Pinched nerve

Do you feel sharp and burning pain usually in the area of your shoulder blades, chest, lumbar spine or intercostal space? It is possible that you have a pinched nerve. Pinched nerve can result from a fall in most cases, but also after lying for a long time on the affected area, or overloading the area during sport or by keeping it in unchanged position for a longer period of time. That creates acute blockage along with increased tension in the muscles as a defending mechanism and a reaction to the negative event.

PINCHED NERVES AND NERVE COMPRESSION SYNDROME

In comparison with the problems mentioned above, pinched nerve can be a group of disorders, which are usually resulting from a pressed nerve in anatomically narrower part of the body (nerve can be pressed by the bone, muscle in higher tension, tumor and many other reasons). It is an illness of peripheral nerve characterized with pain or disorder of the nerve function in terms of mobility and sensitivity and as a result of long-term pressure on the nerve.
At first it can manifest with tingling in the area where the nerve is located. Later it can cause lower strength and mobility in certain parts of the body as a result of worsened supply of the muscles which are innervated by the nerve. Pressure on the nerves is causing restricted blood supply, which results in deterioration of the nutrition and function. If there is no relief, there is a risk of irrecoverable damage with consequences of losing the function of the nerve, sensitivity and function of the corresponding muscles.

CLBolestRukyMOST COMMON NERVE COMPRESSION SYNDROMES

Nerve compression syndrome of the shoulder girdle

In this case there is usually a feeling of tingling in the arms which can worsen when you carry something (for example grocery bags). The pain can sometimes appear close to the edge of the shoulder blade when you move both of your shoulders. Syndrome of the carpal tunnel is often connected with diabetes and significant hormonal changes (for example during pregnancy). Tingling in the fingers is usually common in the morning and evening. Cubital tunnel syndrome is usually accompanied by burning pain on outer side of the forearm, in pinky and ring finger. It is usually caused by injury of the elbow joint.

Nerve compression syndrome of legs and pelvis

The pressure on the nerve in this case can be caused by a tight clothing. People who have a manual job can press the nerves while leaning against a bar/counter in the groin area, pregnant women and obese people tend to overload their muscles in the groin area (ice hockey players, ice skaters). Dominating pain, burning and stabbing sensations, worsened sensitivity on the inner and outer side of the thighs.

CLUzinovySyndromDKIn another case the nerve can be pressed by a piriformis muscle. The pain usually occurs in buttocks and it can also appear in hips and thighs.

If there is pressure on the outer side of the calves, people usually feel tingling in this area, instep and sometimes even in the toes. Problems with flexing the toes may occur.

Runners, but not only them often suffer from Morton’s metatarsalgia. It is usually connected with wearing unsuitable shoes, long-term standing or overloading of the feet. These people usually suffer from flat transverse foot arch. The pain is described as burning, and it usually hurts the most in the area between 3rd and 4th toe. At first it is occurring while standing, later it becomes a permanent problem.

OPTIONS AND SOLUTIONS

Healing treatment

Primary condition for a successful treatment is to find out the cause of the problem and then remove it, or at least eliminate it as much as possible. If it’s concerning problems flowing from unsuitable working position or disproportionate burden, it can be avoided and prevent any future problems. Correcting the position is necessary as well as work space itself. Analysis is necessary if the problems flow from overloading during sport, here the patient usually has to correct the movement stereotype.

If the nerve is pressed by muscles, which are in a higher tension due to frequent burdening, it becomes important to stretch the muscles. For adjustment of the muscle tension you can also use the effects of the radial shock wave therapy.

Physiotherapy is using many techniques with neurophysiological basis (PNF, Vojta, DNS,...), which also adjust the muscle tension, but they mainly optimize the involvement of the muscles in a certain chain, which prevents overloading of individual muscles and joints.

Manual techniques are also frequently used, they are effective in lowering pain in the given area, they improve mobility and adjust the anatomical proportions in the tight area.

Stroking rehabilitation is during a sensitivity disorder effective.

You can also use the effects of manualor mechanical lymphatic drainage, which is very effective in treating edemas.

The nerve can be basically also mobilized, which at the same leads to recovery of the nerve mobility in the area of the pinched nerve.

And last but not least, it is important to focus on the body posture. This correction leads to balance and activation of all the muscles, it adjusts the tension in the affected body areas. Neurophysiological techniques are also used in this case (Propriomed, PNF, DNS…).

A successful supplement of the treatment is using orthosis at night, which keeps the joint in an ideal position.

SURGICAL TREATMENT

In case of extensive disorder of innervation and movement restriction (significantly decreased muscle strength, unbearable pain) surgical treatment because the only solution. The nerve is during the operation released from the pressure. After operation it becomes important to start a rehabilitation. The patient should care for a scar in early stages. Pressure massage or focused shock wave therapy can be applied, it accelarates the healing process



Author:
 FYZIOklinika physiotherapy Ltd., Prague, Czech Republic
Source: Clinical experience from a private practice in physiotherapeutic field, FYZIOklinika

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