When Repetitive Use Damages the Nerve

What is Nerve Damage? Do you have IT? And What Does That Mean?

Compression, overstretching, contusion, and tears can all cause nerve damage. In repetitive strain injuries (RSIs) such as carpal tunnel syndrome or tendonitis, it's the chronic constriction of surrounding muscles that damages the nerves mainly through compression and overstretching. Nerve damage can also occur when immunological causes create a chronic autoimmune response such as is found with fibromyalgia. If you have both an RSI and fibromyalgia, which is not uncommon, this means calming and reversing nerve damage is doubly difficult. Often, fibromyalgia is an end stage complication of an RSI where tissues have been damaged so much for so long that additional disease takes hold in the body. Another reason why getting the right treatment quickly is so important with an RSI.

Signs of nerve injury include any abnormal sensation, hypersensitivity, or mechanical dysfunction. It's usually characterized by a burning sensation in the damaged tissues but there isn't always pain. With mechanical dysfunction, you'll say pick up a glass and it falls through your hand, crashing to the floor. There is no pain per se, but your nerves are damaged beyond the ability to signal to your thumbs to grasp the glass. With Focal Dystonia, a neurological condition that often presents without pain, you'll see things like the bent neck of a violinist that refuses to straighten out.

What makes nerve damage insidious is that it occurs as a decline in the conduction of electrical signals to and from the brain via the nerve. This is often a slow process, so that you don't realize the flow of electrical current is disrupted until it's too late. The chronic inflammation at the heart of RSI can also lead to the development of tight fibrous bands in and around the nerve, making healing extremely difficult. The best way to break up those fibrous bands is through manual manipulation such as massage. But if the fibrosed area lies within a constrained space, such as the carpal tunnel, simply reaching the site for treatment presents additional problems.

Chronic compression also means less oxygen delivery to the cells and the release of chemicals intraneurally that make them far more sensitive. This increases the perception of pain, part of the reason why pain is so misunderstood by doctors. There is scientific proof that certain syndromes, this being one of them, act on the perception of pain, sometimes not producing any evidence of pain at the damage site. Or so they say. The truth is that pain perception is as important as any physical damage and should be treated accordingly.  The chemicals released not only tell the brain there's more pain than there is evidence for, they also over sensitize the larger nerve trunk or surrounding tissues by lowering the firing threshold. In other words, if let go long enough with appropriate treatment, your body will get to the point that the damage will register on currently acceptable tests. But this is not a road to recovery.

What nerve damage means for an RSI diagnosis is that the type and duration of treatments applied must be different. Similar tissue damage systems occur with the muscles; unfortunately, the nerves behave very differently and require distinctive modalities to encourage repair. Sometimes, when there is muscle, nerve and vascular damage, as occurs say in thoracic outlet syndrome, all three have to be addressed. This is why a multidisciplinary approach has had the most successful outcomes. Unfortunately, through lack of education and insurance regulation, it can be difficult to get all the treatments necessary to recover from nerve damage.

Finally, healing the nerves takes a lot longer than the muscles. You should give 12-18 months for nerves to repair themselves, and that's with the proper treatment. When trying any new modality, please give it at least one month or six treatments before you decide whether it's working for you.

I've relied on “Repetitive Stress Pathology: Soft Tissue” chapter of Pathology and Intervention in Musculoskeletal Rehabilitation, 2nd Edition (Saunders; 2 edition (December 4, 2015)] by Nancy N. Byl, Mary F. Barbe, and Jane Fedorzyck for the information contained in this article.

@JillGambaro is the author of The Truth About Carpal Tunnel Syndrome . She advocates healthy playing for musicians through her Blog, Facebook and Twitter. Look for her upcoming documentary Icky Fingers.