What is a Nerve Injury?

Jul 29

Do you have pain, numbness, tingling, and/or muscle weakness in a limb or body part? Did this occur from an injury or impact? You may be dealing with signs of a nerve injury.

How Common are Nerve Injuries?

It is estimated that around 20 million Americans suffer from peripheral nerve damage. Up to 70% of people with diabetes have some level of nerve damage (6).

What Causes Nerve Injuries?

Direct nerve injuries are rather rare, as our body is designed to protect our most vulnerable tissue, nerves included. Nerve injuries are nevertheless frequently seen in traumatic events. Things such as car crashes, sports collisions, overuse injuries, fractures, and lacerations can injure our nerves. These can produce severe symptoms, some of which may be potentially irreversible. The severity and duration of symptoms determine the classification of nerve injury.

There are three main categories of nerve injury:

Neurapraxia as temporary rupture of the nerve impulse delivery occurs with nerve demyelination at the site of injury without rupture of nerve continuity. Complete recovery is achieved upon remyelination, which can take up to 12 weeks.

Axonotmesis is rupture of axon and degeneration distal from the site of injury and proximal to the next Ranvier’s node. Regeneration of the axon proceeds from the site of injury to peripheral organs, at a rate of 1 mm/day.

Neurotmesis is complete interruption of nerve continuity without the possibility of spontaneous function recovery (1).

What are the Symptoms of Nerve Injuries?

Injuries to sensory nerves can result in pain, touch sensitivity, numbness, tingling or prickling, burning sensations, and problems with positional awareness. Damage to motor nerves can produce, weakness, muscle twitching, muscle atrophy, and even paralysis. Damage to autonomic nerves can result in dizziness and light-headedness, constipation, bladder dysfunction, sexual dysfunction, and dry eyes and mouth.

How do Nerve Injuries Affect the Nervous System?

Peripheral nerve injuries have been shown to cause changes in the spinal cord associated with pain processing. Peripheral nerve injuries are often associated with neuropathic pain, and changes in both the central organization and cellular function of pain relay systems in the spinal cord can promote neuropathic pain (8).

A number of negative brain changes have been demonstrated following peripheral nerve injury, including spontaneous neuronal activity, abnormal neuronal responsiveness, new neuronal receptive fields, changes in body maps, and abnormal functional or structural connectivity between brain regions and networks (9).

How are Nerve Injuries Usually Treated?

Diagnosis of the type of injury is usually performed by an examination in coordination with needle elecromyography testing, which measures the nerve and muscles response to electrical stimulation. The healing process begins with Schwann cells, which help insulate and regrow our nerves. Peripheral nerves regrow slowly, at a rate of roughly 1 inch per month. Before they can begin to regrow, the damaged axon will first retract and stabilize before starting to project again towards the target tissue. Muscles that rely on nerve input will atrophy and die off if they do not have their nerve supply restored within roughly 18 months. The nerve fibers that run from the back to the feet are single neuron axons, and depending on the site of injury, this may be pushing the limits of the window of time available for reinnervation. Therefore, it is important to support these cells as much as possible. Research has shown promising results with microsurgery, including nerve grafts and stem cells. This helps Schwann cells and promotes neurotrophic factors and neuropeptides that can enhance the survival and regeneration of nerves (2).

How is the NeuroRescue Program Different?

There are a number of non-invasive therapies that can help with nerve injuries. Gordon and English (3) reviewed literature and found a significant benefit of electrical stimulation to the proximal stump of injured nerves aiding in regeneration. They also found some varying, but mostly positive benefits of exercise, both without, more successfully in conjunction with electrical stimulation.

Studies have demonstrated that electrical stimulation can significanlty increased regeneration of sensory nerves (4,5). Brain-derived neurona; growth factor (BDNF) was also increased by the electrical stimulus. BDNF is a protein that helps promote neuronal connections and regeneration nerves.

We use a wide range of electric stimulation technologies to aide in many different conditions, including nerve injuries. One therapy is peripheral nerve stimulation through a somatosensory evoked potential (SSEP) device, which uses repetitive polarizing electrical stimulus to activate specific peripheral nerves. We may also employ electrical therapies such as interferential current, which has been shown to be very effective in pain reduction (9).

We may employ different types of photobiomodulation strategies as well, including laser and LED therapies. Low-level laser therapy has been shown to be effective in enhancing sciatic nerve regeneration following a crush injury (10). High power laser therapy in conjunction with exercise programs has been shown to be effective in reducing pain and improving median motor nerve conduction studies in patients with carpal tunnel syndrome (11).

We may use various manual therapy techniques, which have been shown in cases of carpal tunnel syndrome to result in similar outcomes on pain and function to surgery (12), and better results than electrical therapy in pain reduction, subjective symptoms, and functional status (13).

We may engage in hyperbaric oxygen therapy, which has been shown to increase the mean axonal diameter in nerve injuries, which suggests a more advanced regeneration process (14). We may employ mirror therapy techniques to help your brain remap the denervated tissue to restore sensorimotor control and functional capacity (15).

We may include balance and coordination training to stimulate the sensory pathways that are the most effective in improving balance and coordination (16), as well as helping to promote nerve regeneration and prevent muscle atrophy (17). We may include vestibular rehabilitation to mitigate fall risk (18). We may include transcranial magnetic stimulation to reduce perception of neuropathic pain (19).

We may also employ supplementation strategies to help limit nerve damage and promote nerve repair and regrowth, including things like vitamin B12 (20) or Hypericum (21).

We tailor all of our therapies to the unique features of your case, to give you the best opportunity for a functional recovery. No two nervous systems are alike, and the same is true of the NeuroRescue program.

How Does the NeuroRescue Program Work?

We design your unique NeuroRescue Program to be among the most comprehensive diagnostic and therapeutic protocols available today. We create individual NeuroRescue Programs based on a comprehensive analysis of every relevant neurological system and pathway, using gold-standard, cutting edge neurodiagnostic technologies and examination procedures and state-of-the-art therapies.

We begin with your Discovery Day, wherein we perform a comprehensive history of not only your condition, but your life on a timeline. This allows us to dive deeply into your case and see all of the factors that led to where you are now. It helps us uncover hidden problems and associated conditions that may be making it difficult for you to move your recovery forward.

Our examination allows us to identify the areas and pathways of your brain and peripheral system that have been impacted to cause your nerve injury. We begin by precisely quantifying the function of your visual, vestibular, and proprioceptive systems through computerized analysis of your eye movements, your inner ear reflexes, and your balance in a host of different sensory conditions.

We employ technologies including Videooculography and Saccadometry to measure several classes of eye movements. We use Video Head Impulse Testing to measure the function of your inner ear, and Computerized Dynamic Posturography to assess your balance in different sensory conditions.

We use NeuroSensoryMotor Integration testing to evaluate hand-eye coordination and cognition, and Virtualis testing to assess dynamic eye tracking and perception of vertical in a virtual reality environment.

We combine all of this with a comprehensive physical and neurological examination of your sensory, motor, autonomic, and cognitive systems. We review any relevant laboratory testing, radiological imaging, and prior neurodiagnostic testing, and integrate that information with our findings.

We use this information to identify which parts of your nervous system are working properly, which systems are struggling, and the precise point at which your systems fatigue.

We can then design a NeuroRescue Program that is unique and specific to your brain, and yours alone. Your NeuroRescue Program works to rejuvenate and reintegrate the damaged neurons and pathways in your brain. It works to improve energy, endurance, and functional capacity within your fragile systems.

We use our technologies and procedures to not only see what we need to address, but also when it is time to stop and let you rest. We address your impaired neurological function from multiple angles of therapy, and provide metabolic support to improve neurological recovery.

Your NeuroRescue Program allows us to take the pathways that are inefficient and maximize their efficiency and endurance. And by focusing on the integration of systems, we can do more than just get pathways working better, we can get them working together again. This gives us our best opportunity to help you get your nerve injury under control and return you to living a healthy, vibrant, and fulfilling life.

Your Next Best Step:

There are non-invasive options for recovering from nerve injuries. To see if the NeuroRescue Program is right for you, contact one of our patient care coordinators to schedule your Discovery Day. And remember, it’s never too late to start getting better.