Categories: Injuries

Understanding Pinched Nerves: Causes, Symptoms, and Treatment Options

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You might have heard one of your friends or coworkers complain of having a “pinched nerve”…but what exactly does that mean? A “pinched nerve” condition is equivalent to the medical terminology of a “radiculopathy”. Webster’s dictionary describes a radiculopathy as an “irritation of or injury to a nerve root (as from being compressed) that typically causes pain, numbness, or weakness in the part of the body which is supplied with nerves from that root”. Typically, these nerve roots are squeezed as they exit the spine. Therefore, a radiculopathy can occur in any part of the spine from the lumbar (low back), cervical (neck) or thoracic region (mid-back which is more uncommon and will not be discussed). [Due to thoracic radiculopathies having less common occurrences, the following information will be concentrated on lumbar and cervical radiculopathy.]

Depending on the nerve pathway that is specific for that nerve root being compressed, radicular symptoms can present as intense shooting or lancinating discomfort, electrical, intense, dull ache, burning, tingling, numbness or weakness. Therefore, the skin or muscle to which that nerve connects or innervates to will be affected.

For example, “sciatica” is a common type of radiculopathy which stems from pressure on one or more roots of the sciatic nerve as it originates from your lumbosacral region to supply the leg for sensation and motor (muscle) activity. In the neck, the most common radiculopathy would be between the 6^th and 7^th cervical vertebrae which compresses the C7 nerve. It can also occur just like sciatica in the low back but obviously affects the arm rather than the leg.

Furthermore, radiculopathy can be due to three main causes:

The disc between the vertebrae allows for a combination of motion and stability while offering shock absorption during various spinal activities. A herniation of a lumbar or cervical disk will encroach upon or crowd and put pressure on one of the roots of the spinal nerve as it exits out of the spinal region from the space or hole created between the vertebra and disk called the foramen.
Another cause can be attributed to degenerative disk disease (DDD) at the lumbar or cervical region. As we age, the space between our vertebras diminish as the disk height also decreases. Such loss of disk height would cause the foramen to also shrink which could also put pressure on the nerve, resulting in various arm or leg symptoms mentioned above.
Spinal stenosis can also place pressure on the nerve root as the actual bony or anatomical space of the foramen decrease due to arthritic changes such as bone spurs.

Home options for relief are listed below, but due to the serious nature of radiculopathy, it would be advised and highly recommended to seek professional medical or chiropractic assistance. For example, if the following symptoms or “red flags” are present, please seek immediate medical attention: changes in bowel/bladder or sexual function, rapid unexplained weight loss, unchanging constant pain, drop foot in either leg, loss of balance, rapidly worsening condition, history of cancer, immunosuppression or osteoporosis.

Radiculopathies can often be helped by conservative measures including chiropractic care and spinal manipulation as well as physical therapy techniques. Additional interventions can involve more aggressive medication, imaging, epidural injections and even surgical options.

Home Options:

Modalities such as ice and heat on the neck or low back (not the arm or leg).
Relieving stretches called “positional traction” which typically takes pressure off the nerve root.
Positions that typically reduce pressure on the nerve root.

WHAT YOU WANT TO HAPPEN

Good, proper progress during a specific therapeutic activity would be defined if the intensity, frequency, or duration of the arm or leg discomfort would diminish while moving up the arm or leg toward the source of the “pinched nerve” at the spine. This improvement would be called “centralization.” PERFORM EXERCISES OR STRETCHES THAT CAUSE CENTRALIZATION.

WHAT YOU DON’T WANT TO HAPPEN

If an activity creates more intense leg discomfort and greater symptoms further down the arm towards the hands or further down the leg to the foot, that activity should be avoided. Such “peripheralization” of the “pinched nerve” symptoms will not assist in your recovery. AVOID EXERCISES OR STRETCHES THAT CAUSE PERIPHERALIZATION.

VERY IMPORTANT: Any exercise should be performed in a relatively pain-free manner with the correct form AS QUALITY IS MORE IMPORTANT THAN QUANTITY. For example, the “no pain no gain” motto DOES NOT apply to this condition. You can have a strong stretch or a sense of muscular fatigue, but you SHOULD NOT have an increase of symptoms like shooting, numbness, tingling or sharp, lancinating in the arm or leg.

Bibliography

Ailianau A et al. Review of principal spinal pathologies causing sciatica and new MRI approaches. British Journal of Radiology. 2012 June; 85 (104): 672 – 681.

Alila Medical Media.com: Cervical spondylosis

ChiroGreek.com

C6C7 Pain Symptoms, Sohrab Gollogly, Author at Sohrab Gollogly, MD

Freburger JK et al. The Rising Prevalence of Chronic Low Back Pain. Arch Internal Med. 2009 Feb 9; 169 (3): 251 – 258. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4339077/pdf/nihms662073.pdf

HEP2Go.com

Iyer S and Kim HJ. Cervical radiculopathy. Curr Rev Musculoskelet Med. 2016 Sep; 9(3): 272–280.

Koes B et al. Diagnosis and treatment of sciatica. BMJ 2007; 334: 1313 – 1317.

Marin BI et al. Trends in health care expenditure, utilization and health status among US adults with spine problems, 1997 – 2006. Spine. 2009; 34: 2077-2084.

Middleton K, Fish DE. Lumbar spondylosis: clinical presentation and treatment approaches. Current Rev Musculoskeletal Med. 2009 June; 2 (2): 94 – 104.