The nervous system is important in transmitting messages between the brain and the body. Most people have experienced nerve pain, if only from a dental injection or from an electric shock, so everyone knows that nerve pain can be very sharp, unexpected and unpleasant.
Nerves have the reputation for being “delicate,” so the idea of performing manual therapy upon nerve tissue may seem likely to cause some harm. Nerves are seen as “delicate” because of their sensitivity, the ability to detect energy changes and produce sensations of all kinds. On the structural level nerves are well supported and protected by connective tissue so it is safe to perform the right type of manual therapy to remove the compressive forces that can trouble nerves.
Physicians diagnose peripheral nerve disease based on certain symptoms like tingling, numbness and loss of sensation. When peripheral neuropathy is diagnosed, both doctor and patient are usually busy pondering, “what’s adversely affecting the nerve tissue?” The doctor will consider a long list of known diseases that affect the health and performance of neural tissue, including uncommon genetic diseases and common diseases like diabetes.
The doctor often fails to consider that a peripheral nerve consists of three layers of connective tissue that give the nerve its structure. This connective tissue also holds in place the capillary beds that supply blood and nourishment to the nerve. Nerve pain can be caused by ischemia, lack of blood supply to the nerves. Neural ischemia is often the result of abnormal connective tissue changes that can be easily reversed with the right kind of manual therapy and the right kind of exercise.
The peripheral nerves of the body are made up of neurons bound together by connective tissue. The nerve’s outer, protective connective tissue sheath penetrates the nerve to form the perineurium. The perineurium holds blood vessels that deliver oxygen and nutrients to the living nerve cells.
Connective tissue is the body’s most abundant tissue by volume. Connective tissue has many functions. It provides form, structure, connections, compartments, and protection to all of the organs, muscles and nerves of the body. All connective tissue, no matter where it is found in the body, is subject to three deformations, compression, compaction and adhesion. When any of these deformations affect one of the three connective tissue layers of a peripheral nerve, nerve pain can occur.
Manual therapy is the perfect answer to nerve pain caused by connective tissue deformation. When performed very slowly, and at the appropriate depth, cross fiber spreading of the connective tissue surrounding the nerves and penetrating the nerves will relieve compressive forces. By definition, compression is the reduction of volume under pressure. Compression adversely affects the movement of the body’s plasma-based fluids. The plasma-based fluids carry oxygen and nutrients to the nerve cells, and also transport waste products (metabolites) away from the nerve cells. The plasma fluids flow through the solvent ground substance of the connective tissues.
Lack of blood supply (ischemia) to peripheral nerves can additionally be caused by compression of the muscles in the vicinity of the affected nerve routes. Peripheral nerves and skeletal muscles have a parallel construction. Similar to nerves, skeletal muscles consist of three layers of connective tissue that provide a structural framework for the muscle fibers. The connective tissue framework also anchors the blood-supplying vascular networks and provides the ground solvent fluid for the movement of the plasma fluid to and from the muscle cells.
It is generally accepted that prolonged pressure on a nerve from excess bodily fluid (such as swelling post-injury) can result in damage to the nerve cell body or its axon. The ground substance of connective tissue provides the medium for the retention and flow of the body’s fluids. It is generally accepted that both obesity and lack of movement contribute directly to interstitial fluid retention. Damage to peripheral nerves could result from three related problems: fluid pollution from stasis, loss of fluid volume, and prolonged fluid retention. Research is needed.
Overweight and under-active people suffer sluggish lymphatic circulation. Older adults also suffer sluggish lymphatic circulation due to negative connective tissue changes that occur over time. Younger patients with a history of injuries will also have connective tissue problems
The fluid environment surrounding nerve cells can become polluted by metabolites and by other toxic molecules that have not been adequately removed by the lymphatic system. Pollution will irritate nerves and may lead to inflammation. It is logical that pollution of interstitial fluids could also interfere with nerve conduction by introducing foreign molecules into the synapse space between axon and the dendrites of the neural body.
When peripheral neuropathy is diagnosed, and when the doctor has eliminated genetic and metabolic causes, connective tissue disease should be considered as the main or contributing cause for the neural pain. The doctor should be on the alert since peripheral neuropathy in diabetic patients who are older, obese, inactive, or who have a history of soft tissue injuries may have a secondary cause in connective tissue deformations.
Manual therapy can contribute to a specific diagnosis and treatment for peripheral neuropathy. The soft tissues (nerve, connective tissue and muscle) can all be evaluated by palpation. The evaluation should assess for signs and symptoms of ischemia, along with signs and symptoms of connective tissue deformations that can cause ischemia.
Manual therapy is the perfect treatment for nerve pain caused by connective tissue deformation. When performed very slowly, and at the appropriate depth, cross fiber spreading of the connective tissue surrounding the nerves and penetrating the nerves will relieve compressive and adhesive forces.