Pinched Nerves

The term pinched nerve is a general term used to describe any damage or obstruction to a nerve or set of nerves. Pinched nerves can occur almost anywhere in the body. Nerves are responsible for sending signals from the brain to the body to cause muscle contraction (movement), to direct organs and systems to perform, and for detecting sensations while sending signals back to the brain to be interpreted (pain, heat, etc.). When a nerve is pinched, these signals may not reach their destination. Pinched nerves can cause numerous symptoms and side effects, such as numbness, tingling, weakness, loss of bowel and bladder control, limping and nerve pain. In the case of a severely pinched nerve, the nerve may permanently lose function and die. We have specialized treatments to treat pinched nerves. The following list details a few of the common types of pinched nerves:

Sciatica
Radiculitis and Radiculopathy
Carpal Tunnel Syndrome
Stenosis

Sciatica

Symptoms

The trademark symptom of sciatica is shooting pain into the buttock and down the back or side of the leg. Other symptoms include burning, numbness or tingling sensations in the foot, or traveling down the leg. With more severe sciatica, weakness or difficulty controlling movements of the leg or foot may develop.

Causes

Sciatica can come about suddenly as the result of a traumatic event (slip and fall, motor vehicle accident, heavy weight lifting, sports) or it can develop over time. Sciatica is the result of your sciatic nerve being irritated and compressed (pinched nerve). This can happen from tight buttock muscles, in particular the piriformis muscle, or from pressure into the sciatic nerve from a wallet or excessive sitting.shutterstock_63759136

Background

The term sciatica is a general term often given to any radiating leg pain from a pinched nerve in the lower back or buttock region. True sciatica involves the sciatic nerve, which is the thickest peripheral nerve in your body that passes through the buttock to reach the structures in your legs. Nerves originating in the lower back supply sensation and muscle control in the lower extremities. The roots of these nerves are located very close to the spinal cord, between vertebral bones. When one or more of these nerve roots is irritated or compressed, this is diagnosed as radiculitis or radiculopathy; however, sciatica symptoms may arise. A lumbar disc herniation may be the source of nerve irritation with sciatica. Other more severe conditions, such as spinal stenosis (narrowing of spinal canal) or spondylolisthesis (one vertebrae slipping forward over the next) can also cause sciatic pain. Increased weight in the abdominal area, as is the case in pregnancy, can place strain on the lower back and result in sciatic symptoms as well.

Aligned Medical Group’s Approach

The key to healing sciatica is relieving or reducing the pressure on the nerve. Treatment may include spinal manipulation, flexion-distraction, therapeutic stretches, core strengthening and stabilization exercises, electric muscle stimulation, cold laser treatment, and ice therapy. We may use Graston Technique to reduce and break apart chronic adhesions, tightness, and scar tissue if the nerve is entrapped. Injections can be performed to target the piriformis muscle with the goal of reducing muscle tension and inflammation.

Radiculitis and Radiculopathy

Symptoms

When a spinal nerve root is pinched near its exit location at the spine, radiculitis or radiculopathy symptoms occur. Pain radiates away from the spine and either down your arm, across your ribs or down your leg, depending on the location of the pinched nerve. Numbness, tingling, pins and needles, burning and weakness may also be experienced. Typically, radicular symptoms are in either your arm or leg.

Causes

Any obstruction can pinch the nerve root, such as a herniated disc, degenerated (flat) disc, thickening of bone or ligament, cysts and tumors. Often, more than 1 structure affects the nerve root due to long-term wear and tear, and breaks down spinal structures.

Background

You have 31 pairs of spinal nerves, each of which could be pinched near the location where they exit the spine. Between your vertebrae, each side has a small opening for a nerve to pass through. Radiculitis is a term referring to the spinal nerve root (radicular) and describes inflammation (-itis). Radiculopathy implies pathology or that the radiculitis has progressed and the nerve is experiencing deficit as it dies from the compression.

Aligned Medical Group’s Approach

To treat radiculitis or radiculopathy, our primary goal is to alleviate pressure on the nerve root. We keep in mind that your nerve is both inflamed and has pressure on it when formulating your treatment plan. Re-assessment within 48 hours following your first treatment is important to determine the severity of nerve pressure. Overnight relief is a good sign that the nerve is mostly irritated, whereas more nerve pain following a gentle treatment suggests a higher level of direct mechanic pressure on the nerve. Relief is best accomplished with hands-on spinal mobilization. A gentle pull on a painful leg can greatly reduce nerve pain from radiculitis. We use flexion distraction chiropractic manipulation in order to gap or open the space between vertebrae where the nerve root is trapped. A pinched nerve often triggers substantial muscle tightness or muscle spasms, which in turn, cause more compression on the nerve.

Our initial goal is to decrease tightness so the nerve pain reduces and the nerve can heal. Ultimately, we target the pinched nerve to reduce inflammation and decompress it. We evaluate the strength of the nerve and may refer for neurodiagnostic studies if the nerve is losing its function. Nerve deficit often manifests as diminished sensation in parts of your leg or weakness in specific leg muscles. If the pinched nerve is due to a disc herniation, Vax-D spinal decompression may be the best course of action.

shutterstock_114113611Carpal Tunnel Syndrome

Symptoms

The most common symptom of carpal tunnel syndrome is numbness or tingling in the thumb, index and middle fingers. The numbness and tingling can be more pronounced during sleep, especially in the early morning hours. Fine-tuned movements of the thumb, index and middle fingers can become difficult. In severe cases, the muscles controlling the thumb become smaller and weak.

Causes

The most common cause of carpal tunnel syndrome is prolonged, repetitive movements of the wrist and hand, especially when the wrist is bent, such as with typing. Trauma from fractures, dislocations of the wrist and injuries leading to scar tissue can also cause carpal tunnel syndrome; however, this is much less common than repetitive overuse. Pregnancy, hormonal imbalances, rheumatoid arthritis and diabetes can also cause wrist swelling, leading to carpal tunnel syndrome.

Background

The carpal tunnel is the area of the wrist between the eight bones of the wrist, known as the carpal bones, and the transverse carpal ligament, which lies on the palm side of the wrist connecting the outermost carpal bones forming a “tunnel.” Passing through the carpal tunnel is the median nerve, which provides sensation on the palm side of the thumb, index and middle fingers, along with sensation to half of the ring finger, and muscle strength to the thumb. Also passing through the carpal tunnel are tendons connecting the muscles of the forearm to the fingers. Carpal tunnel syndrome occurs when the median nerve passing through the carpal tunnel becomes compressed or irritated. This compression is most often caused by swelling of the median nerve, nearby tendons or both, secondary to excessive friction in the carpal tunnel.

Aligned Medical Group’s Approach

Treatment typically involves gentle, hands-on mobilization of the wrist bones to reduce pressure and restore mobility in the carpal tunnel. This is coupled with passive manual traction performed to ease swelling. Modalities, such as muscle stimulation, cold laser, ice or heat can speed up the healing time. Flexibility, exercise rehabilitation, and education regarding proper ergonomic use of your hands are important to stabilize your condition and minimize the chance of recurrence. For more stubborn cases, we inject anesthetics or steroids into the area to reduce pain and inflammation. Some patients benefit from splinting or bracing the wrist during activities involving repetitive use or during sleep. Oral anti-inflammatory medications can also help.

shutterstock_105949631Stenosis

Symptoms

Symptoms of spinal stenosis include pain in the region of your back where the stenosis occurs, or numbness, tingling or weakness in the arms or legs. Symptoms are usually worse when standing straight or leaning backwards, and less severe when leaning or bending forward. Signs of severe stenosis include altered sensations around the buttock area, abdominal bloating and changes to bowel or bladder control. Severe stenosis symptoms are sometimes considered a medical emergency.

Causes

The development of spinal stenosis is generally the result of degenerative processes over time, rather than the result of a traumatic injury. The changes in the shape and size of the spinal canal throughout the aging process can place pressure on the spinal cord itself (central canal stenosis) or on the nerves coming from the spinal cord (foraminal stenosis or pinched nerve). This pressure on the nerve can lead to symptoms of stenosis. Genetics play an important role. If you were born with a narrow spinal canal, you are more likely to have spinal stenosis.

Background

The spinal canal is the space created through the round openings in each vertebra from the upper neck down through the lower back. The spinal cord is housed securely in this canal of bone, which offers protection. Early in life, this canal provides ample space for the spinal cord to rest without any pressure from surrounding bones or soft tissues. The shape and size of the spinal canal, however, can change over time. Ligaments around the spinal column thicken, bony spurs may develop, and discs may bulge, herniate or be pushed back into the spinal column. These collective changes are referred to as stenosis. Stenosis can occur anywhere in the spine. When changes occur in the neck, symptoms are felt in the arms and hands, while changes in the lower back bring about symptoms in the buttock, legs and feet. Stenosis in the cervical spine (neck) is a serious condition since everything from the neck down can be affected, leading to paralysis if untreated.

Aligned Medical Group’s Approach

We work as a team to develop an accurate diagnosis, a thorough understanding of where your stenosis occurs, and which therapy options will benefit you most. We prescribe a comprehensive treatment plan aimed at reducing pain, improving range of motion, and strengthening supporting muscles. Our initial goal is to reduce the stenosis and decrease the pressure on the affected nerves. The treatment plan may include spinal mobilization, therapeutic stretching and strengthening exercises, electrical muscle stimulation and ice therapy. We co-manage with therapies, such as injections for muscle tightness, support braces and sometimes Vax-D decompression to repair damaged discs. Patients are encouraged to stretch at home and we provide numerous exercises and activities to better enable you to self-manage your condition.