Chiropractors and Trapped Nerves
One of the most common reason people phone Worcester Chiropractic Clinic is for treatment of a trapped nerve.
On examination, however, an overwhelming proportion of these patients turn out not to have a trapped nerve. The lesson here is that a trapped nerve is far less common than you might think.
What is a Trapped Nerve?
Often people attribute sharp or sudden onset pain to a trapped nerve, however the reality is that trapped nerves give a wide variety of symptoms. More likely than sharp pain is pins and needles, numbness, or dull aching.
Trapped nerves can affect almost any area of your body, although the most common places are in the arms or legs. Sciatica is an example of a condition affecting your leg that is sometimes called a trapped nerve.
Other terms that people sometimes used when talking about a trapped nerve include neuralgia, pinched nerve, radiculopathy, or compressed nerve.
Trapped nerves are rarely serious and usually respond very well to chiropractic treatment. It is unusual to need scans or x-rays to diagnose a trapped nerve.
Although the term trapped nerve is not a medical diagnosis but a colloquialism, it is a relatively apt description. Nerves pass between muscles, bones, organs and other tissues, and any swelling, tightness or displacement of these structures leads to an increased physical pressure on the transiting nerve.
Causes of a trapped nerve vary from osteoarthritis to tumours, underlining the necessity for a proper examination, but poor posture is the most frequent origin.
The most common place in the body to trap a nerve is as it exits the spine. This is due to the complex arrangement of the vertebral segments and the narrow exit “foramina” that nerves must pass through. In the lower back this might be labelled sciatica.
Other diagnoses that come under the trapped nerve bracket include piriformis syndrome, carpal tunnel syndrome and thoracic outlet syndrome.
Treatment for trapped nerves is dependent on the exact cause, but where there are no disease factors involved chiropractic treatment is very useful. This is made up of a wide variety of treatment techniques to suit each individual case.
What Causes a Trapped Nerve?
Broadly speaking, physical pressure is what leads to a trapped nerve. As nerves leave your spine and travel to their destinations, they pass through narrow holes. Any further narrowing of these holes, for example from a slipped disc or arthritic changes, can cause the transiting nerve to be squeezed.
This squeeze of a nerve causes the nerve to become irritated, leading to pain, pins and needles and the various sensations we describe as a trapped nerve.
Occasionally this squeeze can stop a nerve from conducting traffic, leading to numbness and weakness.
While it is most common for nerves to be trapped as they exit your spine, it is possible that they can become trapped at any point along their length. Each individual nerve has specific areas where it is most vulnerable to becoming pinched.
Carpal tunnel syndrome is a good example of a nerve being pinched away from the spine, occurring as the median nerve passes through a narrow part of the wrist.
It is useful to understand that a nerve will often become irritated before being truly trapped. A small amount of physical pressure causes the nerve to fire, leading to pain or pins and needles which come and go. Ignoring this warning sign can cause things to escalate to becoming a trapped nerve.
Self Help For a Trapped Nerve
There are a number of things you can do yourself to help with a trapped nerve.
The first thing is to remember that the nerve is almost certainly not damaged and that you will recover more quickly if you maintain normal activity levels. Stopping activity is one of the worst things you can do.
However, it is useful to try and avoid things that particularly aggravate your symptoms. Every time you aggravate your symptoms you are irritating the nerve. The more often you irritate the nerve, the longer this irritation will take to subside.
Putting cool packs on the point the nerve is being trapped (you may need guidance with this as this may not be the point of pain) and using anti-inflammatories, such as Ibuprofen and Paracetamol, to decrease any inflammation can dramatically help.
There are some gentle exercises that can provide relief. You can look up nerve flossing exercises or neuro-dynamics.
Topical rubs with heating or cooling effect can be used to help “drown out” unpleasant sensations, but are not going to release a trapped nerve.
Anti-inflammatory gels are less effective than oral anti-inflammatories.
When to see the Chiropractor
Trapped nerves often respond to treatment better if treatment is started sooner. Don’t wait until the pain is very severe as this will invariably take longer to resolve.
There are a few warning signs that can help you identify when you may be experiencing a trapped nerve before symptoms become very severe.
Repeated bouts of pins and needles can be easily ignored, particularly if the resolve with a change of position, but these are often related to mildly pinched nerve tissue.
Tightness affecting one leg or arm can also be a useful indicator that you may have a trapped nerve, as can episodes of back or neck pain.
If you have a sudden back spasm or cricked neck, this can be the reaction of your muscles to an underlying trapped nerve.
The most important thing that a chiropractor will provide is an accurate diagnosis. This is not just helpful in confirming whether or not you have a trapped nerve, but also where and why that nerve is trapped.
Having established a comprehensive diagnosis, a chiropractor will then be able to explain your different treatment options. In many cases your chiropractor will be able to offer you treatment there and then.
When not to see the Chiropractor
Because chiropractors are primary care clinicians with expertise in diagnostics, there aren’t really any circumstances when seeing your chiropractor is the wrong thing to do if you suspect you have a trapped nerve.
If you have any clinical signs that suggest your symptoms require further investigation or treatment other than that which chiropractors can provide, your chiropractor will refer you as appropriate.
Diagnosing a Trapped Nerve
Scans and x-rays are rarely required to diagnose trapped nerves. In fact, without prior physical and neurological examination, they are often unhelpful.
A static image may show no pinching of a nerve when, on certain movements, the nerve is indeed being pinched. This is known as a false negative. Similarly, a scan may show a nerve is being pinched, but the image does not tell us whether this pinch is causing any symptoms. This is known as a false positive.
The best way to diagnose trapped nerves is by conducting a thorough physical and neurological examination.
Physical examination to investigate a suspected trapped nerve involves moving a patient into lots of different postures and positions to try and recreate or aggravate their symptoms.
Depending on which tests are provocative, this process can expose which nerve is being pinched and where along its course, and often by what tissue.
A proper physical exam will also involve testing for other conditions that could mimic a trapped nerve.
Neurological examination is also very helpful at ascertaining which nerve may be involved, as well as how that nerve is functioning.
Neurological examination may include testing your reflexes (by tapping certain tendons with a small hammer), testing your strength and sensation of certain areas of skin. Specific tests to rule out pathologies are also done at this point.
Chiropractors are trained to carry out full neurological and physical examinations and, through their use, can provide accurate diagnoses, screening for sinister pathologies at the same time. This process can usually be completed in 30-45 minutes, but can take longer in complex cases.
If there is any doubt, further investigation, using MRI scans, blood tests or nerve conduction studies, will be requested from your GP.
Treatment for a Trapped Nerve
Sometimes a trapped nerve will resolve on its own, but it is likely that symptoms will return if the underlying cause is not addressed.
Most causes of a trapped nerve can be treated conservatively, using the types of treatment that chiropractors provide.
Conservative treatment includes manual therapy and exercise. Manual therapy will consist of a combination of manipulation, mobilisation and soft-tissue releases.
Exercises are also an important part of treating a trapped nerve. The main role of exercises is to causes adaptations in your body that make it less likely you will trap a nerve again.
Trapped nerves generally have a very high likelihood of responding to conservative treatment, although this depend on the exact nature of the problem.
It is possible that conservative treatment can aggravate the symptoms of a trapped nerve, but this is typically only a temporary thing.
Other approaches to managing a trapped nerve include pharmaceuticals, injections and surgery.
Pharmaceutical options should start with over the counter anti-inflammatories such as ibuprofen or paracetamol. Where these are insufficient a short course of prescription anti-inflammatories may be useful.
Combining the use of anti-inflammatories with conservative treatment can be helpful.
Courses of prescription anti-inflammatories lasting longer than three weeks should be avoided due to the risk of side-effects.
Other medications that target nerve pain more specifically can be offered when pain is very persistent. These medications, such as gabapentin or amitriptyline, come with serious side-effects and should only be used where pain is unrelenting and very severe.
Injections are sometimes used for the treatment of trapped nerves. Typically these injections consist of a local anaesthetic and a potent anti-inflammatory. Injections should only be offered if conservative treatment is not appropriate or has failed to significantly alter symptoms.
Surgery for trapped nerves is becoming quite unusual. Because of the other options available and because of the associated risk factors, surgery is a last resort.