Doctor of Chiropractic, Dr. Alexander Jimenez breaks down how pinched nerves cause back and neck pain.
You hear people say it a lot:
�I have a pinched nerve, and wow, it hurts.�
But what exactly is a pinched nerve? How does it cause back pain or neck pain? What are the symptoms of a pinched nerve�beyond pain? And most importantly, what can you do about a pinched nerve? Learn the basics of pinched nerves here.
Pinched Nerves: A Common Cause of Back & Neck Pain
What Is A Nerve?
Nerves are your body�s messengers. They transport signals to and from your brain�messages like �Move this toe� or �Ouch, that cactus needle really is sharp.� You have a central nervous system, which is made up of your brain and spinal cord. You also have a peripheral nervous system, which is the system of nerves that branches off the brain and spinal cord.
What Do Nerves Look Like?
If it helps, think of nerves like a garden hose (except they aren�t green). They have an outside membrane that transports those electrical messages. Inside nerves, there�s a fluid that nourishes and replenishes the outer membrane.
You�re Getting on My Nerves
When a nerve gets pinched, the messages and the nourishing fluid don�t flow quite as well as they should (still helpful to think of a garden hose here). A pinched nerve can start sending the �Ow, pain� message to the brain, and it can also have trouble communicating clear messages, possibly leading to weakness, numbness, or tingling.
What Can Pinch a Nerve?
As a nerve exits the spinal canal, it can be pinched by a herniated disc or a bone spur. Bone spurs, also known as osteophytes, are bony bumps that can develop on a spinal joint over time. They can push into the spinal nerve, as you can see in this illustration (red = pain generator, of course).
What Does a Pinched Nerve Feel Like?
A pinched nerve mostly feels like pain. If you have a pinched nerve in your low back, it can cause pain to travel (or radiate, in doctor-speak) down your leg. You may also know that as sciatica. A pinched nerve in the neck can create pain that shoots down your arm. Other symptoms of pinched nerves include muscle spasms, burning, tingling, and a hot/cold sensation.
Now the Good Stuff: Pinched Nerve Treatments
Pinched nerve treatments fall into two categories: what you can do at home (self-care) and what your doctor may prescribe for you.
Pinched Nerve Self-care #1: Heat and Ice
Heat and ice can work wonders on a pinched nerve. Switch between 20 minutes of heat and 20 minutes of ice�and remember that you shouldn�t put the heat and ice packs directly on your skin.
Pinched Nerve Self-care #2: Get a Massage
The muscles around a pinched nerve can become tight, so having a professional massage therapist work the painful area can bring pain relief. You may also consider a handheld massager.
Pinched Nerve Self-care #3: Take a Walk
Let�s say it�s your low back�a pinched nerve in your low back�that�s hurting you. A nice, easy stroll is a good way to stay active and address your pain. Gone are the days of extended bed rest for back pain: doctors now are more likely to recommend you exercise and stretch to help relieve your pain.
When Should You Call a Doctor?
If you try the self-care thing and yet your pinched nerve pain persists, you should consider calling the doctor. If you�ve been in pain for more than a couple of days, schedule an appointment. You should also call the doctor if you experience a very sudden onset of weakness, or if you experience profound numbness. Losing bowel and/or bladder control is also a good reason to call the doctor.
How a Doctor Treats a Pinched Nerve
The doctor will try to diagnose the cause of your pinched nerve, and then the doctor will be able to develop a treatment plan. That plan may include prescription pain medications, physical therapy, or cortisone injections. But keep this in mind: the treatment plan will be specifically tailored for you, and it�s in your best interest to follow it closely.
There is significant excitement among surgeons as well as among patients following the recent FDA, or Food and Drug Administration, release of the Charit� Artificial Disc (DePuy Spine, Inc.). The delight among patients with degenerative disc disease comes from the perception that there’s now a safe way to eliminate pain from degenerative discs while also maintaining normal movement. Several patients have developed advanced stages of disc degeneration requiring an additional fusion process or have heard about others with similar difficulties getting fusion processes before, who still continue with constant pain or had more than one effort at fusion. They’ve also discovered the successful results following disc arthroplasty in Europe which has been highly publicized by the media in America.
Lumbar Fusions and Other Discoveries
That is certainly an exciting new addition to the variety of therapies and methods for treating degenerative disc disease. An almost amazing quantity of progress has been made when looking at the way in which the evaluation and treatment for degenerative disc disease has developed over recent years. Many healthcare professionals are now able to recognize disc disorder with MRI and pain generators with discography and facet blocks. Now they could be performed through incisions that are barely observable either anteriorly through the abdomen or through the back where only a decade past, lumbar fusions were being performed through substantial posterior incisions. With the usage of instrumentation that is presently available, achievement rates for one amount fusions approach 90 to 95 percent. Regrettably, not every patient who has degenerative disc disease and contains a successful fusion has a successful clinical result. There’s still a number of patients for whom fusion will not effectively relieve pain.
Risks of Disc Replacement
Disc replacement arthroplasty has the prospect of the treatment of most of the spinal motion segment illnesses which are currently being treated both successfully and not by one of the numerous fusion techniques. At this comparatively early phase of disc replacement development, many healthcare specialists don’t know all of the issues which will be encountered following these procedures. Because the surgical strategy is via the abdomen either retroperitoneal or transperitoneal, in other words, around or through the gut, there are several foreseeable complications including vascular injury, thrombophlebitis, or vein inflammation accompanied by blood clot formation, nerve root injuries, injury to the ureter, and retrograde ejaculation in men.
It’s also known that several disc replacements have failed and have been converted to some fusion with varying clinical consequences. Removing artificial discs, especially at the L4-5 level, poses a substantial risk of vascular injury due to scarring round the prosthesis. Surely, it’s known that artificial joints produce wear debris where that is obviously not an issue with fusion and an inflammatory reaction which could escalate over time.
Early Results of Procedure
Spine specialists and other healthcare professionals in general are very positive and excited about total disc arthroplasty, and suitably so. Appropriate training via cadaveric labs and courses will help minimize the learning curve of the procedure, to avoid other possible complications. There will without a doubt be many improvements and modifications in the prosthetic layouts.
Early results are surely encouraging in the hands of the investigational surgeons but are fraught with the numerous problems common to the creation of a procedure that is new. Total disc arthroplasty is likely to be an option that is better than fusion for several degenerative disorders of the lumbar spine as layout advancements continue being made and as further encounter defines the indicators because of its use.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Brain injuries are common complications in our modern world. Approximately 2 million individuals experience a head injury in the United States alone each year. Although most brain or head injuries are not considered life threatening, they could sum up to billions of dollars in annual revenue. Brain injuries are often categorized according to patient response. Only 1 out of 4 reported brain injuries are considered moderate or severe.
Doctor of Chiropractic, Dr. Alexander Jimenez examines people that see�a chiropractor and their reduced�usage of opioids and other types of drugs.
The draft Guidance for Prescribing Opioids for Chronic Pain, issued in December 2015 by the U.S. Centers for Disease Control and Prevention, included �many complementary and alternative therapies (e.g., manipulation, massage, and acupuncture)� among its recommended non-pharmacologic approaches. However, when the final Guidance was released three months later, manipulative therapy and its 75,000 licensed chiropractic practitioners was not directly referenced. A recent study from James �Jim� Whedon, DC, MS, pictured, suggests that the CDC harmed its mission with its excision of explicit reference to manipulation. Patients using chiropractors were less likely to use prescription opioids.
Whedon is currently a researcher at the Southern California University of Health Sciences, and is co-chair of the Research Working Group of the Academic Collaborative for Integrative Health. He is a relatively rare resource in the integrative health community, as a specialist in diving into huge data sets of insurers and seeking to extract useful information. Whedon is a veteran of arguably the most important research center in this type of work, The Dartmouth Institute at the Geisel Medical School at Dartmouth College.
Whedon�s research began with awareness that �little is known about the comparative effectiveness of non-pharmacological care for low back pain as a strategy for reducing the use of opioid analgesics.� What is well known, as Whedon shared in his poster and presentation at the 2016 conference of the Academy of Integrative Health and Medicine, is that patients with such pain are swimming in opioid prescriptions. Whedon�s presentation included a Baskin-Robbins-like list of 39 opioid varieties. He postulated that opioid use would be less likely among those receiving chiropractic care.
Association Between Utilization Of Chiropractic For Back Pain & Use Of Prescription Opioids
Preliminary results of a health claims study,� Whedon reports what he found through examining the New Hampshire All Payer Claims Database.� Of roughly 33,000 adults registered as having low back pain, slightly over a third saw a chiropractor. Of these, 38 percent had at least one opioid prescription. Of those who did not see a chiropractor, 61 percent had at least one opioid prescription.
The core question that interested Whedon was how many prescription fills the two sets of insured patients received. Those whose opioid prescription was integrated with chiropractic care had an average of 3.9 fills. Those who did not receive chiropractic manipulative therapy averaged 8.3 fills per patient. He estimated that the average per person opioid charges were $88 for those using chiropractors. The figure was $140, or 60 percent higher for those not using chiropractic care.
Whedon�s conclusions were, first, that the likelihood of filling a prescription for a high-risk drug of any type was 27 percent lower. Secondly, the likelihood of filling a prescription for an opioid analgesic was 57 percent lower in the chiropractic-using population.
�These are preliminary results,� Whedon cautioned. �We intend to analyze the data further, applying robust methods to reduce the risk of bias that can result from other differences between people who use chiropractic care and those who do not.�
Comment: While Whedon takes care to note that �no causal inferences can be made,� the associations should be of real interest to the CDC and other policy makers. A follow-up study might attempt to compare the whole costs of the chiropractic-using population and those who didn�t.� These costs could include, on the one hand, the cost of chiropractic treatment, and on the other, the costs of other medications or treatment that may be prescribed for those on longer-term opioid treatment who may end up cycling into the addiction.
Doctor of Chiropractic, Dr. Alexander Jimenez looks at high heels at what they do to the back.
Ladies, ever wonder why you suffer from regular bouts of lower back pain?� Achy hips?� How about crazy tight leg muscles?� Don�t blame it on your cycling class, or too many squats or, the trainer you only see once or twice a week.� Look down.� Are you wearing high heels?� Bingo!� You�ve heard high heels are bad for you.� But it�s not just because they cause all kinds of pain and trauma to your feet.� High heels are also messing up your physical fitness. �They throw you out of proper postural alignment causing your joints and spine to take on more�wear and tear, which means aches and pains.
Is it possible to still look rockin� and save your joints? �My suggestion is more Athleisure-wear. �I know some fashion hard-liners say, no way will I walk around in yoga pants on a weekday!� But we�ve come a long way since those flare-leg, fold-over yoga pants.
Let�s chat for a moment about the evils of high heels.
First there�s the obvious.� They make your feet hurt.� Blisters, calluses and swelling are par for the course.� And pointy toes, fuhgeddaboutit!� I�m sure they were invented by someone on the Marquis de Sade�s payroll.� Second, they can lead to foot injuries like plantar fasciitis (usually from a bone spur that makes your heels hurt), hammertoes, bunions, and neuromas.� �Then there�s the domino effect.
Not only do high heels make your feet hurt, but problems with the feet can travel up the leg and cause injuries in the back, knees and hips. �Your knees take on extra pressure from the weight being pushed forward onto the balls of the feet. �Walking in this position makes your hip flexors and calf muscles short and tight. �And it doesn�t stop there.� Back problems are incredibly common in women who don�t give up their high heels.
Back Problems are incredibly common in women who don�t give up their high heels
Here�s why:
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Postural changes:�The S-curve of your spine has cushiony discs in between the vertebrae that act as a shock absorbers to protect them from stress. Like when you�re bending or jumping. �Wearing heels causes the lower back to arch more than normal because the body weight is pushed forward.� To compensate, the upper body has to lean back to maintain balance.� This puts extra stress on the discs. ��Spending hours with your body in funky alignment can lead to muscle spasms and back pain. �Tight hamstring muscles, which�attach to back of the pelvis and lower back, can also make your back ache.
Anatomical changes: Wearing high heels on a daily, or very regular basis, over years, can actually cause anatomical changes to your body.� In addition to the extra strain on your back and knees, the calf muscles can also shorten and the tendons can get tighter and thicker.
And It Can Get Even Nastier If You Get One Of These Spine Injuries:
Spondylolisthesis: it�s a mouthful, but is a common injury that can happen in the lower back from too much hyperextension (arching the back).� It�s when one vertebra slips forward over another.
Foraminal stenosis: I have this one congenitally and it sucks. This is a spine and nerve issue that occurs when anatomical abnormalities reduce the spaces the nerves travel through as they exit the spinal column.� The spaces are called foramina, and when they get blocked, the nerves get squeezed.� The pain can radiate through the buttocks and down the legs.� Symptoms are shooting pains, numbness, tingling, muscle weakness, spasms and, or cramping.
Sciatica:�The sciatic nerve is the longest one in the body. �It runs from the bottom of the lumbar spine all the ways down the legs. �When the sciatic nerve gets compressed it causes radiating pain, tingling, numbness and muscle weakness down the leg and can The pain can travel all the way to the bottom of the foot.
What Can You Do? �My Case for Athleisure-Wear To Combat Back Pain
It�s time for stuffy office attire to retire. �Comfy clothes and flat shoes can be very chic. �Have you seen the boards on Pinterest?� Thanks to this hopefully permanent fashion style, my jeans and heels spend more time in my closet than on my body.� Leggings and cute kicks are my go to�s.� Night out?� No prob.� I reach for my sleek workout leggings, a ruched top or off the shoulder top with some high heel sneaks (they�re wedges so not nearly as bad for you). �I also discovered these by Bluprint which I put to the test at 2 huge conventions where I walking and standing for hours on end.� The soles made of memory foam � like those beds!
My podiatrist friend, Steven Rosenberg, DPM has been preaching the need for comfy shoes to his female clients for years. �(Fortunately for his practice, not everyone listens!) �Dr. Steve says, wearing shoes designed more for comfort can help you live more pain-free. ��Because comfort shoes are made of�soft cushiony materials�with soft foam innersoles, those are what you should turn to for shopping, walking or standing for long periods of time to avoid�blisters, muscle spasms or arch cramps.� � He also says to check for arch support in your shoes. �If there�s none, you can buy ones to put inside.
Even after reading this, you may still not be willing to give up high heels for good. �Me either.� I still get glammed up once in a while.
Here Are Some Tips For When You Must:
Wear them for as little time as possible.
Try to opt for heels around 2� high
Steer clear of pointy toes.
Buy shoes with leather insoles to so your foot doesn�t slide.
Buy arch inserts or use orthotics to support your arches.
Vary your footwear so you�re not wearing high heels every day.
Gradual or lower slopes are a little better, go for platforms or wedges instead of stilettos
Thicker heels are better than spiky heels
Stretch and strengthen the overworked muscles.
Here�s How:
Stretch your leg muscles and hip flexors before and after wearing heels.� For the calves, stand on a step and let one heel hang down until you feel a stretch.
Try this convenient device, the foot rocker by Vive.� It stretches the calf and the sole of the foot relieving pain from plantar fasciitis.
Front of the hip and thigh stretch for before and after wearing high heels
Hamstring stretch for before and after wearing high heels
Massage and stretch the muscles in the soles of your feet.� Roll your foot on a golf ball before and after wearing heels and, get regular foot massages.
Strengthen and increase the range of motion in your ankles and feet.� Put a rag on the floor.� Using your foot, write the letters of the alphabet.� Also put a bunch of marbles on the floor.� Pick one or a few of them up using just your foot.� Put them down about 6 inches away without lifting your foot off the floor.� Try that 10 times.� If you don�t have marbles, you can do it with a hand towel.
So next time you�re shopping for shoes, think about your foot fitness first. �Look for fashion that keeps you closer to the ground and that will hopefully keep you farther away from the doctor.
Doctor of Chiropractic, Dr. Alex Jimenez examines Tiger Woods’ and his latest back surgery.
We have a look at Tiger Woods’ extensive history of injuries during his career. USA TODAY Sports
Tiger Woods Won�t Be Back For Some Time
Woods, that has made just three starts in a couple of years, likely won�t play again this year after he’d his back surgery that is fourth in Texas. The latest procedure alleviated pain in his back and leg, Woods announced on his web site Thursday.
That I’m confident this will relieve my back spasms and pain, and The operation went well,� Woods said in a statement. When fixed, �, I anticipate playing with my kids getting back to a normal life, competing in professional golf and living without the pain I’ve been fighting so long.�
Woods, who also has had four surgeries on his left knee, first had surgery on his back and then had two procedures in the autumn of 2015.
According to his statement, a disc in Woods back seriously narrowed because of causing sciatica, the three surgeries and severe back and leg pain. During the recent operation, the damaged disc was removed and the collapsed disc space was elevated to levels that were regular. The goal is to relieve the pressure on the nerve, the statement said. The procedure was performed by Dr. Richard Guyer of the Centre for Disc Replacement at the Texas Back Institute.
A Look At Tiger Woods’ Injury History
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Woods, 41, last played in February, where he shot a birdie-free 77 in the very first round before removing. Where he missed the cut his only other start was in the Farmers Insurance Open the week prior.
His only appearance on the golf course in 2016 arrived at the Hero World Challenge in December. While he finished 15th in the 17-man field, he tied for the tournament lead in birdies (24), seemed healthy and upbeat.
Before beginning therapy, he will be resting for several weeks. The recovery interval is usually about half a year. That would mean Woods, a winner of 14 major tournaments and 79 PGA Tour titles, won�t play in any of the four majors for a second straight year. He is now rated No. 788 in the world.
Woods is in good spirits after the surgery, said his agent, Mark Steinberg.
USA TODAY Sports, he believes somewhat that the large weight was lifted off his shoulders,� Steinberg told. �The three previous operations were somewhat temporary repairs. But it got to the point where the pain was more common and this latest surgery was something he had to do.�
Steinberg said Woods decided to take a conservative approach along with his back previously three years with his difficulties. That alternative wasn�t accessible this time.
�This just isn’t a temporary repair,� Steinberg said. � his physicians proposed him that this is the top path to a healthy, energetic lifestyle. He and his children were playing but he was in so much pain.
�Now he �ll possess a healthy life without pain.�
One, Steinberg said, that can include playing golf.
�Entirely,� Steinberg said. �He desires to get out (on the PGA Tour) again.�
Woods� last public appearance ahead of the operation was Tuesday in Hollister, Missouri, where he pronounced he�s designing his first public golf course. The course will probably be called Payne’s Valley in honor of Missouri native Payne Stewart. Woods is a partner on the project with CEO Johnny Morris and Bass Pro Shops founder.
Doctor of Chiropractic, Dr. Alexander Jimenez looks at the cervical spine and low back pain.
Low back pain and leg pain are the most common cause of disability worldwide. As such new research based treatment approaches are needed. This new randomized trial by BCP Non-profit and Cairo University tested the ability of the cervical Denneroll orthotic to improve cervical spine curvature and its consequent effect on low back and leg pain. Great short term results were found where patients receiving the cervical spine Denneroll improved with low back pain, leg pain, neurological outcomes and disability compared to a PT only interventional group.
Surgery is a common approach to treat carpal tunnel syndrome. But, physical therapy may work just as well, a new study indicates.
Researchers found that physical therapy improved hand and wrist function and reduced pain as effectively as a standard operation for the condition. Moreover, after one month, physical therapy patients reported better results than those who underwent surgery.
“We believe that physical therapy should be the first therapeutic option for almost all patients with this condition,” said lead study author Cesar Fernandez de las Penas. “If conservative treatment fails, then surgery would be the next option,” said de las Penas, a professor of physical therapy at King Juan Carlos University in Alcorcon, Spain.
Also, one extra benefit of therapy over surgery may be cost savings, he noted.
Treatments for Carpal Tunnel Syndrome
Carpal tunnel syndrome occurs when the median nerve, which runs from the forearm into the palm of the hand, becomes squeezed at the wrist. It often arises from repetitive motions required for work, such as computer use or assembly line work. Symptoms usually start gradually, with patients noticing numbness and weakness in the hand and wrist.
Surgery for the condition generally involves cutting a ligament around the wrist to reduce pressure on the median nerve, according to the U.S. National Institutes of Health.
Results of Physical Therapy vs Surgery
For this study, de las Penas and his colleagues followed 100 women from Madrid who had carpal tunnel syndrome. Half were treated with physical therapy and half underwent surgery.
For three weeks, the therapy patients received weekly half-hour manual therapy sessions — meaning therapists only used their hands. The therapists focused on the neck and the median nerve. They also applied manual physical therapy to the shoulder, elbow, forearm, wrist and fingers. On their own, patients performed neck-stretching exercises at home.
After one month, the therapy group reported greater daily function and greater “pinch strength” between the thumb and forefinger compared to the surgery patients. After three, six and 12 months, however, improvements were similar in both groups. All participants experienced similar reductions in pain.
Study co-author Joshua Cleland is a professor with the physical therapy program at Franklin Pierce University in Rindge, N.H. “Manual physical therapy may be just as beneficial in improving function and symptom severity as surgery despite the severity of their condition,” he said, noting that 38 percent of those in the therapy group had “severe” carpal tunnel syndrome.
“These manual physical therapy techniques are commonly used here in the United States as well and should become a standard of practice for physical therapists working with patients who have carpal tunnel syndrome,” Cleland said.
Dr. Daniel Polatsch is co-director of the New York Hand and Wrist Center at Lenox Hill Hospital in New York City. He treats several hundred cases of carpal tunnel syndrome each year, of which 15 to 20 percent require surgery. Treatment should be decided on a case-by-case basis, Polatsch said. Mild cases may be treated with conservative approaches that can include splinting, injections, therapy and activity modification, he added.
“Surgery is necessary when there is muscle weakness or atrophy from the nerve being compressed at the wrist,” he said.
Polatsch added that this type of surgery is generally safe and effective.
Still, operations can have complications, said Cleland. He cited a previous research finding that “approximately 25 percent of individuals undergoing surgery for carpal tunnel syndrome experience treatment failure with half of those requiring an additional surgical procedure.”
According to the researchers, almost half of all work-related injuries are linked to carpal tunnel syndrome. And, more than one-third who undergo surgery for the condition are not back at work eight weeks later.
Because this was a small study focusing only on women, the study authors said that future studies need to examine men.
The study results were published in the March issue of the Journal of Orthopaedic & Sports Physical Therapy.
SOURCES: Cesar Fernandez de las Penas, P.T., Ph.D., professor, physical therapy, King Juan Carlos University, Alcorcon, Spain; Joshua Cleland, P.T., Ph.D., professor, physical therapy program, Franklin Pierce University, Rindge, N.H.; Daniel Polatsch, M.D., co-director, New York Hand and Wrist Center, Lenox Hill Hospital, New York City; March 2017, Journal of Orthopaedic & Sports Physical Therapy
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Additional Topics: Chiropractic and Carpal Tunnel Syndrome
Carpal tunnel syndrome, which occurs when the median nerve, found between the forearm and the palm of the hand, becomes compressed at the wrist, can be treated in a variety of ways, including physical therapy and even surgery. New research has also determined that chiropractic care can be effective towards treating carpal tunnel syndrome and its symptoms. Chiropractor utilize manual manipulations to relieve the painful symptoms.
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