Once again Jean-Pierre Barral, D.O. and Alain Croibier, D.O. have followed the original idea of Barral’s thinking and practical experience: that the content is more essential to the organism than the container. In line with this general thought, the central and peripheral nervous systems (CNS and PNS) have been the focus of explorations over the past eight years. The fruit of this work is now becoming available in English-language editions, already with the publication of Manual Therapy for the Peripheral Nerves (Churchill Livingstone) in 2007, and with the forthcoming Cranial Nerve Manipulation (Churchill Livingstone, due in autumn of 2008).

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The anatomy and function of the peripheral nerves – a network of about 60,000 miles (100,000 km) in length, with their own neurovascular support systems, internal pressure (turgor effect), and their global ruling influence on the human structure – seem obvious after the excellent description in Manual Therapy for the Peripheral Nerves. That nerves themselves have a supreme function and will protect themselves when necessary is experientially obvious to anyone that has had an irritated cervical nerve and a “stiff neck” – muscle spasms protect the irritated nerve from further injury.

In our structural integration practice we see the spine functioning primarily as a spacer, distributing weight and supporting gravitational alignment; or functionally as a spinal engine, inducing contralateral movement. What is often forgotten is the foremost important function of the spine: to protect the CNS and to support the unobstructed gliding extensibility of the CNS with its dural complex and continuous PNS. The spinal dura mater lengthens in flexion (forward bending of the spine) about 3 inches (7 cm) and shortens in extension (backward bending of the spine) about 1 inch (2.5 cm); the embedded spinal cord has to do almost the same excursion.

Nerves themselves are made up of their own vascularization (vasa nervorum) and their own enervation (nervi nervorum) embedded in various layers of connective tissues (epineurium and perineurium). Peripheral nerves consist of from 50 to 90 percent connective tissue (CT), depending on their function. The CT protects nerves in general from too much extension; the vascular turgor effect protects them from compression. As we know, tensions and injuries do show up in the connective tissue and will impinge the vascularisation of a nerve and create a feedback loop to the brain via the nervi nervorum. Thus, local, protective muscle spasms may have their origin in the nerve tissue itself.

In addition, as highlighted by Peter Hujing at last year’s Fascia Research Congress, the neurovascular bundle itself is a highway of very direct force transmission, reaching further than the “regular” myofascial CT tension distribution and then possibly affecting the anterior or posterior horn of the spinal cord. Thereby any mechanical traumas will also be stored in the peripheral nerves themselves and will need to be released with a “nerve specific touch”, respecting the tissue quality and the turgor effect involved.

Manual Therapy for the Peripheral Nerves lays the anatomical groundwork for the manual resolution of these tensions and their muscular compensations, and shows the relationships between the various nerve plexuses and possible nerve-based pathologies in the limbs and the related spinal restrictions. Once again Barral and Croibier prove that soft tissue components are often primary to structural spinal fixations. It is a worthwhile practical book for practitioners to read and use as a dictionary. As would be expected, initiation into “nerve touch” is best learned in a course taught by someone experienced and approved by Barral himself; the learning then happens in one’s own practice.

The book Cranial Nerve Manipulation is already available in French (Manipulation des nerfs crâniens; Elsevier, 2006). It elucidates the next step on this “nervous journey”: the diagnosis and manipulation of the cranial nerves as they innervate the cranium and face, the meninges, the throat and the whole body via the vagus nerve are excellently described. The book contains the best illustrations I have ever seen so far, giving a clear three-dimensional view of where in space you will find the structures described. The cranial nerves themselves require highly sensitive manual perception skills on the part of the practitioner. Due to their very central effect on the whole human system via the most “noble human part” – the brain itself – it is important knowledge for any advanced practitioner to acquire.

The book itself will enhance your knowledge of the cranium’s content and open the door to enhance your perceptual skills and help with lasting results on cranial lesions and many more structural problems you may encounter in your practice. However, even for experienced cranial practitioners, it is recommended to participate in a course by Barral-approved faculty to enter the realm of the brain in a safe and specific way.