Pinched Nerve
Pinched nerves are a frustrating injury to suffer and they can last a long time. They can cause a wide range of symptoms and limit many activities. I want to review what a pinched nerve actually is, what causes it, possible symptoms, and how you can treat pinched nerves including some exercise suggestions.
There are 31 pairs of spinal nerves and they can combine to form other nerves including your sciatic nerve and your medial nerve among others. Nerves originate from your brain where all senses and actions are interpreted. Sensory nerves run from your skin to your spinal cord up to your brain for understanding of what your body is feeling. Motor nerves run from your brain, down your spinal cord, and into your muscles to control movement and actions. Nerves work extremely quickly. Healthy nerves send signals 50-60 meters per second according to healthline.com. Considering 2 meters is 6 feet 6 inches, 60 meters per second would go up and down a tall human 30 times in a single second!
Because of how precise and important nerves are, it makes sense that our body would want to protect them. Pinching or compression of nerves can have many consequences throughout the entire length of the nerve. For instance, if a nerve is compressed exiting the low lumbar spine then it can result in symptoms in your foot.
Pinched Nerve Cause
There are many potential causes of a pinched nerve, and I will review 3 possibilities. The first is closest to where the nerve exits the spine and it involves a herniated disc.
We have intervertebral discs between each segment of our spine except for our sacrum (tailbone) to provide cushion and increase mobility. I previously wrote about herniated discs here, but I will briefly review them. The disc can tear from a traumatic event, usually bending and twisting, which causes the nucleus pulposus to push into the space occupied by the nerve root. The nucleus pulposus is the fluid inside the disc that allows it to cushion and absorb force.
The excretion of the nucleus pulposus into the nerve space can compress the nerve before it exits the joint. At this point, the nerve has not differentiated into sensory or motor and is referred to as a mixed nerve. A variety of symptoms can result from this condition. Luckily, there is an excellent healing prognosis for herniated discs with conservative care including physical therapy. Once the fluid has been reabsorbed or scarring has occurred, the nerve is able to return to its normal state.
Herniated discs typically occur between the ages of 20-50. After 50 years old, the discs compress to the point that it is hard to herniate them. At this point, spinal degenerative changes are the more likely cause of a pinched nerve. Spinal stenosis refers to the narrowing of the space that a nerve passes through. This can be in the central canal through which the spinal cord descends. It can also occur in the lateral canal or foramen where the nerve exits the spine. The image below courtesy of simsfinnchiropractic.com.au highlights the three types of stenosis.
Stenosis usually occurs from bony overgrowth which happens as we age. In areas of stress, our bodies will create more bone for support. Unfortunately, this can decrease space for the nerves. People suffering from stenosis tend to have worse symptoms with standing upright and extending their back. Extension compresses the already minimized joint space and can worsen symptoms.
The final cause of a pinched nerve is muscular tightness. Nerves run between many muscles as shown below with the ulnar, radial, and median nerves winding through the muscles of the forearm courtesy of overhaultraining.com
You can imagine that muscular tightness along the path of the nerves can result in compression and poor conduction of signals. It can be difficult to determine the exact muscle that is causing the pinched nerve without a thorough evaluation. Improving mobility of that muscle can decrease the stress on the nerve and lead to healing. Unfortunately, nerves heal slowly at a rate of 1 inch per month according to a study by Hoke, so it can be a slow process.
Pinched Nerve Symptoms
Pinched nerve symptoms can be varied based on the location of the compression as well as the nerve being affected. The most common symptom involves numbness or tingling along the pathway of the nerve. Greater compression of the nerve can lead to increased numbness in the area. Less compression can cause brief tingling that is alleviated by positional changes that decrease stress on the nerve.
Tightness along the pathway of the nerve can also be a symptom. The sciatic nerve runs down the back of your leg into the bottom of your foot. Compression of the sciatic nerve can make you feel increased hamstrings and calf tightness. However, stretching the muscles is not the answer and can actually be counterproductive as I will discuss below.
Pain can occur when the nerve is compressed in such a way that pain receptors are activated. Pain also appears anywhere along the pathway of the nerve, making it difficult to determine the exact cause. Sensory nerve compression can result in tingling, numbness, and pain. Motor nerve compression can lead to weakness of the muscles innervated by the particular nerve.
Weakness can result in decreased strength, but it can also lead to clumsiness or poor balance. If the nerves innervating the muscles of your legs and feet are compromised, then the muscles will be weakened and have a slower reaction time. This is similar to what can occur in people suffering from diabetes who suffer from neuropathy of the feet.
Pinched Nerve Treatment
Treatment for a pinched nerve can take many forms depending on the cause of the injury. A detailed evaluation by a healthcare provider should give some answers as to what is causing the compression and that will dictate how best to alleviate the symptoms. Manual therapy can be beneficial early on in treatment and especially in situations of significant pain. It can involve soft tissue mobilization including scraping, cupping, and trigger point dry needling to decrease muscle guarding. If the nerve compression is a result of muscular compression, then this can provide rapid relief.
If joint issues are to blame for nerve compression, then mobilizing the joint can provide a reduction of symptoms. Mobilizations provide relaxation for the surrounding muscles and can decrease pain sensation in the area. Similarly, traction can be beneficial to temporarily relieve stress on the joint and nerve. Benefits from manual therapy are usually temporary as I discussed in a blog post here and it should be followed by individualized exercises.
Pinched Nerve Exercises
As I mentioned, exercises should be based on the individual’s symptoms and presentation. One exercise that is beneficial for many people suffering from a pinched nerve are nerve glides. Skimble.com provides an image of a sciatic nerve glide that can be very beneficial below
The sciatic nerve runs from your low back, through the back of your hips and leg, into the bottom of your foot. Nerves do not like to be stretched in the same way as muscles. They prefer to be treated more like floss and move back and forth gently. Extending your knee and bringing your toes towards you would tighten the nerve at the knee and ankle. Instead, you want to extend the knee and point the foot as shown to stretch the nerve at the knee but leave the ankle relaxed. After you hold this position for a second, you can bend the knee and bend the ankle as if stretching your calf. This tightens the nerve at the ankle but relaxes the knee. Repeating these motions 20-30 times can mobilize the nerve and improve symptoms. The key is not to aggressively stretch the nerve, as this will only worsen your discomfort.
Similarly, walking or biking can be beneficial for lower body pinched nerves, as the rhythmic movement can mobilize the nerve without an aggressive stretch. If the nerve is compressed due to a herniated disc, then walking is typically better. If a spinal stenosis is suspected, then biking will be better tolerated due to the relatively flexed posture in sitting. Gentle, repeated movements can accomplish mobility much more effectively than sustained stretching.
Isometrics refer to exercises that do not change the length of a muscle. They can be an excellent starting point when recovering from a pinched nerve as they will provide beneficial stimulus and blood flow to a muscle without too much stress. Bridges and planks are a common starting point to work on the back and front muscles respectively in a stable position.
An evaluation should also try to determine the root cause of the pinched nerve along with any factors that led to the injury. Weak muscles can lead to tightening as they are not strong enough to carry whatever load is required of them. Strengthening these muscles can lead to long term improvements and prevention of future injuries in the future. For example, strengthening your hamstrings can prevent them from tightening up during exercise and compressing the sciatic nerve.
As always, if you are suffering from pain, nerve symptoms (numbness, tingling, or weakness), or anything else significant, please see a healthcare provider. This blog is meant to be educational and is not a substitute for medical advice.
Hopefully you learned something about pinched nerves and their symptoms and treatment. If you have interest in other neck or low back injuries, check out our neck page or low back page. If you found this blog helpful, please share it with someone. We hope to continue to grow and help people better understand how our bodies move and work. If you want to subscribe so that you don’t miss any other posts, click the sign in button on the top right of this page. Once you have created an account, click the drop-down menu in the top right next to your name and go to your settings page. Click the subscribe button next to “Blog Subscription” and you won’t miss any future posts! If you are in the Sterling, Virginia area and would like to work with me or you have any questions, please email me at danny@eclipsewellnessnova.com or follow me on Instagram or Twitter @drdannydpt.