Updated: May 5, 2022
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