Many people may have heard of a “pinched nerve” but what is it exactly? Why does it cause pain and what can be done to help?
Most commonly a “pinched nerve” refers to pressure on a nerve in the spine of the neck or the lower back. The nerves start as microscopic cells in the brain or at the ends of the tissues like the skin, tendons or joints. They travel in and out of the brain through the spinal cord and enter the spinal cord as nerve roots.
A nerve is typically pinched if it exits the spine. Pinching can occur from a disc that is bulging or herniated, an overgrown joint or thickened ligament. This typically causes pain and symptoms that travel in very discrete patterns. For instance, a nerve pinched by a disc herniated at C5/6 on the right will nearly always cause pain, numbness and tingling into the thumb and index finger and sometimes weakness in the biceps of the arm or a particular forearm muscle.
The good news first – most pain from a pinched nerve goes away by itself, WITHOUT SURGERY! The goals then are to:
- Make sure you get an accurate diagnosis from a doctor to ensure this is a not a dangerous problem.
- Treat the pain and help you remain as functional as possible while you heal on your own.
- Help you develop a spine fitness program to prevent further occurrences in the future.
In rare cases, surgery will be needed but it should only be as a last resort or for special circumstances that permanently endanger your nerve function.
Getting an Accurate diagnosis – are you seeing a doctor, or a nurse?
The first step is to get an accurate diagnosis – what is the cause of your pain? Is it really a pinched nerve? Is it coming from the spine, the brain or the nerves in the arms or legs? Could there be something growing outside your spine, or an infection? A visit with an experienced doctor is designed to answer these questions. At Start To Finish Spine Care, you will see a doctor first. On your first visit, you will see a spine specialist who will spend 45 minutes with you to understand your medical history and make sure you are safe. At most other spine clinics, you will often see a nurse for 95% of your visit and a doctor will spend perhaps 5 minutes with you. That is the difference between other spine clinics and Start to Finish Spine Care.
Nurses and physician’s assistants are not trained, experienced or able to make an accurate diagnosis and come-up with a treatment plan for you. Nor is this position able to ensure ruling out the more rare causes of pain that may be more serious. Make sure you see a doctor who spends their time with you. You are paying the same – why not get the best? Even better, you can usually get an appointment to see an experienced spine specialist within a few days or the same day at Start to Finish Spine Care. Such a quick visit with a specialist is a rarity these days (except at Start to Finish Spine Care).
The doctor will work with you to determine if you need specific tests to help diagnose your problems, such as an MRI, and will then order them and have you come back into the office to explain the results. Many times, extensive and expensive testing will not be needed and can be avoided. This is helpful in times when more and more health costs have to be paid for out of your own pocket. No nurse is going to be able to give you sound advice when it comes to picking the right test and no doctor who spends 5 minutes with you will do it as well as one that spends the entire visit with you.
Treating your pain – without surgery in 95% of cases.
Once you get your diagnosis – what can be done to help ease your pain – without surgery?
After your spine specialist ensures that there is no danger requiring urgent surgery, there are many options that can help. First are basic medications like prescription strength versions of drugs like Motrin (called “NSAIDS” – non-steroidal anti-inflammatory drugs). Muscle relaxants can help, as can mild narcotic pain medications. Narcotic pain medication must be used with extreme caution and should be used only temporarily when other methods do not work.
Physical therapy is a critical part of recovery to ensure that muscles and joints remain functional and moving. Pain may cause us to internally splint certain joints so they don’t move. That is a phenomenon that must be guarded against. Physical therapy can help get the spine moving again and can also help with local pain treatments like deep heat, massage, ultrasound and electrical stimulation.
The spinal muscles of the low back and neck may also spasm or become inactive. This is where “osteopathic manipulation” can come in. The spine can be mobilized by a trained physician with experience in treating patients with pain. The lining of the muscles may need to be released (“myofascial release”) and certain joints mobilized so they don’t “lock up” and cause further problems. Our start to Finish Spine Care Osteopathic physician, Dr. Rizk, can help with spinal manipulation to relieve neck, back, arm and leg pain while the body works to heal itself.
When pain is very severe or not decreasing quickly enough, spinal injections may be the next best step. Small doses of steroids (“cortisone shots” ) can be delivered with great precision right onto the lining of an effected nerve or into a joint lining or ligament that has swollen and is pinching a nerve. These procedures can be done in minutes in our spinal injection suite right at Start To Finish Spine Care.
In rare cases, surgery will be needed early, or if symptoms are not gone in 6-8 weeks. At Start to Finish Spine Care, experienced Spine Surgeon, Dr. David McKalip is rapidly available to Dr. Rizk who can consult with him if there is a concern that a surgical visit is needed quickly. During surgery, microscopic-size incisions are made to make a small tunnel to the spine and allow the pressure on the nerve to be relieved. Simple cases can be done in 45 minutes and require a brief stay in the hospital with discharge the same day. More complex cases may require more time and a longer stay.
Keeping your Spine in Shape
So you have gotten through your episode of having a pinched nerve and you never want to go through that again. What now? It is time to make sure your spine is well supported and our team at Start to Finish Spine Care will help you devise a plan to keep your spine in shape. That means working with the Physical Therapy Department to develop a Home Exercize Program. Perhaps you need multiple physical therapy visits to focus on particular problem areas. It is vital to develop a program that meets multiple goals:
- Strengthen the muscles that support the spine in the abdomen, back and in the fronts and backs of the legs.
- Improves posture by focusing on exercise, balance training and perhaps through osteopathic manipulation to mobilize joints and muscles.
- Promotes weight loss to allow a lower stress on the spine.
- Restore as much lost function as possible from weakness or numbness from any past pinched nerves.
Sometimes it is hard to keep up with a home exercise program, which is why Start to Finish Spine Care is working with partners who offer onsite exercise programs right on the lot next to our building. Classes now include Tai Chi and basic and advanced Chinese martial arts instruction such as Chi Gong, Ba Gua Zhaung and Shao Lin Kung Fu. We are working on bringing partners for Yoga and traditional calesthenics as well.
A pinched nerve can be a painfully memorable experience that can limit function for at least a few weeks. At Start to Finish Spine Care, we will be there to help you get a diagnosis from a doctor, develop a treatment plan and develop a spine fitness plan to keep you from having repeat episodes in the future.
