What is a pinched nerve?

A pinched nerve occurs when excessive pressure is applied to a nerve by surrounding tissues — such as bones, cartilage, muscles or tendons. This pressure disrupts the nerve's function, causing pain, tingling, numbness or weakness.   A pinched nerve can occur in a number of areas in the body, as well as in the spine. A herniated disc in your neck or back may cause numbness and pain in your extremities, bone spurs, degenerative disc disease, and various bony changes may compress nervous tissues. The cranium bones may also compress nerves that may cause head and neck pain.   A number of conditions may cause tissue to compress nerves. Injury, poor posture, osteoarthritis, stress from repetitive strains, sports, occupations, stressful hobbies, bad habits, or tight muscles can contribute to or cause of nerve pressure.    

What are the common causes of a pinched nerve?

    A pinched nerve occurs when too much pressure (compression) is applied to a nerve by surrounding tissues. In some cases, this tissue might be bone or cartilage, and in other cases it may be muscles or tendons:  
  • Herniated disc may compress a nerve root as it exits the intervertebral canal and causing pain that radiates down the arm or the back of your leg (sciatica).
  • Degenerative facet joint with little bone spurs overtime infringe on the available space and passage for the nerve root. Specific movements will close this space more and together, the disease and the position will pinch the nerve chronically and repetitively
  • Carpal Tunnel syndrome in the case of carpal tunnel syndrome, a variety of tissues may be responsible for compression of the carpal tunnel's median nerve, including structures in the wrist as well as structures in your neck that may create a double crush syndrome.
  • Tight and over developed shoulder and chest muscles. Muscle or tendons may compress passing nerves and this can happen in the area of the pectoralis minor, as well as the anterior and posterior scalene muscles, typically when muscles become very tight from overuse and working postures. The nerves may be compressed as they travel form your neck to your arm and this condition has been known as thoracic outlet syndrome.
  • Upper ribs and muscles of the neck may compress the brachial plexus of nerves traveling down the side of the neck and under the axilla and also cause pain and numbness in your arms and hands
  • Muscles – Pirifromis is a muscle that travels from your sacrum (tail bone) to your hip bone and it is responsible for rotating and stabilizing the hip joint. The sciatic nerve passes directly beneath or occasionally through the piriformis muscle. Due to this anatomic relationship, the sciatic nerve can be compressed if the muscle is tight and or following a piriformis strain. It is common in those who have:
    • stiff hips, lower back and pelvic joints.
    • weak gluteals muscles
    • poor posture
    • in those who train excessively or inappropriately
    • long distance runners and walkers
    • inadequate warm up
    • a pronation pattern of lower body posture
  When this occurs the condition is known as piriformis syndrome. This syndrome is one that is typically missed as a diagnosis because it can cause very similar pain to that of sciatica caused from a disc herniation or pinched spinal nerve root. It takes a very experience physiotherapist to determine which of these structures is the cause, and in the case of these two differential diagnoses, it is critical because the treatments are critically different in nature. A herniated disc pinching the nerve root requires a flexion pattern of exercises while a piriformis syndrome requires the opposite.

 

What can increase the risk of experiencing a pinched nerve?

  • Posture. Poor posture adds pressure to your spine and nerves. Specifically ask your physiotherapist about a forward head posture and how it compresses the nerves of the lower thoracic spine that supply the arms. Sitting, reading, working, and many occupations and physical activities if performed with poor mechanics can become a risk factor.
  • Gender and Genetics. Women are three times more likely to develop carpal tunnel syndrome, possibly due to having smaller carpal tunnels. Genetically, some people appear to be genetically predisposed to conditions that lead to pinched nerves.
  • Bone spurs. Trauma and or bone thickening, such as osteoarthritis, and degeneration can cause bone spurs and one spurs can stiffen the spine as well as narrow the space where your nerves travel, pinching nerves.
  • Overuse. Jobs or hobbies that require repetitive, head, shoulder, elbow, hand, wrist movements, such as assembly line work, dentists, technicians, and or anyone who performs increase your likelihood of a pinched nerve.
  • Injury and or accidents. In some cases, trauma and or very quick movements may create an acute pinched nerve.         
   

What is the prognosis of pinched nerves?

    This pressure causes inflammation of the nerve and disrupts the nerve's function. If a nerve is pinched for only a short time, there's typically no permanent damage. Once the pressure is relieved, nerve function returns to normal. However, if the pressure continues, chronic pain and permanent nerve damage can occur.    

How can physiotherapy and massage therapy help pinched nerves?

This problem requires urgent care to stabilize an acute episode. The most frequently recommended treatment for pinched nerve is rest, reliving positions, and modalities such as Low intensity Laser Therapy (see below) that reduce inflammation and promote healing. Your physiotherapist will be able to educate you about these modalities and the things that you can do to reduce inflammation.   Depending on the location of the pinched nerve, you may need a splint or brace to immobilize the area. If you have carpal tunnel syndrome, your physiotherapist may recommend wearing a splint during the day as well as at night because wrists flex and extend frequently during sleep. One common nerve compression syndrome is call the piriformis syndrome and this condition produces sciatic like symptoms as well as buttock pain and requires manual physiotherapy and massage therapy to resolve and then a program of stretches and myofascial release. Likewise, when soft tissues are the culprit, the release of these structures is how physiotherapists and massage therapists can help you.

   

Manual Physiotherapy

Manual physiotherapists are educated in the anatomical and pathological sciences and understand the biomechanics of human movement. Pinched nerves require an assessment by a health care provider to determine the structure and or position or movement mechanics that is responsible for the compression. Your physiotherapist and your doctor can help you. As part of this process, your physiotherapist will assess you and make recommendations that are related to the anatomy and biomechanics of movements.  Although the most widely know pinched nerve is from the neck or back, they also occur from soft tissues like muscles and ligaments. Carpal tunnel is an example of a nerve compressed as it passes thru a bony and ligamentous tunnel at the wrist. Piriformis syndrome is a pinched and compressed nerve in the buttock where the piriformis muscle because tight and affects the nerve. Physiotherapists have an understanding of anatomy and pathology and how the biomechanics of movement affects these structures. There may be exercises, activities, and positions that are adding to the problem and aggravating the inflammation. These may have to be modified or stopped until your nerve settles down. The sports medicine approach to physiotherapy is to modify or replace rather than stop.

How can exercise and physical development help after pinched nerves?

Assessment of Functional Movement

We start with a functional movement screen that looks at some of the essential movement skills for daily living and also for an activity based lifestyle. This information in addition to our previous orthopaedic assessment findings will allow us to develop a personal improvement plan just for you. This plan will have specific goals, be measurable, will call you to action, will be realistic, and will be time sensitive so that you will see progress and we will monitor and support your success from a medically based standpoint and from a sports science stand point.

   

Rehabilitative Exercise after a Pinched Nerve

Initially, exercises and positions are designed to correct posture and decompress the affected nerve. Pinched nerves, with the exception of those caused in an accident, can benefit from a progressive rehabilitative program. There are specific positions and exercises that can decompress the nerve and allow the nerve to heal and in conjunction with laser therapy, rest, and avoidance of aggravating positions the nerve inflammation will settle down. and posture is important. As pain improves, the physiotherapist will perform a functional movement screen and evaluate the functional and biomechanical roots to your imbalances. With this information along with the orthopedic examination performed on your initial visit will be analyzed and a physiotherapy diagnosis made and treatment plan of exercises to correct any deficiencies that you may have to regain strength and correct posture. There are a series of exercises to progressively develop optimal posture. Patients will start with simple posture correction exercises that both reinforce good posture but also stretch and strengthen this postural pattern. Trunk control, engaging the abdominal muscles and core and head control by engaging the scapular muscles and brining your shoulder blades back and down.  Initially in standing and in supine, later in sitting and while lifting and bending. Abdominal control during different activities and in different positions is essential for the development of safe functional movements such as when, lifting or bending, or working and then during posture control while driving a car or putting dishes away or working at the computer etc. We typically start with active postural correction and then with resistance using elastic bands and cables. Your Physiotherapist will advise which exercises are appropriate at which point of each patient's treatment and will progress the exercises throughout the course of treatment.

   

Physical Development after a Pinched Nerve

The final step is to establish a personal improvement health plan to continue to develop physically throughout your life. This is especially necessary after injury or an accident when you have become deconditioned. All of our staff have a combination of health sciences and sports sciences training, having dual training in both kinesiology and physiotherapy and allowing us to provide a biomechanical focus. Once you have recovered from your injuries, our therapists will perform a functional movement screen and analysis to identify individual muscle imbalances that are unique to your inherited structure, to your movement patterns, and to your goals and interests in living a healthy physical life. We develop a individualized program that focus on:  
  • Your specific imbalances and movement patterns at work, home, and those evident during the activities that you participate in.
  • You structural and genetic posture and alignment characterizes and how they affect your interests to do activity etc.
  • We look at the ergonomics specific to your workplace and home
   

How can low intensity laser therapy help pinched nerves?

Low Intensity Laser Therapy (LILT) is the use of monochromatic light. Meditech Bioflex has been producing this technology for 20 years and has an extensive in house clinical lab.   The light source is placed in contact with the skin allowing the photon energy to penetrate tissue, where it interacts with various intracellular biomolecules resulting in the restoration of normal cell morphology and function. This process also enhances the body's natural healing propensities.   Low Intensity Laser Therapy does not heat or cut tissue. Unlike many pharmacological treatments that mask pain or only address the symptoms of the disease, Laser Therapy treats the underlying condition or pathology to promote healing. The technology utilizes superluminous laser diodes to irradiate diseased or traumatized tissue with photons. These particles of energy are selectively absorbed by the cell membrane and intracellular molecules, resulting in the initiation of a cascade of complex physiological reactions, leading to the restoration of normal cell structure and function.   The process is curative and therefore results in the elimination of symptoms including pain. In addition, it enhances the body’s immune system response and facilitates natural healing. The therapy is completely safe and has no adverse side effects. The technology is highly effective in the treatment of musculoskeletal conditions, arthritis, sports injuries, wound healing and a wide range of dermatological conditions. Whiplash injury typically involves injury to muscles, ligaments, and joints and typically involve several levels and a more wide spread area of injury due to the force full nature of the injury. Muscles of the neck, although short, cross over several joints and so the discomfort is generally more global initially. Laser therapy directed by multiple diodes are able to reach these tissues.    

Physiological effects of Low Intensity Laser Therapy

With LILT there is an increased production and release of:  
  • Endorphins which - natural analgesics
  • Cortisol – a precursor of cortisone
  • Growth hormone – instrumental in tissue repair
  • ATP – improves and regulates cellular metabolism
  • An increase in protein synthesis – collagen, DNA, fibroblasts
  • A facilitated venous and lymphatic flow
  • Increased angiogenesis – the elevation of oxygen saturation
  • Enhanced immune response
  These responses are some of the many processes that accelerate cellular regeneration (cartilage, epithelium) and restore normal cell morphology and function. Treatments are typically 25 minutes to over 1 hour depending on the condition and area being treated   The most popular technical / clinical information requested is available on the Meditech website under Laser Reports. You may visit the Meditech website research section directly for detailed abstracts, case profiles and articles on a variety of topics relating to the use of low intensity laser therapy in the treatment of various medical conditions.  

What life style and self-care measures can you do for yourself to relieve acute and chronic neck pain?

A number of conditions may cause nerves to be compress. Injury, poor posture, osteoarthritis, stress from repetitive strains, sports, occupations, stressful hobbies, bad habits, or tight muscles can contribute to or cause of nerve pressure.  
  • Posture. Maintaining optimal posture is important to prevent pinched nerves as well as many other injuries. Ask your physiotherapist about a forward head posture and how it compresses the nerves of the lower thoracic spine that supply the arms. Sitting, reading, working, and many occupations and physical activities if performed with poor mechanics can become a risk factor.
  • Gender and Genetics. Knowing that women are three times more likely to develop carpal tunnel syndrome, possibly due to having smaller carpal tunnels extra care may be taken to avoid excessive wrist flexion. Sleeping posture, habits, activities, and positions where the wrist is maintained in extreme flexion or repetitively placed into this position  should be avoided.
  • Bone spurs. Trauma and or bone thickening, such as osteoarthritis, and degeneration can cause bone spurs and other changes that may cause pinching nerves. Keeping an active and healthy lifestyle as well as maintaining good mobility and flexibility are important for good spinal health.
  • Overuse. Your physiotherapist can help educate and coach you to avoid excessive stresses that may cause injuries and subsequent pain. Jobs or hobbies that require repetitive, head, shoulder, elbow, hand, wrist movements, such as assembly line work, dentists, technicians, and or anyone who performs increase your likelihood of a pinched nerve.
  • Injury and or accidents. In some cases, trauma and or very quick movements may create an acute pinched nerve. These are not always avoidable however by improving general strength and fitness and movement skill patterns, one can avoid incidental strains and sprains.
   

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