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C h e c k o u t A B M P 's l a t e s t n e w s a n d b l o g p o s t s . Av a i l a b l e a t w w w. a b m p . c o m . 89 SCIENCE OF NERVES Pathological changes also develop in the nerve if there is a double or multiple crush phenomenon. Multiple crush describes a situation where there is more than one site of nerve compression. With more than one site of compression along the nerve, symptoms are often magnified due to the multiple sites of impairment. The best analogy to understand the multiple crush is to think of the nerve like a hose with water flowing through it. Step on that hose somewhere along its length and the water flow at the other end will be decreased. If you step on it in a second location, the water flow is decreased even further. Nerves are responsible for transmitting their own nutrient proteins throughout the entire length of the nerve. They transmit these nutrient substances through a continuous flow of axoplasm (cytoplasm of the nerve axon) within the nerve cells. Remember that nerve cells extend the entire length of the nerve fiber they are located within. With an impairment in the axoplasmic flow, distal nerve tissue is nutritionally deprived and therefore it becomes symptomatic, causing symptoms such as paresthesia, numbness, or burning sensations. Nerve tissue ischemia from impairment of blood flow to the nerve can also produce these symptoms. The multiple crush phenomenon is also a common cause for clinical confusion and improper treatment. Treatment may be directed at a distal nerve compression pathology (like carpal tunnel syndrome), assuming it is a localized disorder. Failure to recognize more proximal nerve compression that exists simultaneously could mean that symptoms perpetuate even after treatment. The multiple crush phenomenon is a likely explanation for why so many carpal tunnel treatments are unsuccessful. THE MASSAGE THERAPIST'S ROLE The pressing question for massage therapists is what role we can play in addressing nerve compression and tension pathologies. When muscles become dysfunctional with tightness or myofascial trigger points, our primary treatment strategy is to decrease their tightness and improve function. Pressure and gliding movements applied directly to dysfunctional muscles are effective in producing beneficial therapeutic changes. The strategy for addressing symptoms of nerve compression or tension pathology is quite different. Nerve tissue will be further aggravated if it is compressed or stretched when already injured. However, that does not mean massage is not an effective treatment. The first order of treatment is to prevent any additional irritation of the nerve, and this is where massage plays such an effective role. In many instances compression of the nerve is caused by tight or restricting local soft tissues. Massage is very effective in reducing tightness of these tissues that may be compressing the nerve. When pressure is relieved from the nerve, the natural healing process can proceed and the nerve can regain its optimal function. Massage therapy treatment for nerve- related disorders is most effective when the practitioner can identify the most likely site of pathology. Treatment can then be aimed at the local tissues that are contributing to the dysfunction. However, caution in treating these areas is imperative because working on them without adequate knowledge of what you are addressing could easily make nerve symptoms worse due to mechanical aggravation of the nerve. That is exactly why having a solid understanding of many nerve-related disorders will make you a far more successful clinician. Whitney Lowe is the developer and instructor of one of the profession's most popular orthopedic massage training programs. His texts and programs have been used by professionals and schools for almost 30 years. Learn more at 6 Location of symptoms in relation to nerve fiber innervation of muscles. Compression site B Compression site A Nerve

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