Double Crush Syndrome and Smoking

In Optim's most recent COMT course, we talked about the significance of various kinds of double crush syndrome. For those of you unfamiliar with the topic, double crush syndrome refers to the concept of a nerve being affected at 2 or more separate sites. This can be due to impingement in the spine and neural tension distally. For example, the spinal nerves may be compressed slightly in addition to restricted mobility of the common fibular nerve around the fibular head. With restriction at a proximal region, the nerve becomes more easily affected due to altered blood flow and oxygenation of the nerves distally. Think of it as a "kink" in a water hose. Everything down the line already has less water and will more easily restrict water flow. In the class, we primarily focused on compression of nerves at 2 different locations, as that is what others primarily think of. However, we also discussed the possibility of lifestyle habits contributing to altered neurodynamics.

Normal nerve conduction requires approximately 20% of our body's oxygen. Thus, any situation where oxygenation or nutrition is altered can potentially contribute to double crush syndrome. Smoking is one of the most obvious examples. Smoking lowers the oxygenation of our blood and thus decreases how much oxygen our nerves can acquire. It's at this point we should become concerned with nerves having increased susceptibility to damage/abnormal signaling. Another example is altered blood sugar. Diabetes can occur from hyperglycemia. As you may have seen from your clinical experience, patients with diabetes often develop peripheral neuropathy. It is for this reason, we should consider each aspect of our patients' health when addressing the nervous system.

So how does this affect our treatment? For starters, we should educate our patients on the impact their diet or bad habits can have their nervous system, and potentially their pain. People don't like to make lifestyle changes often, but pain can be a strong motivator. While we are not experts in nutrition, we can at least point our patients in the right direction. Secondly, in patients with these conditions, it is even more important to address any neural mobility restrictions we find. With poor oxygenation and/or nutrition, nerves are put at risk for injury. Add that to any other restrictions present along the path of the nerve, and our patients are more prone to muscle weaknesses, pain, neural tension, and any other nerve symptoms. We have to improve nerve mobility and health as much as possible.

-Chris

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