Pinched nerve
Pinched nerve these days is a lot more common than before; it can happen in any part of the body but a pinched nerve in the lower back and the neck are the most common areas. While most people think of sciatica when they have excruciating pain running down the legs, pinched nerve in the lower back has the same type of pain as well. Pinched nerve in the neck can cause pain going down the arm all the way or part way to the fingers. If you are active with symptoms, if you are young and not so active with symptoms, if you are elderly with symptoms, the following applies to you! Pinched nerve, with the exception of a mass pressing on the nerve, boils down to a deteriorated posture and lack of proper movement. Yes you can be an athlete and still lack proper movement!! What is pinched nerve and what does a pinched nerve feel like?
What is Pinched Nerve?
Spinal nerves in your spine are the main communication pathways between the brain and your body parts; the brain sends the command based on your needs (some you are aware of but most you have no clue about) and the body parts do as they are told and report back to the brain. There are different types of nerves that fire up based on the type of stimulus and the situation. I promise, this is not going to be a neurology course but it is important for you to understand that a well working nervous system is essential for a well working body and therefore, sustenance of health. When talking about pinched nerves, we typically talk about pressure (can start with irritation leading to more and more pressure) on a specific nerve(s) at the site of nerve exiting the spine or along the path of that nerve as it goes to the specific body part.
When it comes to pinched nerve involving nerves exiting the spine in the neck or lower back, the common presented signs and symptoms are weakness in the muscles of the arms or legs (depending on where the compressed nerve is located), pain traveling down the hands or feet and perhaps some numbness and/or tingling down the arms or legs. Let’s make sure you do know that pinched nerve is NOT the only cause of tingling nor pain down the legs and arms. Here is a blog I wrote that explains this further and the use of Active Release Technique and Trigger Point Therapy as the treatment of choice for those situations.
What Are the Signs of Pinched Nerve?
Depending on the location and severity of the condition, the signs and symptoms vary from sharp, shooting pain, numbness, tingling, down the arms or legs (depending on the location of the pinch); in case of herniated disc or some cases of stenosis, pain in the back with coughing, sneezing, or bearing down to use the bathroom are common complaints. Heaviness in the arm or legs, difficulty getting up or sitting down with increased pain, and/or difficulty finding a comfortable position are common complaints that bring patients to my office. These symptoms don’t all have to be present but the presence of those signs and symptoms require ruling out other issues before the diagnosis of a pinched nerve is made. I have seen many athletes, from weightlifters and throwers to cyclists complain about symptoms that are associated with their way of doing their sport. A Pinched nerve is NOT the issue for old and out of shape and is not gender, age and activity specific!
What Causes Pinched Nerve?
Repetitive Stress Movements like sitting behind the desk and typing, staring at your monitor or digital device all day, sleeping in the wrong position (essentially on the stomach or not having the right amount of support for the neck CURVE), being active BUT not having the right posture when doing the exercises are common situations leading to pinched nerve. Of course, if the bad habits persist through your life, it is only a matter of time that degeneration of the spine, leading to structural damage leads to irritation and pinching of the nerves at the exit point from the spine or somewhere down the path of the nerve. In my blog on neuropathy, I explore this fact in detail. Do not disregard the impact of simple things you do throughout your day on your health and in this case, your pinched nerve. Conditions such as herniated disc, and spinal stenosis, the narrowing of space where the spinal cord resides or where the spinal nerves exit the spine, or a tumor are more advanced potential causes of a pinched nerve that need to be ruled out.
What Is The Treatment For Pinched Nerve?
Depending on the severity of your condition there are many different ways to treat a pinched nerve. First, it is important to make sure the condition is in fact, pinched nerve. I have seen MANY cases of patients with misdiagnoses of a pinched nerve. Trigger points can shoot pain down the arm and leg so the key is to make sure the pain pattern follows a specific nerve pattern. While bearing down and coughing can cause pain down the leg for instance, and more than likely the issue is a disc disease, not every disc disease has those symptoms attached. Unfortunately, by the time patients come to my office, they have seen a long list of doctors and health care providers some of whom providing some degree of relief but nothing to write home about!!! Sometimes x-ray of the area is needed to rule out any structural damage that is leading to nerve irritation. At times, MRI is the best study of choice to rule out any soft tissue mass or a disc condition.
- While medication helps with pain to some degree, it never addresses the cause of the condition. If needed, many take over the counter medication to help with the pain. I do recommend Tens unit which acts as an electronic pain
- killer but never think medicine or TENS unit will make your problem go away for good.
- I do not find modalities such as Electrical Muscle Stimulation or Ultrasound beneficial toward resolving this issue and therefore unlike some physical therapy clinics and other Chiropractic offices, I hardly ever see a need for them for this condition.
- Cold Laser Therapy, is a non-invasive tool that has gained popularity recently. In my practice, I use that especially with patients whose injuries are recent or they are having a flareup.
- There are times that the source of nerve pinch is permanent. Disc herniation or stenosis of the spine is a great example of those. Fear not, just because you have these conditions does not mean you are doomed for life!! It just means that you have to be extra cautious living day to day. For instance, you should never gain excess weight especially around the abs. Keeping the back and abs strong is a requirement of keeping the symptoms at bay.
- Once pain is lessened and you are able to move with less restriction, I immediately start with functional rehab. That means strategic movements, under observation, making the right muscle perform the right task while doing Active Release Technique (ART). I am not a big fan of Graston technique but know many who swear by it. Scraping the muscles is not for everyone and frankly, it should only be done on the fit, the strong and the ones with scar tissue. That is simply my opinion and I am sure there are people out there who disagree with me!
- DNS or Dynamic Neuromuscular Stabilization is what I incorporate in almost all cases I treat in my practice. It is essentially bringing back the movement within a joint and joints together CORRECTLY when it comes to movement and activities that cause pain. DNS is nothing new and it is known as a result of studying muscle and nerve patterns developed and perfected between the ages of newborn to walking (14-16 months of age). PROPER Yoga exercises work on DNS but continue reading to know what I am talking about!
- Brain-Based Neurology and Posture, is the mapping of the brain with regards to posture, to learn where the weak areas are. You may have heard of neuroplasticity: the ability of the brain to react negatively to negative stimuli and positively to positive stimuli. By strategically activating and exercising the brain in these weak areas, we can bring those parts up to par and improve the posture. This is a fantastic way of improving the posture and improving the integrity of the soft tissue (muscles, tendons and ligaments) and joints to either remove or decrease the nerve irritation. Certain PROPER Yoga exercises activate the brain and have a positive neuroplasticity. The key is ‘proper’.
Let’s talk about yoga exercises for a moment. It is easy to mechanically perform yoga poses but not engage the right muscles, overdo the move, or disregard the compensation the body takes in order to perform the yoga pose. For the longest time, I was so proud of my own ‘happy baby’ pose just to learn through DNS that I was to engage the pelvic floor and not simply hold the pose and rock my body from side to side.
What Can I do to Prevent a Pinched Nerve?
Pinched nerve in almost all cases is acquired meaning they develop as a result of choices and lifestyle. We, as human beings are meant to move. Sitting behind a computer and resuming sedentary life is simply against the design of the body and damaging. I follow 17 tips daily that help me with better posture which in turn, minimize the chances of posture related issues- pinched nerve being a potential. Remember, good health is not about treating injuries but about preventing them! The true treatment of pinched nerve is assessing the failed posture, rebuild it step by step. Surgery is not necessarily the solution and the treatment is a process and not an event.
Daily stretches of the neck to prevent headaches are important for neck nerve irritation as well. Take a look at this video for my favorite ones.
Remember, you are the Designer and the Director of your own life so design and direct it the way you wish to live it. Your health decisions are yours and you are the active participant in the direction you go.
Dr.Shakib