top of page

What is a "pinched nerve"? Why do they cause symptoms? And how can I treat this without surgery?

Spoiler – What commonly get referred to as "pinched nerves" do not often involve actual structural obstruction or "pinching". In fact, many cases can be readily managed through a combination of conservative methods like certain anti-inflammatory medications, joint mobilization/manipulation, and exercise focused on addressing nerve mobility and health.


Pinched nerves and spine-related nerve pain

When interacting with someone at an initial consult, the question regarding a "pinched nerve" comes up quite frequently. I nearly always preface the conversation with acknowledging that this diagnostic term probably isn't the most accurate representation of what is going on with our bodies when symptoms of a nerve root irritation or injury present. In this post, we'll explore some of rationale that points away from this end-all, be-all structural issue; we'll look at the data that would suggest advanced imaging like MRIs should NOT be the first direction you should go when seeking care; and we'll examine a few pieces of evidence that demonstrate that non-invasive treatments can often help to manage and mitigate these symptoms.


The Physiology of Nerve Pain (and why structure/mechanical compression may not be your issue)

How useful is advanced imaging really?

So if I don't have a structural issue, how can a physical therapist help me?


 

The Physiology of Nerve Pain (and why structure/mechanical compression may not be your issue)


Below is a very technical-sounding, neatly-packaged flow chart that explores many of the mechanisms at play in why nerves produce pain.


Understanding "pinched nerves" and nerve pain

If you've got a technical health background, you can probably parse through this and what it means. However, there's a big takeaway to be had here. NOWHERE does it highlight that some mechanical compression (i.e., pinching) needs to be present. In fact, let's think about it not from a technical lens but a logical lens. Let's say you have been told you have a pinched nerve. So why do your symptoms vary? Why do your symptoms fluctuate through the day? Certain positions make your nerve pain pretty bad, but other movements or positions actually alleviate your symptoms? If there were a legitimate obstruction of the space where your nerve lies, wouldn't your symptoms be reasonably constant and generally not changing much in response to movement, position, or activity?


I won't pretend that there aren't situations where there can be some part of your anatomy full-on encroaching on a nerve and creating mechanical compression, but for the majority of people we see, this isn't the case. What this chart does nicely highlight is how our nerves functionally change in response to some kind of insult or irritation. Some mechanically or chemically irritating stimulus may cause an upregulation of your nervous system. Imagine for a second that someone breaks into your nextdoor neighbor's house – odds are that you and your other neighbors are going to be more vigilant, be it putting in a doorbell camera or spotlights or whatever other measures to try to protect yourselves. This metaphor is probably a more apt comparison – our nerve in this case may become sensitive to movement in certain directions.


When it comes to nerves and nerve injuries, I would contend that the more significant concern lies not in the presence of radiating symptoms but in the presence of isolated but altered reflexes, isolated loss of strength, and a disturbance of your sensation in a given area (what in medical terms is referred to as a "radiculopathy"). It is well accepted that certain nerve roots are responsible for the sensation in particular parts of the body (e.g., the C5 nerve root being attributed to facilitating sensation along the upper, outer arm). The same logic applies to the strength of certain muscle groups and certain tendon reflexes. This is why we test your nervous system at an initial encounter (and at any follow-up visits as necessary) – to determine if the nerves in your body are showing signs that they are not conducting signals appropriately.


How useful is advanced imaging really for "pinched nerves"?


Another common question we hear – do I need to get an MRI? My answer – my level of concern is more likely to be influenced by your neurologic physical exam than by your imaging. If there are signs and symptoms that suggest something more sinister, like a metastatic lesion/tumor, that may be a different conversation. Again, a lot of really valuable information can be taken away by simply asking structured, targeted questions about your health and actually doing a physical exam. Additionally, advanced imaging like an MRI may be appropriate if your symptoms are not responding to conservative management, but evidence would suggest that the majority of people can have their symptoms managed through non-invasive, conservative treatments.


Data on false positive imaging

So back to the question about the MRI... Any provider worth their weight should readily tell you that we know MRIs are not the end-all, be-all. Again, I will also be the first to acknowledge – there is absolutely a role for MRIs, but we see them being done way more frequently than they should be done. A 2015 study in Spine, widely considered as one of the most impactful scholarly journals worldwide, looked at over 1000 people WITHOUT neck symptoms and completed a neck MRI. To the right/above, you can see their findings – in people WITHOUT symptoms, nearly 90% of the group showed disc bulging. With progressive age in this cohort, the likelihood of finding "abnormal changes" increased.


So, you might ask, how do you know if the changes found on my MRI are relevant? All too often we see people referred to us that have already had an MRI complete. If the focal interpretation of the radiologist highlights highlights the overwhelming degeneration and disc bulging at C4 and you have numbness and tingling along the inside of your forearm to your pinky and ring finger (i.e., an area commonly innervated by nerve roots a few segments lower than that). It cannot be stated enough that if you are being referred for an MRI and no one has conducted a meaningful, thorough physical exam in the office first, you're being shortchanged.


So if I don't have a structural issue, how can a physical therapist help me?

A manual physical therapist can provide evidence-informed treatment for conditions like nerve root pain or irritation by combining clinical expertise with the best available research and patient preferences. Techniques such as spinal mobilization and manipulation have been shown to alleviate symptoms by improving nerve function and reducing pain. For instance, a study by Leininger et al. highlights that spinal manipulation can significantly reduce pain and disability in patients with lumbar radiculopathy, and similar trials have been published looking at similar diagnoses from the neck. Additionally, specific exercise prescription tailored to the individual can enhance mobility and ease of movement and promote neural recovery, as supported by clinical guidelines from the American Physical Therapy Association (Delitto et al., 2012). By utilizing these evidence-based methods, physical therapists can effectively address the root causes of radiculopathy, leading to improved patient outcomes and overall quality of life.


Interested in learning more about how we can help you specifically? Reach out by email at info@smithfieldphysicaltherapy.com to set up a time to chat!


References:


Nee RJ, Butler D. Management of peripheral neuropathic pain: Integrating neurobiology, neurodynamics, and clinical evidence. Phys Ther Sport. 2006;7:36-49.

Nakashima H, Yukawa Y, Suda K, et al. Abnormal findings on magnetic resonance images of the cervical spine in 1211 asymptomatic subjects. Spine. 2015;40(6):392-398.

Delitto, A., George, S. Z., Van Dillen, et al. Low back pain. Journal of Orthopaedic & Sports Physical Therapy. 2012;42(4), A1-A57.

Leininger, B. D., Bronfort, G., Evans, R., Reiter, T., & Mitchener, L. A. (2020). Spinal manipulation or mobilization for radiculopathy: a systematic review. Journal of Manipulative and Physiological Therapeutics, 43(6), 558-569.



23 views

Recent Posts

See All

Comments


Commenting has been turned off.
bottom of page