[libribook.com] Traumatic Scar Tissue Management 1st Edition

Pathophysiological Consideration
A nerve fiber remains undisturbed upon fascial traction/stretch only within
certain limits – typically up to 1 cm or anywhere from 8–20% of its ‘nontractioned’
length (Sommer 2010). When stretch of the neurofascia reaches
its boundary of ‘normal limit’, intrafascial mechanoreceptors are activated.
Mechanoreceptors monitor tensional changes and can initiate rapid
relaxation in response to sudden over-load or a quick burst of movement.
Rapid relaxation response occurs to reduce the potential that the fascia will
be torn. This mechanism provides protection from injury (Stecco et al.
2007, Chaitow 1998).
Peripheral nerves are most commonly traumatized by pressure, traction, friction,
anoxia or cutting but can also be impacted by thermal or electrical injury. Spinal
nerve roots lack well-developed epi and perineurium, rendering them susceptible
to compressive forces, tensile deformation, chemical irritants (e.g. heavy metals,
alcohol) and metabolic disturbances (Magee 2008). Neural trauma and sequelae
will be covered in more detail later in this chapter.
Nerves are supplied by extra and intraneural blood vessels and neurofascial
coverings are innervated by small nerves (Bove & Light 1997,
Sauer et al. 1999, Bove 2008). This ‘nerve of a nerve’ is referred to as nervi
nervorum. Nervi nervorum are nociceptive and also nocifensive, meaning that
they are responsive to damaging stimuli by contributing to local inflammation,
thus helping to defend and maintain the nerve’s local environment (Lembeck
1983, Light 2004, Bove 2008). Research suggests that nervi nervorum and their
associated plexus of nociceptors play a role in nerve trunk and dyesthetic pain.