Research Review: Peripheral Nerve Entrapment & Massage Therapy

Carpal Tunnel Syndrome and Massage

Peripheral Nerve Entrapment & Massage Therapy

Massage Therapists may be aware of some of the research behind peripheral nerve entrapment from Michael Shacklock and his book Clinical Neurodynamics. In this book the author provides some insight into how mechanical irritation may lead to localized nerve inflammation.

Running parallel to this work - Geoffrey Bove and Mary Barbe have investigated how trauma and ongoing inflammation can be a contributing factor to connective tissue changes (increased collagen and TGF-β1 deposition).

This process has been described as a progression from densification (alterations of loose connective tissue) to fibrosis (alterations of collagen fibrous bundles).

Functionally, these changes may influence biomechanical properties secondary to tissue adherence or tethering structures to each other. It may also induce chronic compression of peripheral nerves (ie. carpal tunnel syndrome, hamstring syndrome, meralgia paresthetica, infrapatellar syndrome etc...).

What Are The Implications for Massage Therapy?

The underlying mechanisms of massage therapy are complex and multifactorial. In addition to endogenous pain modulation, soft tissue mobilization may help diminish intraneural edema and expedite clearance of pro-inflammatory cytokines.

Additionally, an interesting area of research is to what degree can soft tissue mobilization mitigate the development of post-inflammatory connective tissue fibrosis, and how does this effect epineurial and perineurial structures.

Then if massage therapy is applied with an optimized dosage, what are the implications for patients with repetitive strain disorder or peripheral neuropathy.


More to Explore

Andrade et al. (2018). The potential role of sciatic nerve stiffness in the limitation of maximal ankle range of motion. Sci Rep.
https://www.ncbi.nlm.nih.gov/pubmed/30266928

Boudier-Revéret et al. (2017). Effect of neurodynamic mobilization on fluid dispersion in median nerve at the level of the carpal tunnel: A cadaveric study. Musculoskelet Sci Pract.
https://www.ncbi.nlm.nih.gov/pubmed/28734168

Bove, G.M. (2008). Epi-perineurial anatomy, innervation, and axonal nociceptive mechanisms. J Bodyw Mov Ther.
https://www.ncbi.nlm.nih.gov/pubmed/19083672

Bove et al. (2016). Manual therapy as an effective treatment for fibrosis in a rat model of upper extremity overuse injury. J Neurol Sci.
https://www.ncbi.nlm.nih.gov/pubmed/26810536

Bove et al. (2017). Attenuation of postoperative adhesions using a modeled manual therapy. PLoS One. 
https://www.ncbi.nlm.nih.gov/pubmed/28574997/ 

Carro et al. (2016). Deep gluteal space problems: piriformis syndrome, ischiofemoral impingement and sciatic nerve release. Muscles Ligaments Tendons J. (OPEN ACCESS)
https://www.ncbi.nlm.nih.gov/pubmed/28066745

Chimenti et al. (2018). A Mechanism-Based Approach to Physical Therapist Management of Pain. Phys Ther.
https://www.ncbi.nlm.nih.gov/pubmed/29669091/

Cholok et al. (2017). Traumatic muscle fibrosis: From pathway to prevention. J Trauma Acute Care Surg.
https://www.ncbi.nlm.nih.gov/pubmed/27787441

Cohen & Mao. (2014). Neuropathic pain: mechanisms and their clinical implications. BMJ.
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Courtney et al. (2017). Mechanisms of chronic pain - key considerations for appropriate physical therapy management. J Man Manip Ther.
https://www.ncbi.nlm.nih.gov/pubmed/28694674

Festen-Schrier & Amadio (2018). The biomechanics of subsynovial connective tissue in health and its role in carpal tunnel syndrome. J Electromyogr Kinesiol.
https://www.ncbi.nlm.nih.gov/pubmed/29108853

Fisher et al. (2015). Increased CCN2, substance P and tissue fibrosis are associated with sensorimotor declines in a rat model of repetitive overuse injury. J Cell Commun Signal.
https://www.ncbi.nlm.nih.gov/pubmed/25617052

Greening et al. (2018). Evidence for Increased Magnetic Resonance Imaging Signal Intensity and Morphological Changes in the Brachial Plexus and Median Nerves of Patients With Chronic Arm and Neck Pain Following Whiplash Injury. J Orthop Sports Phys Ther.
https://www.ncbi.nlm.nih.gov/pubmed/29690828

Isu et al. (2018). Superior and Middle Cluneal Nerve Entrapment as a Cause of Low Back Pain. Neurospine.
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Ji et al. (2018). Neuroinflammation and Central Sensitization in Chronic and Widespread Pain. Anesthesiology.
https://www.ncbi.nlm.nih.gov/pubmed/29462012

Ji et al. (2016). Pain regulation by non-neuronal cells and inflammation. Science.
https://www.ncbi.nlm.nih.gov/pubmed/27811267

Kim et al. (2017). Low back pain due to middle cluneal nerve entrapment neuropathy. Eur Spine J.
https://www.ncbi.nlm.nih.gov/pubmed/28681191

Klingler et al. (2014). Clinical Relevance of Fascial Tissue and Dysfunctions. Current Pain and Headache Reports.
https://www.ncbi.nlm.nih.gov/pubmed/24962403

Kwon et al. (2018). Anatomical analysis of the distribution patterns of occipital cutaneous nerves and the clinical implications for pain management. J Pain Res.
https://www.ncbi.nlm.nih.gov/pubmed/30310306

Hangge et al. (2018). Quadrilateral Space Syndrome: Diagnosis and Clinical Management. J Clin Med.
https://www.ncbi.nlm.nih.gov/pubmed/29690525

Latef et al. (2018). Injury of the Radial Nerve in the Arm: A Review. Cureus.
https://www.ncbi.nlm.nih.gov/pubmed/29666777

Mackinnon SE. (2002). Pathophysiology of nerve compression. Hand Clin.
https://www.ncbi.nlm.nih.gov/pubmed/12371026

Martin et al. (2017). Nerve entrapment in the hip region. Int J Sports Phys Ther.
https://www.ncbi.nlm.nih.gov/pubmed/29234567

Muir B. (2017). Dorsal scapular nerve neuropathy: a narrative review of the literature. J Can Chiropr Assoc.
https://www.ncbi.nlm.nih.gov/pubmed/28928496

Paraskevas et al. (2014). Fascial entrapment of the sural nerve and its clinical relevance. Anatomy & Cell Biology.
https://www.ncbi.nlm.nih.gov/pubmed/24987554

Porr et al. (2013). Entrapment of the saphenous nerve at the adductor canal affecting the infrapatellar branch - a report on two cases. J Can Chiropr Assoc.
https://www.ncbi.nlm.nih.gov/pubmed/24302782

Saban et al. (2014). Deep massage to posterior calf muscles in combination with neural mobilization exercises as a treatment for heel pain: a pilot randomized clinical trial. Man Ther.
https://www.ncbi.nlm.nih.gov/pubmed/24090993

Schmid et al. (2018). Entrapment Neuropathies: Challenging Common Beliefs With Novel Evidence. J Orthop Sports Phys Ther.
https://www.ncbi.nlm.nih.gov/pubmed/29385943

Schmid et al. (2013). Reappraising entrapment neuropathies--mechanisms, diagnosis and management. Man Ther. 
https://www.ncbi.nlm.nih.gov/pubmed/24008054

Schmid et al. (2009). Reliability of clinical tests to evaluate nerve function and mechanosensitivity of the upper limb peripheral nervous system. BMC Musculoskeletal Disorders. (OPEN ACCESS)
https://www.ncbi.nlm.nih.gov/pubmed/19154625

Stecco et al. (2016). Fascial Disorders: Implications for Treatment. PM R.
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Szikszay et al. (2017). In vivo effects of limb movement on nerve stretch, strain, and tension: A systematic review. J Back Musculoskelet Rehabil.
https://www.ncbi.nlm.nih.gov/pubmed/28869435

Thompson & Usichenko (2018). Pain in the hand caused by a previously undescribed mechanism with possible relevance for understanding regional pain. Scand J Pain.
https://www.ncbi.nlm.nih.gov/pubmed/29959889

Triplett et al. (2018). Compressive Lateral Femoral Cutaneous Neuropathy Secondary to Sartorius Muscle Fibrosis. JAMA Neurol.
https://www.ncbi.nlm.nih.gov/pubmed/30304318

Wolny et al. (2017). Efficacy of Manual Therapy Including Neurodynamic Techniques for the Treatment of Carpal Tunnel Syndrome: A Randomized Controlled Trial. J Manipulative Physiol Ther.
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Wolny & Linek (2018). Is manual therapy based on neurodynamic techniques effective in the treatment of carpal tunnel syndrome? A randomized controlled trial. Clin Rehabil.
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Zhu et al. (2018). Neural Mobilization Attenuates Mechanical Allodynia and Decreases Proinflammatory Cytokine Concentrations in Rats With Painful Diabetic Neuropathy. Phys Ther.
https://www.ncbi.nlm.nih.gov/pubmed/29309710

Zügel et al. (2018). Fascial tissue research in sports medicine: from molecules to tissue adaptation, injury and diagnostics. Br J Sports Med.
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