Pinched Nerve

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A pinched nerve is a compressed nerve. Surrounding tissues that press on nerve roots can cause pain, numbness, and tingling in different areas of the human body. In many cases, the cause is a herniated disc slipping out between vertebrae in the spinal cord and pressing on the spinal nerve that goes down the leg. Most pinched nerves originate in the neck (cervical radiculopathy), upper middle back (thoracic radiculopathy), or lower back (lumbar radiculopathy). You can also experience pinched nerves in your hands, elbows, and wrists (carpal tunnel syndrome).

A pinched nerve can be very painful, but it is usually treatable simply with rest, over-the-counter medication, and physiotherapy. Most patients recover fully from a pinched nerve, however pinched nerves can happen throughout your body based on the location of the nerves being affected. The other common areas where you will most likely feel the effects of a pinched nerve are the following:

 

  • Neck and shoulder (compressed cervical nerves)

 

  • Back and upper chest (compressed thoracic and lumbar nerves)

 

  • Arm and elbow (caused by pressure on the ulnar nerve; for example, pain in this nerve is felt when you hit your elbow’s “funny bone”)

 

  • Wrist and hand (often caused by carpal tunnel syndrome)

Causes & Symptoms

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A pinched nerve is a direct compression or pressure on a nerve either from the disc, ligament, or the surround bony structure in the foramen. Any number of conditions may cause a pinched nerve including an injury or repetitive movement. Poor posture, smoking, and heavy lifting are additional actions that may cause spinal or disc degeneration. Once a nerve becomes pinched, an inflammation process begins that may cause neck or lower back pain. The pain can radiate from the neck to the shoulder and arm or down the leg (Sciatica). Some conditions that can cause tissue to compress a nerve include:

 

  • Injury
  • Stress from repetitive work
  • Obesity
  • Sports activities
  • Rheumatoid or wrist arthritis

 

If a nerve is pinched for only a short period of time, there is usually no permanent damage. If the pressure is not relieved, chronic pain and permanent nerve damage can occur. The most common symptom of a pinched nerve is a tingling sensation which can also include numbness. Initially, this symptom can come and go, however, it can become more severe over time. The following are some of the symptoms regarding pinched nerves:

 

  • Sharp or dull pain in the lower back which may worsen with physical activity
  • Cramping
  • Muscle spasms
  • Leg weakness
  • Loss of leg function
  • Sciatica (pain, burning, electrical, tingling and numbness that extends from the buttock to the leg or foot)

 

In more severe cases, muscle weakness may occur because the nerve that controls the muscle is irritated. If this symptom is not treated properly, the muscles will decrease in size and function. If nerve compression goes untreated for a long period of time, the protective area around the nerve can breakdown and cause swelling, severe inflammation, and scarring. This can lead to peripheral neuropathy, carpal tunnel syndrome, and severe pain.

Who Gets Pinched Nerve?

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Anyone may experience a pinched nerve; however, the following factors will increase the likelihood:

 

  • Bone spurs – Trauma or a condition that causes bone thickening, such as osteoarthritis, can cause the development of bone spurs. Bone spurs can stiffen the spine as well as narrow the space where your nerves travel, pinching nerves.

 

  • Gender – Women are more likely to develop carpal tunnel syndrome rather than men, possibly due to having smaller carpal tunnels.

 

  • Thyroid disease – People with thyroid disease are at higher risk of carpal tunnel syndrome.

 

Anything which increases pressure around a nerve can cause a pinched nerve. Common causes include body position such as leaning on elbows, habitually crossing legs, or poor posture. Over time this may lead to pressure injury to nerves in these regions including the following:

 

  • Disc herniation or bulging discs and arthritis in the spine can cause pressure on nerve roots, leading to nerve pain or the discomfort associated with a pinched nerve.

 

  • Weight gain or water retention can predispose people to developing pinched nerves; thyroid disease can contribute to both water retention and weight gain, increasing the risk of pinched nerves.

 

  • Pregnancy, which is associated with increased weight and occasionally associated with water retention, is also a common risk factor for developing certain types of pinched nerves.

 

  • Repetitive activities (typing and using certain tools) can also increase swelling around specific nerves and lead to symptoms of a pinched nerve.

How Does It Affect You? How Serious Is It?

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If the nerve is pinched, the flow of blood and nutrients is reduced or blocked. Eventually, the membrane starts to lose its healthy ability to transmit tiny electrical charges and the nerve fiber may eventually die. When enough fibers stop working, a muscle may not contract and skin may feel numb. A nerve can be pinched as it leaves the spine by a herniated disc or bone spurs that form from spinal arthritis. Another common place for pinched nerves is the carpal tunnel. This is a bottleneck area, through which all the finger flexor tendons and the median nerve must pass to the hand. Regardless of where the nerve is pinched, in the neck or carpal tunnel, the patient often will feel similar symptoms of numbness in the hand, because the brain does not know how to tell the difference between the beginning, middle, or end of a nerve. It only knows that it is not receiving signals from the hand, and so numbness begins.

Recommended Rehabilitation & Treatment

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Before treatment is advised, a physical examination is often required when experiencing a pinched nerve. Patient history and physical examination are typically the very first step in diagnosing pinched nerves. Types of symptoms, duration of symptoms, treatments that have been already performed, and past relevant medical problems or surgeries, are all collected during the history review. The physician completes a physical exam to check for any specific symptoms by inspecting the back, assessing gait, and testing the upper and lower extremities for motor strength, reflexes, and range of motion. Both history and physical exam contribute to the diagnosis of a pinched nerve, however, imaging is also necessary to finalize the diagnosis. X-rays are typically obtained first to look at the overall alignment of the spine and to check for spinal abnormalities such as scoliosis (curvature in the spine), that may affect viable treatment options. These 2D results are then supplemented with advanced imaging tests such as MRI or CT scans because these show a 3D view of the spine. MRI scans show soft tissue, such as nerves and discs, so are generally preferred over CT scans, which show bony elements. Advanced imaging can show exactly which nerve or nerves are being pinched and what is causing the nerve to be pinched. History, physical examination, and imaging are all necessary in order to make a correct and accurate diagnosis to then design an optimal treatment plan for a pinched nerve.

When it comes to medical management (non-surgical), this is the first line of treatment for pinched nerves and includes the following:

 

  • Time and rest – For many people, time takes care of a pinched nerve, and it does not require any kind of treatment. The pain should go away in a few weeks or even days depending on the severity level of the pinched nerve.

 

  • Ice and heat – Apply ice and heat with any swelling area for temporary relief.

 

  • Splints and cervical collars – A physiotherapist may advise you to wear a soft hand splint or neck collar for a short time to limit motion as you heal.

 

  • Corticosteroids – A doctor may prescribe you strong anti-inflammatory medications, like prednisone, to relieve pain. These can be taken orally or injected directly into the affected area.

 

  • Physiotherapy – Stretches and light exercise can help ease pressure on your nerves and relieve minor pain. Talk to a physiotherapist about what types of exercises are most recommended for the pinched nerve you are experiencing.

 

Surgery is the last resort in treating a pinched nerve when non-surgical treatment has not relieved pressure on nerves. Examples of surgeries that can fix spinal nerve compression include:

 

  • Anterior Cervical Discectomy and Fusion (ACDF) – Surgeons will remove disc or bone spurs that have compressed nerves from the spine, then stabilize the spine through fusion. Within fusion, the vertebrae are joined, eventually forming a single, solid bone.

 

  • Posterior cervical surgery – The laminate is the arching bone backside of the spinal canal. The surgeon thins down the laminate for better access to the damaged area and removes the bone spurs and any tissues that are compressing the nerve.

 

  • Disc replacement – The injured disc is removed from the spine and replaced with an artificial part, similar to a knee or hip replacement. This allows more flexibility in the spine.

 

Mild pain may be relieved with gentle exercises in a slow manner. You can perform them while sitting down or standing up. The following exercises may help relieve the pain and discomfort of a pinched nerve:

 

Side bends – Side bends help reduce neck and back tension whilst building strength. To perform a side bend, you must stand with your hands clasped over the head. Afterward, keep the neck and head straight, then lean slowly from the core to the right and then to the left, without letting the body bend forwards or arch backwards. Repeat the procedure 10 more times.

 

Walking – Sitting in the same position for a long period of time, especially with crossed legs, can slowly damage the nerves and muscles. Instead, take frequent walking breaks. To get the most out of walking and help ease a pinched nerve, keep the head in a neutral position.

 

Shoulder rolls and shrugs – Moving the shoulders can help reduce tension in the neck. It can also alleviate the headaches that some people receive with pinched nerves and muscle tightness. To perform the shoulder roll, first off, shrug the shoulders slowly up and down for a duration of 30 seconds. Afterwards, rest for a few seconds, then roll the shoulders forwards and up toward the ears, then back down, pushing the shoulder blades together. Repeat this method for 30 seconds, then reverse the direction.

 

Twist – Some people find that performing twists can provide relief from muscle tension and nerve-related numbness. To perform a twist, you must sit in a comfortable chair with feet flat on the floor and your back in a straight position. Next, put your right hand on the left knee whilst slowly twisting to the left. Finally, hold the stretch for 5 seconds and then return to facing forwards. Repeat the procedure on the opposite side, placing the left hand on the right knee.

Alternative & Homeopathic Treatment

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There are many at-home remedies any patient can do in order to relieve the pain from a pinched nerve, including:

 

  • Rest and sleep – Getting extra sleep and rest is effective in relieving many mild body pains, including nerve pinches. Avoid physical activities that may increase your pain and overuse your nerves, such as lifting heavy objects, high impact sports, and high-intensity/high-speed exercises. Sleeping also heals nerves as the body repairs itself during sleep. Getting enough rest and sleep also helps the body reduce symptoms quicker.

 

  • Ice and heat compress – You can use either a hot or cold compress to reduce body swelling and inflammation. Apply a hot pack or heating pads directly onto the pinched nerve for 10-15 minutes at a time. This method relaxes tight muscles around a pinched nerve and increases blood flow, which is vital in the healing process. You can also apply ice packs to reduce swelling and inflammation. Just simply hold the cold compress directly onto the pinched nerve for 10-15 minutes.

 

  • Anti-inflammatory drugs (NSAIDs) – Non-steroidal anti-inflammatory drugs such as ibuprofen and aspirin, also decrease swelling and relieve the pain of minor pinched nerves. These pain relievers are available for purchase over-the-counter or online.

 

  • Splint – Wearing a splint when you experience a pinched nerve is one of the standard at-home treatments to heal the affected area and prevent further damage. A splint is also helpful to prevent any irritation when you sleep.

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