WHAT IS A PINCHED NERVE?
A pinched nerve is a term used to describe an ailment in which a nerve has become entrapped. This is usually due to tight muscles, tendons or ligament (e.g. disc) compressing the nerve, which in term leads of numbness down the distribution area of the nerve. Discussed in this section are some of the most common pinched nerves we see at the office and their associated treatment protocols.
- SPINAL NERVE ENTRAPMENT (RADICULOPATHY)
- BRACHIAL PLEXUS SYNDROME (TOS)
- CUBITAL TUNNEL SYNDROME (ULNAR N.)
- CARPAL TUNNEL (MEDIUM N.)
- PIRIFORMIS SYNDROME (SCIATIC N.)
- MERALGIA PARESTHETICA (LFCN N.)
One of the most common neuropathies or pinched nerves is carpel tunnel in which the median nerve has become compressed at the wrist. Often times, spinal nerve entrapment is confused with other conditions such as a peripheral neuropathy like carpel tunnel syndrome. To be able to tell the source of the compression, we need only to find what elicits the numbness. If compression of the head, for example, causes a thumb to go numb, we know it can’t be carpel tunnel because the spinal nerves are being compressed with head compression. Finding the cause is critical and allows for the right treatment to be administered.
1) SPINAL NERVE ENTRAPMENT (RADICULOPATHY)
By far one of the most common conditions we treat at the office, spinal nerve compression can be very effectively treated with the right care management. Spinal nerve entrapment is usually caused by trauma (i.e. motor vehicle accident or lifting injury). Severe Inflammation and muscle guarding will follow shortly after along with tingling, burning, or numbness down an extremity. Sciatica is often times mistaken for a lower lumbar spinal nerve entrapment as the numbness distribution pattern is very similar. A few quick orthopedic tests though can help differentiate between the two. Please see the Sciatica (5) for more information if symptoms do not match a spinal nerve problem.
Our office has specialized equipment specifically geared towards treated disc related problems. Treatment is broken up into three parts. The first being the acute phase where inflammation and muscle guarding is managed. Phase two starts when the body is able to handle a Chiropractic adjustment and other muscle related therapies. Phase three is all about rehab and making sure the ligaments surrounding the injury site are strong, which will prevent future injuries. Please note that this is an inflammatory condition and is made worse by heat. Ice will calm the area down and also provide analgesics / bracing. Heat will relax the muscle but inflame the area more cause the body to recruit more muscles to brace. If a disc problem is suspected in the low back, a brace might be recommended in order to keep the muscle from overworking.
2) BRACHIAL PLEXUS SYNDROME (TOS)
Thoracic outlet syndrome is a group of disorders that occur when blood vessels or nerves in the space between your collarbone and your first rib (thoracic outlet) are compressed. This can cause pain in your shoulders and neck and numbness in your fingers. Common causes of thoracic outlet syndrome include physical trauma from a car accident, repetitive injuries from job- or sports-related activities, certain anatomical defects (such as having an extra rib), and pregnancy.
The reason for the compression of the brachial plexus will determine what treatment is needed. If the injury is trauma in nature, deep soft tissue mobilization will not be utilized during the acute phase due to muscles already being overstretched. In most other cases, stretching and muscle work is critical to loosed the grip the neck and shoulder muscles have on the nerve bundle. Chiropractic adjustments to the lower neck can greatly mobilize an extra rib for example and be all that’s required to decrease the numbness.
3) CUBITAL TUNNEL SYNDROME (ULNAR N.)
Cubital Tunnel Syndrome is a condition that involves pressure or stretching of the ulnar nerve (also known as the “funny bone” nerve), which can cause numbness or tingling in the ring and small fingers, pain in the forearm, and/or weakness in the hand. The ulnar nerve runs in a groove on the inner side of the elbow. If putting pressure on the inner elbow elicits the numbness down the arm, cubital tunnel syndrome is likely.
Depending on the reason for the conditions, a brace might be recommended to take pressure off on the inner arm. Additionally, there are Chiropractic adjustments that can be made to reposition the radial head of the humerus and ulnar bone so that more space is freed up at the joint. Many of the soft tissue techniques including Graston and rapid release therapy can help with prevention and future entrapment of the ulnar nerve
4) CARPAL TUNNEL
Carpal tunnel syndrome is a common condition that causes pain, numbness, and tingling in the first 3 digits of the hand. The condition occurs when one of the major nerves to the hand, the Median Nerve, is squeezed or compressed as it travels through the wrist. In most patients, carpal tunnel syndrome gets worse over time, so early diagnosis and treatment are important. Early on, symptoms can often be relieved with simple measures like massage, Chiropractic adjustments, wearing a wrist splint or avoiding certain activities. If pressure on the median nerve continues, however, it can lead to nerve damage and worsening symptoms.
Chiropractic adjustments to the carpal bones can reposition the muscle and tendons to decrease strain on the area. Other therapies such as Graston Technique can loosen the scar tissue even after surgery. A buildup of scar tissue and wrist tightness is a cause of this ailment, which is not a hard thing to manage and treat. Surgery is greatly overused and a second opinion or visit to our office is encourage before surgery is performed.
If you suddenly start feeling pain in your lower back or hip that radiates to the back of your thigh and into your leg, you may have sciatica. Sciatica may feel like a bad leg cramp, with pain that is sharp (“knife-like”), or electrical. The cramp can last for weeks before it goes away. You may have pain, especially when you move, sneeze, or cough. You may also have weakness, “pins and needles” numbness, or a burning or tingling sensation down your leg. This form of sciatica as opposed to piriformis syndrome, can take a little longer to heal as there is a disc involved instead of a tight muscle.
Sciatica can either fall into one of two categories for treatment. It either doesn’t respond to traction or it does. A simple test allows us to figure out which treatment path will work best. Among the other soft tissue mobilization techniques utilized at the office, it is encouraged to ice and stretch at home in between visits to help with the healing process.
6) PIRIFORMIS SYNDROME (SCIATIC N.)
Piriformis syndrome is a condition in which the piriformis muscle, located in the buttock region, spasms and causes buttock pain. The piriformis muscle can also irritate the nearby sciatic nerve and cause pain, numbness and tingling along the back of the leg and into the foot. The sciatic nerve has a very distinct distribution pattern. If the numbness travels into the anterior part of the leg or foot itself, it is likely related more to a spinal nerve entrapment problem. The exact reason for piriformis syndrome varies from sitting too long to rotation of the pelvis. For example. The pelvis on the right is higher than the left from a posterior perspective, the hamstring will be stretched on that side, which can lead to this condition.
Piriformis syndrome can be effectively treated by limiting the amount of strain on the glut muscles, which in turn eases the pressure on the sciatic nerve. Chiropractic adjustment can be crucial if the pelvis is rotated to correct the imbalance of the low body. Additionally, any muscle therapy to help loosen the muscle itself will be therapeutic. At-home therapy includes ice, stretching and gentle muscle work with a home therapy tool such as a foam roller or tennis ball.
7) MERALGIA PARESTHETICA (LFCN N.)
Meralgia paresthetica is a condition characterized by tingling, numbness and burning pain in your outer thigh. The cause is due to compression of the nerve that supplies sensation to the skin’s surface. Rotation of the pelvis, tight clothing, obesity or weight gain, and pregnancy are common causes of meralgia paresthetica. However, it can also be due to local trauma or a disease, such as diabetes.
Meralgia paresthetica can be effectively treated by correcting the imbalances of the spine and gentle muscle work to loosen the tension on the LFCN nerve. At-home therapy includes ice and targeting deep tissue stretching.