Some readers will be familiar with the term “neurological symptoms,” usually denoting some form of numbness or tingling, general increased or decreased sensation, decreased tolerance to sensation (“hypersensitivity”), sometimes shooting and/or lingering pain, and if bad enough sometimes even weakness or fatigue, among other manifestations. The purpose of this article is to discuss a specific but very common form of neurological symptom that happens when the nerves coming out of the spine or skull that travel to different parts of the body are “pinched” (more academically known as an “impingement”) in such a way that interferes with their ability to function normally.

Some clinical diagnoses you may be familiar with where this can happen in a specific region include “radiculopathy” from the neck or back (usually travelling down the arm or leg), “carpal tunnel syndrome,” “piriformis syndrome,” “thoracic outlet syndrome,” among others. Or you may be familiar with more general diagnoses of the same phenomenon such as “double crush syndrome,” or sometimes as vague as “neural entrapment syndrome.” And sometimes this phenomenon can contribute to or even underlie other regional diagnoses such as “hip bursitis,” “golfer’s elbow”/medial epicondylitis, “tennis elbow”/lateral epicondylitis, migraines (from the cranial nerves), “plantar fasciitis,” and several other phenomena such as “reflex sympathetic disorder” AKA “complex regional pain syndrome.”

Nerves generally work by sending signals to and from the Central Nervous System (or “CNS”) made up of the brain and/or spinal cord to the muscles and other tissues away from the spine or skull via the “Peripheral Nervous System (or “PNS”). We also call these kinds of nerves that make up the PNS “spinal nerves” if they come out of any part of the spine (neck or back), or “cranial nerves” if they come out of the skull. I like to think of the nerves as rivers, and the signals of strength, sensation, and automatic motion they send as the water in the river that flows up and down. If you dam up a river, you interrupt the flow enough that the water slows or even stops, and in our metaphor you can imagine a scenario in which if the nerves are pinched by some mechanism, the flow of nerve signals would likewise slow or even stop.

Many times the above symptoms and diagnoses are either caused or significantly contributed to by a situation similar to the “dam in the river” metaphor where at one or several points the nerve has been pinched by some other tissue enough to alter its ability to conduct signals up and down itself. The lack of sensation signals can manifest as numbness, tingling, or otherwise decreased ability to feel. The lack of strength signals to the muscles can more obviously manifest as weakness or less obviously as a lack of proper control of normal motion. In addition, the fight-or-flight portion of the subconscious brain may interpret this lack of normal flow as a critical situation that needs to quickly be taken care of, and may begin to bring attention to the problem by provoking pain, hypersensitivity, or other similar types of reactions either close to the areas where the nerve is pinched or even throughout the entire nerve and the tissues it connects to!

Nerve impingement at various points can behave like multiple dams in the same river

Traditional medicine generally well understands this type of problem when it happens with tissues that can be seen on different imaging tests such as Xrays, MRIs, CT scans, and the like. For instance, it is well understood when bone growth in the holes that the spinal nerves come out of (known as “foramen”) begins to grow into the space the nerve occupies and can begin to press into it. This is known as “foraminal stenosis.” Or if a vertebral disc bulges out into the same space from the inside and similarly compresses the nerve, known as a “disc bulge” or “disc herniation.” It is sometimes even understood when certain soft tissue structures impinge on a nerve, such as when the lower portion of the median nerve is compressed by the flexor retinaculum at the front of the wrist in the carpal tunnel. However, traditional medicine is often stumped when this same phenomenon happens in less well established ways.

Carpal Tunnel Syndrome caused by compression of the median nerve by the flexor retinaculum

A practitioner with an understanding of what the Fascial System is and how it works is much better able to “zoom out a frame” and see the totality of the bigger picture in order to more clearly established what is going on, especially when traditional medical intervention has failed to resolve a patient’s symptoms. And with this understanding, they may be more able to assess the problem and treat it in a way that has a significantly higher chance of returning the problem to normal. This is because they understand that because the Fascial System is continuous throughout every part of our body from head to toe, front to back, and side to side, when portions of the fascia that are along and/or near the nerves get tight enough to begin to restrict them, these types of symptoms can begin to manifest. That is, local fascial tissue tightness can be a “dam in the river” just as easily and as much as bone, disc, or ligamentous tissue. Even easier, in fact, because it can pinch a nerve much more quickly than other tissues when it contracts.

For instance, many of us have had or know someone who has had “sciatica,” or “piriformis syndrome,” usually described as feeling some form of neurological symptom from the back of the hip travelling some distance down the back of the leg, or even to the foot. This is usually thought of as happening when the sciatic nerve is pinched by the piriformis in a part of the back of the hip bone called the “sciatic notch.” That is, there is a “dam in the river” of the sciatic nerve at this specific place. And often that is part of the problem. But a therapist with knowledge of the Fascial System will understand that it’s just one part and there is usually much more to the whole story. Sometimes the upper portions of what becomes the nerve can be pinched coming out of the spine and into the lower back muscles as well. Sometimes in the muscles at the back of the thigh, as tight hamstrings from sitting is very common. Perhaps even additionally in the lower portions of the nerve it splits off into, such as the tibial and/or peroneal nerves in the calf or ankle structures.

Oftentimes what a patient feels as their symptoms is the totality of all of the “dams in the river,” and to take care of the problem completely you have to find and fix every one of them. If the fascia is the culprit, it’s hard to see on tests like a Xray or MRI because fascia does not easily show up on most common methods of clinical imaging. Usually it requires an expert process of carefully going along a nerve and feeling the tissue for restriction, then trying to apply specific pressures in ways meant to provoke symptoms to “map out” the entirety of the problem. Once this is done, the therapist can treat and come up with targeted interventions to help shrink the “dams” that are pinching the nerve and fix the problem.

If you, or someone you know, has symptoms similar to these described above anywhere in the body, especially if other types of medical intervention or therapy have not been successful, it may be indicated to try Myofascial Release as a way to return the Fascial System and nerves it may be impinging to their normal state of function. Oftentimes this can be the key to fixing the totality of the root causes instead of just trying to cover up the symptoms, and can return a patient to being able to do the things they want to do and live their life normally again. If so, please contact us to make an appointment, as we would be glad to help!

Fascia and Nerve Dysfunction: “Dams in the River”

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