What You Need to Know about Intraneural Facilitation (INF)

In 2006, Mark Bussell, DPT, developed a physical therapy technique called intraneural facilitation (INF) to relieve nerve pain, numbness and tingling. Since then, he has treated more than 4,200 patients with a high degree of success. Currently, Dr. Bussell and other therapists provide INF at Loma Linda’s  Neuropathic Therapy Center.

How does INF work?

The pain, numbness and tingling that occurs from damaged nerves are often due to blood supply being cut off to those nerves. INF is a treatment that works to restore blood supply to damaged nerves.
Physical therapists perform INF with their hands to stretch joints, muscles and blood vessels to reduce inflammation and widen openings in tiny blood vessels called capillaries. Once the capillaries are delivering enough blood flow and oxygen to the nerves, those nerves stop sending messages to the brain that cause the pain, numbness, and tingling. Given time and treatment, the damaged nerves can regrow. 

Who can benefit?

We’ve been able to help people with diabetic neuropathy, chemotherapy-induced neuropathy, chronic nerve pain, fibromyalgia, and even post-COVID patients who have long-term aftereffects. We typically work on the legs, feet, arms, and hands. To maximize results, you should have some mobility and be able to lie on your back during treatment.

How can INF change people’s lives?

This therapy provides people with hope. A recent patient had struggled with pain for years and often couldn’t sleep. The first time she received treatment in our office, she received relief. She’s now doing INF on her own. It was life-changing for her. Patients receiving chemotherapy often get numbness in their fingertips and toes. With INF, we can restore the feeling to those areas. People with spinal cord injuries normally don’t see nerve regrowth, but we are working with other therapists to restore nerve growth and help people use their hands and feet again.

How many sessions do I need and how long is a session?

We like to see people twice a week for an hour each time. In general, we see maximum benefit after about six weeks. It takes time for inflammation to decrease and nerves to regrow.

Is the treatment itself painless and how much pain relief can I expect?

The different therapy holds are almost totally painless, and there are no side effects. After just one session, 90% of our patients report a significant difference in pain level. For example, a pain level of 9 could be reduced to a 4. Pain will continue to decrease with each session. 

How long do results last?

During initial treatments, the relief you feel may begin to wear off after 24 to 48 hours. As circulation is gradually restored to the nerves, you should notice pain, numbness and tingling being reduced. The more severe your nerve damage, the longer it will take to achieve lasting results.

Have you done research to prove the effectiveness of INF?

As part of the Loma Linda University School of Allied Health Professions, we do rigorous research to test and refine INF and document our results. Patients complete clinical sensory tests, answer questionnaires and do a Neurovascular Index (NVI) test to assess muscles and nerve cells both before and after their 12 sessions.

Can people do the technique themselves at home?

Yes. During our sessions, we teach people how to do the therapy themselves at home. We want to give them that tool in case their symptoms return. We recommend doing therapy holds once or twice a day, for 45 minutes to an hour. And you always have the option to return to us for additional sessions.

Do insurance companies pay for the therapy?

Not yet. It’s still a fairly new therapy, and we are working to educate insurance companies about its benefits.