Case Study: Nerve Entrapment or Fascial Dysfunction?

When it comes to cases of nerve entrapment, many clinicians simply identify the entrapment site and perform a fascial hydrodissection, injecting saline into the fascial planes to restore nerve gliding. But while that approach can provide quick pain relief, it overlooks the underlying factors that led to nerve entrapment to begin with. 

A classic example is a runner with pinpoint calf pain – the condition is often quickly labeled a “strain” or an “irritated nerve” without taking a closer look. But a more comprehensive clinical exam and ultrasound imaging frequently reveal a sural nerve entanglement, where the nerve is trapped between the crural fascia and the epimysial fascia of the gastrocnemius.

Ultrasound-guided hydrodissection, especially when higher volumes of saline are injected, can be a useful approach for pain relief, but it only treats the symptoms without questioning why the nerve became entrapped in the first place. Lasting results can only occur when the entire functional fascial plane is addressed.

Fascial densification, loss of gliding, and altered force transmission along the posterior chain — especially in runners with suboptimal mechanics — all set the stage for nerve entrapment. Simply releasing the point of entrapment without restoring fascial continuity and load-sharing is a recipe for long-term failure. 

In such cases, an integrative approach is called for: 

• The clinician must be able to match sonography images to fascial anatomy.
• Ultrasound findings must be integrated with a clinical movement evaluation.
• The clinician must have an understanding of Stecco fascial planes, and be able to manually identify Centers of Coordination (CCs) and Centers of Fusion (CFs).

An in-depth knowledge of anatomy, skills in interpreting sonography images, and the ability to identify fascial planes via palpation, all directly translate into a superior injection strategy. Not only do we need to know where to inject, but also how far along the fascial plane we need to go to restore gliding and recalibrate force transmission. 

Successful rehabilitation requires more than just asking which nerve is compressed – it demands a deeper investigation into why the fascia became dysfunctional, setting the stage for nerve entrapment.