found. Because of their inconsistency and lack of evidence (with conventional examination methods and imaging procedures) symptoms are often overlooked.

Often functional nerve lesions develop after neurotropic diseases (like herpes zoster) or as a result of posture imbalances. More frequently they derive from mechanical forces and energies: friction, pressure (compression) or traction forces (stretch), all of which affect the nerves. To bring about lesions, a trauma does not have to be severe. Often, it is a matter of repetitive micro-traumas. For example, a non-physiological movement, a harmless sprain, faulty posture or muscle contractions. Pathological processes can take place intra- and extraneurally.

Intraneurally the trauma affects distinct nerve structures:

  • demyelination, neurinoma, hypoxia of certain fibers (in the conducting nerve tissues),
  • epineural scarring, perifascicular edema, fibrosis, irritation of the arachnoid space or the dura mater (in the neural connective tissue).

These categories of pathology are rarely found in isolation. Clinically we typically find several together. Extraneural disturbances are caused chiefly by a narrowing of the spinal canal. Trauma can also impact the “nerve bud” or a functional intersection of the nerve tissue. For example, a nerve or epidural hematoma, an epineural tissue fixation, a dura adhesion in the spinal canal, as well as pressure caused by bone or muscle swelling can result.

Intra- and extraneural function disturbances often occur in tandem. In our opinion, they are closely connected with a neural fixation dysfunction and/or are even the cause of it. Our aim is to treat this kind of fixation with manual techniques or at least to minimize their negative results.

Neural Manipulation FAQs

  • With interferences in certain body zones, the respective spinal cord and/or brain structures may also be irritated. A peripheral nerve treatment can influence these so-called facilitated areas and therefore promote a common or systemic effect. Manual treatments are basically effective due to the mechanical effects that cause neural stimuli, which can be transmitted at a local or central level. Manual neural manipulation changes intra- and extraneural pressure, improves sympathetic function to blood vessels due to the auto-innervation of the sympathetic gangli and sympathetic innervation of peri-neural connective tissues both of which are affected with treatment of fixations in the nerve sheaths.

    To find a therapist in your area, go to International Association of Healthcare Practitioners.

  • Treatment to nerves is through precise applied pressure. The tension of the perineurium and all other neural connective tissues is transmitted down to the root sheaths, so the distal contact has a central effect mechanically and reflexogenically.


    Practitioners share their NM experience:


    I find the NM techniques are very effective on patients with increased neural tension or sign of nerve restriction. I learnt from 3 instructors from different regions, all of them were very experienced and informative. The teaching about the theory and techniques was very clear. I really enjoy and appreciate how they give enough time to ensure all students have enough time on practicing the new technique, and yet able to emphasize on the precision and deep knowledge of the work.

    In my practice, I see many people with movement dysfunction related to compensation or disuse causing problem with radiating pain. After applying the technique on related nerve, I can progress the movement retraining more efficiently and effectively. I also find that after applying the technique on indicated structure, it is easier to perform soft tissue release. The course has enable me the skill to release the local nerve restriction or fixation, and enhance me with the knowledge to identify and restore the global dysfunctional patterns that causes many functional limitations.

    I highly recommend this course as it offers a sophisticated approach to use as an integration to my current manual and movement practice. Very modest and effective technique to apply easily.”

    Choong Li Sann, PT


    NM1 provides an explanation to the clinical manifestations of whiplash injury in a logical manner. It also helps me to understand the biomechanics physiology effects of a mechanical trauma. I find some of the techniques helpful in ameliorating the pain experienced by clients with whiplash injury.

    TS Ng, PT


    “I have completed NM1 – 4 and have been using the techniques learnt extensively in my work. Recently I treated an 68 year old client with osteoarthritis. Her pain had worsened after a holiday where she walked too much. Her right knee extension range of motion was limited to -8o. There was also much tension over the Popliteus Fossa. After a session of Neural Manipulation on the Tibial Nerve, the knee was able to achieve  -3o knee extension range of motion. She was able to walk out of the clinic without pain. After a 2nd session, she was able to gain full knee range of motion and there was no pain in her knee. The fascia of the Tibial nerve had caused much restriction which prevent the knee from attaining full knee extension.”

    Gigi Kuwan, PT



    Studying NM techniques has been an invaluable experience which has given me additional abilities that allow me, as a practitioner, to work more holistically.

    The NM techniques themselves are simple yet effective and based on sound anatomical principles.

    The neuro-muscular treatment approach bridges nicely the disciplines of craniofacial-sacral techniques and visceral techniques with the musculoskeletal system, working together to create a seamless treatment experience for my patients.”

    Richard de Barry, Osteopath

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