What is a Pinched Nerve?
A pinched nerve occurs when a nerve exiting the spine or further downstream has undue pressure put on it and becomes irritated. When nerves are irritated they begin by sending increased signals downstream which can cause pain, tingling, a pins and needles feeling, and increased tension and trigger points or knots. As they are irritated for longer periods of time or have even more pressure placed upon them the symptoms will change to a loss of function instead of more function and that is when symptoms such as numbness, loss of sensation, and weakness begin. The exact symptoms will depend on location, but can be as simple as a small area of numbness to as serious as loss of bowel and bladder function. These are all examples of the nerve signal being interrupted and changed. Symptoms can often shoot down the limb and be described as shooting or electric. Often, specific movements are further irritating and there are frequently certain positions that give relief as well.
This increased pressure on the nerves can come from several different types of sources. Often happening more frequently in places where nerves go through tunnels or other small spaces in the body. This can occur anywhere throughout the body but is typically seen in the neck, low back, shoulder, and wrist. The pain is typically named based on the location, with the term radiculopathy traditionally used. So for example, a pinched nerve in the neck that runs down the hand would be called cervical radiculopathy. Other names describing types of pinched nerves include spinal stenosis and nerve entrapment.
What Causes Pinched Nerves?
These compressed nerves can occur for many reasons, including: tight muscles, herniated discs, joint restrictions, chronic postures, overuse injuries, and trauma. Both pregnancy and arthritis can also increase your risk of a pinched nerve by changing how you move as well as the amount of space the nerve has when exiting the spinal column.
Tight muscles can be caused from chronic poor posture or repetitive movements from work or sports. Chronically poor posture and repetitive movements can change the way we move as well as increasing tight muscles. This could be something as simple as having a desk job and sitting every day at work for years. Additionally, habits such as sitting on a wallet in a back pocket, always crossing the same leg over the other, or leaning to one side such as when driving a car or sitting on the couch can also contribute. The small changes when done over years and decades can create joint restrictions as well as tight muscles.
Trauma due to accidents or falls can also cause joint restrictions or muscle tension that change how we move over time. These altered movement patterns can create muscle activations and tension that are not ideal, and contribute, with repetition, to pinched nerves. Additionally, herniated and bulging discs can restrict the space that the nerve has to exit the spine, irritating the nerve as it leaves the spinal column. General and local inflammation can increase how easily a nerve can be irritated and further restrict space for the nerve to exit the spine.
During pregnancy changes such as weight gain, baby growth, and hormonal changes that affect ligaments can cause large posture and muscle activation changes. Therefore, there is also an increased incidence of carpal tunnel syndrome as well as sciatica. These are both instances of irritated nerves due to increased pressure.
Arthritis of the vertebrae in the spine adds bone which can further restrict the tunnels that the nerves exit through. Herniated or bulging discs change shape and occasionally bulge into the tunnel where the nerve is exiting the spine. These are a very common cause of nerve irritation and radiculopathy.
Signs it’s More Serious
Often pinched nerves resolv with rest, ice, and at home stretching. However, some cases are more serious and require professional conservative or even possible medical referral.
The number one reason to see a professional would be weakness, as it is the most serious symptom. Weakness indicates a loss of function and sometimes requires medical intervention like steroid shots and even surgery. If you are having a loss of function including things such as dropping objects, having trouble walking, or especially loss of bowel or bladder function… you should seek professional help. Handling symptoms like that on your own does not usually help. Other signs that would require professional care would include if symptoms are getting worse, spreading, or lasting more than several days. Muscle tension that is made worse or not improved with at home soft tissue work would also indicate that a professional may be needed to overcome the pinched nerve. Trigger points in muscles that are very tender to the touch and are not improved with massage would also indicate that treatment may be needed.
Nerve irritation tends to go further away from the body the worse it is. So, if symptoms from your neck are shooting into your shoulder and a few days later are in your forearm, that is a sign it is getting worse. Likewise, if you have pain from your lower back into your toes, and after some stretching only to your knee… that is a sign it is getting much better. These are all instances in which you should be evaluated by a Chiropractor, Physical therapist or medical Doctor.
How We Treat Nerve-related Issues
At IHS, we use an exam to discover why the nerve is pinched in the first place. This helps us target our treatment so we are primarily focused on the muscles, joints, or discs that are responsible for the nerve irritation. We often ask a lot of questions about postures, habits, movement patterns, and even sleeping positions to try and discover why this happened. Putting all that together helps us come up with a plan that is specific for you and takes into account exactly what needs to change and be addressed so that symptoms resolve and ideally this never happens again.
We use a combination of chiropractic adjustments to restore movement to restricted joints. We also use dry needling with tens and manual therapy by hand or using instruments to release tension and trigger points. At home stretches are also often given to ensure faster results and consistent muscle work. Finally, based on the exam and any altered movement patterns, we use at home functional rehabilitative exercises to restore proper patterns. This helps further relieve tissue tension and set up a new pattern to discourage this issue from happening in the future. If adhesions in the nerve sheath are suspected, then nerve flossing is also integrated into the protocol.
Putting all these types of treatments together is extremely effective and gives the best chance for conservative care to alleviate symptoms and prevent future issues. If treatment is not helping as expected, imaging and referral are indicated and discussed.
At-home Strategies
Typically most at home strategies would include ice, rest, heat, and muscle work such as pressure and stretches. Ice is typically best used at the origin of the pain/nerve. So for example, pain that begins in the back and runs down the back of the leg should be iced at the back, not the leg. Icing the leg will not help. Heat is typically helpful wherever there are tight muscles and for more chronic issues. Pressure can be a really useful tool for relaxing muscles and can be as simple as leaning into a tennis ball against the wall or floor. Stretching out the affected area and tight muscles can also be really relieving and helpful. Rest can help with pinched nerves that are caused by repetitive movements. This can be changing your ergonomics, such as getting a standing desk when you have been sitting for years. Or, could be as simple as an over the counter brace to limit movement of the body part.
Additionally, figuring out if there are triggers that are causing an increase in symptoms can be very helpful. This can be something as simple as changing how you sit at your desk, the height of your chair, to making sure you have good movement patterns for things you do many times a day such as standing up for missing position, and getting in and out of a car. Even really small things make a difference when you do them thousands of times.
A Recent Pinched Nerve Patient
At integrated health solutions patients coming in with symptoms of a pinched nerve are very common. A recent patient came in with pain in his neck and upper back as well as difficulty lifting his shoulder. He had begun having increased tension and pain in his neck/upper back several years prior. The sensation was not consistent and would come and go and he didn’t think much of it. Over time, the sensations became stronger and more frequent and began affecting his shoulder and eventually down into his hand. By the time he came into the office, he could not bring his arm all the way up to his ear and he had near constant pain and tingling into his entire hand. Everyone has a different limit for pain, but there is no need to suffer like this! Earlier treatment would’ve avoided the escalation of symptoms as well as most likely had an improved response time to treatment. using some of the methods discussed earlier. We were able to receive the pain and throbbing sensation out of his hand and return him to fall shoulder mobility. The neck and upper back tension was the last piece to resolve. In his case, excessive computer time and clenching his jaw had increased the tension of the muscles running up and down the sides of his neck. This increased tension had pinched the nerves at the lower neck that are responsible for all movement and sensation in the entire arm in hand. We used a combination of dry needling, soft tissue work to his jaw and neck, adjustments, and at home exercises. The main focus was on stopping the jaw clenching and improving the way he moved and used his shoulder blade/shoulder. Within 3 treatments he was feeling very improved and had a total resolution of symptoms in 12 visits. He also had improved shoulder movements, so he should not have this problem again!
Pinched nerves are very common and quite treatable. They can often be treated at home with rest, muscle work, and ice. However, ignoring consistent or worsening signs can lead to more serious issues and lasting pain. With the right conservative treatment, full functions can usually be restored with a return to a pain-free life. Don’t wait until symptoms become severe – schedule an appointment today to be evaluated and start feeling better. Nerve pain does not always get better on its own, so let’s catch it early!
Sources:
https://www.healthline.com/health/pinched-nerve-remedies
https://www.spine-health.com/blog/how-long-does-pinched-nerve-last
Content Provided by Dr. Elizabeth Bouse
