8.5. Nerves move to avoid damage

Public examination of a doctoral dissertation in the field of Physiatrics

Doctoral candidate: MSc (Orthopaedic Medicine) Marinko Rade

Date and venue: 8.5.2015 at 12 noon, Canthia CA102, Kuopio Campus

Language of the dissertation and the public examination: English

New data presented by Marinko Rade in his doctoral thesis can help explain the insurgence of widespread syndromes such as Carpal Tunnel Syndrome or Sciatica. He showed that neural movements can be measured using non-invasive techniques, also applicable in diagnostics and rehabilitation planning.

For the results published as part of his thesis, he has been awarded the "Young Scientist Award 2013" by the Finnish Spine Society, and the "2014 Young Investigator Award" by the world top-rated scientific journal Spine.

Work or hobbies can put a strain on nerves

Daily motions can be extremely various in terms of movements of peripheral nerves. Office workers can be writing for hours on computer keyboards, repeatedly compressing the median nerve in its pathway into the carpal tunnel, but not all of them will develop carpal tunnel syndrome. Water polo and handball players are vulnerable for stretching of the median nerve around the glenohumeral joint and in front of the elbow during the preparation for a shoot, but not all of them will become symptomatic and develop peripheral neuritis. Auto mechanics are prone for compression of the median nerve in the carpal tunnel in a similar way as keyboard workers do but not all of them will eventually need medical help. Marinko Rade's doctoral thesis helps us better understand the reasons behind all this.

Nerves move, this is why

It has been widely showed on cadavers that nerves move. But why should nerves move within the body in the first place? It is believed they move in order to avoid potentially harmful mechanical forces such as tension and compression. So nerves slide longitudinally to avoid tensile forces and transversally within our body to avoid compression. However, it has not been known whether the direction and magnitude of such movements can be measured and predicted in patients.  Marinko Rade showed in his dissertation that neural movements can indeed be quantified and also predicted, and moreover, using non-invasive techniques.

His research offered new data on the subject, particularly in aspects that have not been studied before, namely spinal cord movement and muscular protective effects during limb movements that produce excursion of nerve tissues. Research on living patients now being possible, cadavers may be a thing of the past.

More individual rehabilitation planning

In the first part of his doctoral thesis Marinko Rade explored the use of magnetic resonance imaging to investigate the neural movements into the thoraco-lumbar vertebral canal of in-vivo and structurally intact asymptomatic human subjects. He showed that those movements can be predicted and used in clinical practice to perform diagnosis and plan a very specific rehabilitation process.

In the second part of his doctoral thesis he focused on electrophysiological methods to quantify the muscular reactions in response to neural stress following the hypothesis that the muscles may be reflexively activated in order to protect the peripheral nerves in the most logical way; by shortening their pathway and opposing the harmful body movement. From the results it seems that it is indeed like that.

"In order to explore the normal neural adaptation mechanisms, the principle of no-harm has to be respected, that is, the investigation methodologies have to be non-invasive," Marinko Rade says.

He adds that the aim of his dissertation is not only to present plain data, but to try to shift the clinician's concept of nerves passively enclosed in tunnels delimited by bones, ligaments and muscles,  to the concept of nerves sliding and moving freely in those tunnels in order to avoid potentially harmful mechanical forces as tension and compression arising from interfacing structures, and increase the awareness of the fact that those movements can be measured, understood, predicted and also possibly used at our advantage in our everyday clinical practice.

"It is theorized that the preservation of a free sliding of the neural structures in the anatomical tunnels might be the conditio sine qua non for maintaining an asymptomatic situation. If this will be achieved, then this thesis will have served its purpose."

The doctoral dissertation of Master of Science Marinko Rade, entitled Between neuroradiology and neurophysiology: new insights in neural mechanisms will be examined at the Faculty of Health Sciences. The opponent in the public examination will be Professor Jacob Patijn of Maastricht University, and the custos will be Docent Olavi Airaksinen of the University of Eastern Finland.

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