FASCIA IS A PRIME CULPRIT IN NUMEROUS ENTRAPMENT NEUROPATHIES
"Entrapment mononeuropathies represent a common reason for visiting primary care and outpatient neurology practices. Accurate diagnosis is paramount because these presentations can be very similar to radiculopathy or systemic neuropathy. Numerous experimental and clinical studies have demonstrated that nerve mechanosensitivity can be heightened in the absence of nerve injury and therefore of neuropathic pain. All the nerves in their course have direct contact with fasciae and cross them. Until now, the role of the fasciae in etiology has been underestimated." Some cherry-picked sentences from the study being discussed today.
What do we know about nerve entrapment pathologies related to fascia? For one, we know they are common. A few of the titles I came across while doing a quick Google search included.....
Although that study was published when I was ten years old; a couple weeks ago a brand new study was released on this topic by renowned Italian fascia researchers, Antonio and Carla Stecco (MD's) and physical and rehabilitation medicine specialist, CF Pirri. The Steccos have been instrumental in educating physicians and clinicians on the importance of understanding the relationship between inflammation and fibrosis (HERE), fascial "thickening" (HERE, HERE, HERE, HERE, HERE, HERE, HERE, HERE and HERE) and something they refer to as FASCIA DENSIFICATION. Their study, Fascial Entrapment Neuropathy, published in April's issue of Clinical Anatomy covered more of the same ground, with some interesting new twists.
Basing these statements off of their findings in the scientific literature, the Steccos made a bold conclusion --- particularly in light of the exploding prevalence of DIABETIC NEUROPATHY. "Entrapment neuropathies are the most prevalent type of peripheral neuropathy and can have profound physical, psychological and economic impacts on patients." In other words, nerve entrapments are as common as they can be severe. And all too often these entrapments revolve around FASCIAL ADHESIONS. "Our research has underlined a finding common to many authors: fascial tissue is relevant to the etiology of entrapment neuropathy."
The authors searched PubMed and came up with almost 22,000 potential studies for review, eventually settling on 72 that were published between the years of 1947 (just after WWII) and 2010, and fully met their criteria. Besides those mentioned earlier, here are some of the fascial nerve entrapments that were spoken of by the Stecco's team.
What are the chief causes of nerve entrapments?. "Increased fascial thickness" was at the top of the list. But what causes increased fascial thickening? How about repetitive trauma found in any number of sports / hobbies and jobs ("We hypothesize that, in idiopathic nerve entrapment, repetitive micro-traumas and/or overuse can transform the extracellular matrix from sol to gel in multiple regions within the deep fasciae"). Naturally, this leads to "increased viscosity of the ECM" --- in other words, the liquid ECM becomes thicker, with less ability to lubricate tissues, which causes "loss of intra-fascicular gliding". Another factor is "increased pressures" such as seen in compression or even compartment syndromes.
In talking about the ability of nerves to "glide" or "slide" longitudinally (this "reduces the local stretching that would otherwise occur during limb movement"), the authors mentioned GLYCOSAMINOGLYCANS, HYALURONAN, and the "ADIPOSE TISSUE" that makes up a significant portion of the fascia. All of which helps explain why thickening or stiffening (frequently the result of SYSTEMIC INFLAMMATION) is such a huge contributing factor for nerves that become "entrapped" in fascia (BTW, the study had a couple of excellent pictures of nerves trapped in fascia.
All of this information is wonderful, but as always, the place where the rubber meets the road is what it may take to solve the problem. "The management of peripheral nerve entrapment syndromes depends on multiple factors including the chronicity and severity of symptoms, the underlying mechanism, and associated predisposing factors. Understanding the underlying mechanism of injury and the associated natural history is fundamental to designing an appropriate treatment strategy." Whether your particular problem is chronic or acute (or more likely a combination of both --- HERE), everything can be boiled down to one simple question --- can your specific entrapment be successfully addressed with conservative methods or is it going to require surgery? How might you find out?
First, as is the case with most health issues, ailments or injuries, start addressing the underlying inflammation. I'm not simply talking here about using ice to diminish local swelling, but using diet and other "tools" to lessen the impact of systemic inflammation --- the inflammation coursing through your body due to lifestyle choices (EPIGENETICS). Second, try some tissue remodeling --- it's why people come to see us from across the country and around the world (HERE). Third, use YouTube to your advantage. If you have been diagnosed, for instance, with peroneal nerve entrapment, YouTube it and learn everything you can about it, including what you could be doing to resolve it non-surgically.
Part of what I've done for you on my site is to create a generic protocol that addresses all these factors. It's not a "cure-all" and it might not do anything for your particular problem, but it will provide most chronically ill or chronic pain patients with a DIY starting point (HERE). Also, if you appreciate our site, be sure and get it in front of the people you love and value most. A great way is still liking, sharing, or following on FACEBOOK.
Dr. Schierling completed four years of Kansas State University's five-year Nutrition / Exercise Physiology Program before deciding on a career in Chiropractic. He graduated from Logan Chiropractic College in 1991, and has run a busy clinic in Mountain View, Missouri ever since. He and his wife Amy have four children (three daughters and a son).