Nerves and Pain

Nerves are the communicators of the human body. They are bundles of axons which pass information between the brain, spinal cord and tissues using electrochemical signals. They tell the muscles to contract, as well as provide sensory feedback to the brain regarding sensation, and can communicate between themselves.

Nerves course through the body through the torso and limbs, they pass between muscles, joints, fascia, and fibrous tunnels. Because daily movements change the position of joints, muscles and other tissues, their force on neural structures also changes throughout the day. In order to be remain protected from the daily changes within the mechanical structure of the body, nerves must be able to slide and elongate, as well as withstand a certain amount of pressure and angulation. When these protective mechanisms fail or are exceeded, symptoms may result. Disc derangement, high intramuscular pressure, arthritic changes, instability, and overuse are examples of disorders that often have negative neural consequences.

Altered neural function can cause many symptoms; pain, numbness, weakness, pins and needles, altered reflexes, changes in muscle tone, and inflammation of surrounding tissues. The pain can occur anywhere along the pathway of the nerve, or in any of the tissue the nerve ‘connects’ to. This means that a nerve can be compressed in the back, and symptoms could be felt anywhere along the pathway of the nerve all the way down to the big toe.

During an assessment, physiotherapists will assess the nerves to ensure that they are not the cause of any pain or discomfort felt in the body. Nerve tension and neurodynamics are important to assess when looking at the nervous system. This involves stretching the nerves and sliding them through the tissues they travel through to determine if there is any discomfort or differences in tension and movement from the painful side to the non-painful side.

Patients can be surprised when the pain at the bottom of their foot that they had assumed was plantar fasciitis ends up being a neurodynamic issue. Sometimes torn hamstrings that ‘haven’t healed’ can lead to the sciatic nerve being entrapped in scar tissue. A nerve compressed by tight forearm muscles or stiff vertebrae in the neck can be the cause of tennis elbow or golfers elbow pain. Nerves have a very powerful impact within the body and it is important not to overlook them.

A common way to improve and treat neural function is to improve the neurodynamics. Restoring the balance between the movements of neural tissues and surrounding mechanical interfaces, reduces pressures on the neural tissue and promotes optimum function. Physiotherapists often prescribe ‘flossing’ techniques, where the nerve slides back and forth by tensioning one end of the nerve while slacking the other, and then changing the tension back and forth from end to end. These techniques are very gentle and can feel like they are hardly doing anything, but can create huge changes in the entire neural system.

Acupuncture is another technique that can create a dramatic change to the nervous system and neurodynamics in a relatively short period of time. By targeting the pathway of the nerve and the tissues the nerve passes through, acupuncture can help change the pressure imparted on the nerve and can influence transmission of signals through the nerve.

If you feel like you have unresolved pain or have been diagnosed with a condition that isn’t resolving the way it should, you may have nerve involvement. Contact us today and see if one of our talented physiotherapists can help assess your neurodynamics and determine if this is a contributing factor to your condition.

What is Sciatica?

Sciatica is an umbrella term referring to all conditions or injuries that cause irritation to the sciatic nerve. The sciatic nerve is the largest nerve in the body. This nerve originates between the vertebrae in the low back and travels down the backside of each buttock, hip and leg.

What are the Causes of Sciatica?

The sciatic nerve can be compromised in a variety of different ways. The nerve can be pinched or compressed by a herniated or prolapsed disc and/or by a bone spur or narrowing of the inter vertebral foramen (a boney canal where the nerve exits the spine). The nerve can also be compressed through the myofascial (muscles and its connective tissue) tunnels that it passes through as it travels down your leg, such as the piriformis muscle which is the most common point for Sciatic nerve compression deep down the glutes.

What are the Symptoms of Sciatica?

Since the nerve can become irritated in a variety of ways, the presentation can vary from person to person based on their unique presentation. In general, patients who have sciatic pain will complain of discomfort in their low back and leg. Also, patients may also describe feelings of shooting pain, tingling or numbness in their leg and foot as well as weakness of their leg muscles.

Symptoms that are more concerning is severe pain, tingling or numbness down both legs, increase frequency and urgency to urinate and constipation. If these symptoms are present it is urgent that you see a medical doctor that day.

How can a Physiotherapist or Chiropractor treat Sciatica?

Conservative management strategies such as physiotherapy or chiropractic care are treatment solutions that have been supported by the research and provide better outcomes over the long term. Your physiotherapist and/or chiropractor will complete a thorough evaluation of your back, pelvis, hips and lower extremity to determine the underlying cause of your sciatic symptoms.

Once your therapist determines where your sciatic nerve is being compressed they will use manual techniques to mobilize your restricted joints/tissues, use prescriptive exercise to improve your muscle imbalances and incorporate other modalities to facilitate recovery of the sciatic nerve. In addition, acupuncture and or dry needling/IMS can be used to reduce your pain and facilitate nerve tissue healing.

Shockwave therapy can minimize pain, break soft tissue adhesion, loosen up tight muscle fibers, speed up healing, and improves mobility quickly.

One of the most important exercises to do to protect your low back spine is core strengthening and posture correction.

They may also refer you to consult with a sports medicine doctor, have regular massage therapy intervention or to get custom orthotics to address lower extremity alignment issues.

What are the Best Exercises for Sciatica?

Dural Flossing

Core strengthening

Piriformis Stretching

How to Treat Sciatica at Home?

Heat / Ice

Applying heat/ice to the muscles of your lower back, buttocks or back of your legs may help to relive the pain.

Rehab exercises

Please refer to the last section for an overview of rehab exercises. Try to do the exercises daily and at an appropriate level in the initial healing phase and maintain 3x/wk for longer term prevention. A good program should address strength of your core and pelvis stabilizers and flexibility of your hips and lower extremity.

Activity Modification

Simple thing like sleeping with a pillow between your knees at night, using a lumbar support role in sitting, moving around often and avoid the things that aggravate your symptoms can be helpful.

Maintaining Proper Posture and Ergonomics

It is very important for you to keep up right posture habits and follow ergonomic principles while working to prevent yourself from unwanted over, under used stress and injuries.

Deep Breathing

Your nervous system is compromised and it is the largest oxygen consumer in the body, why not give it what it needs.

What to Avoid if you have Sciatica?

Avoid Prolonged Sitting

Try to get up and move around often. It is especially important that if you are sitting you are maintaining a good posture and have a lower back support. Sitting can place extra stress of the lumbar discs or tighten the muscles in your hips and back of the thigh.

Avoid Heavy Lifting

Bending forward and twisting of your spine- all these movements can place extra stress on the lower back and lumbar discs. If this is the cause of your sciatica you will be contributing to the aggravation. If you do need to bend down, do it slowly using a squat or lunge as opposed to your back, try to engage your core muscles and try not to do it repetitively.

Avoid Prolonged Rest

You do not want to spend too much time lying in bed or on the couch, although that may help not aggravated your symptoms it will decondition your muscles quickly (within 48 hours) and create more pain when you try to get back to your lifestyle. The best solution is to pace your day, do short periods of simple activity such as walking slowly every hour or two and increase duration and intensity as your symptoms improve.

How Long Does it Take to Recover from Sciatica?

This answer will be dependent on many variables like the cause of the sciatica, how long you have had symptoms, your treatment and lifestyle.

If you take a committed approach to treatment and lifestyle management and become more aware of your body you can see improvements in the first few weeks which should continue to full resolution in 2-3 months. If your injury is more complicated or continues to be aggravated with setbacks or lifestyle then you can take up to 6 months to improve and get back to things you enjoy.

Your Physiotherapist and Chiropractor will inform you if your recovery is delayed and will refer you to physician for further consultant and possibly investigation. In rare more severe cases surgery can be an option but that will only be considered, this is often dependent on length of time present and failed conservative management and also MRI results.

To book in with one of our experienced physiotherapists or chiropractors please contact us today.

Radiculopathy is a compression of one or more spinal nerve roots as it exits the spine. The compression causes dysfunction of the nerve and leads to tightness, pain, numbness or tingling sensations and/or weakness in the limbs. The injury occurs where the nerve exits the spine, but the symptoms commonly appear in the limbs, in the specific area that is supplied by the affected nerve root.

This injury most commonly occurs in the neck (cervical) and low back (lumbar) regions. A cervical radiculopathy will cause symptoms in the shoulders, arms or hands while a lumbar radiculopathy will cause symptoms in the buttocks, legs and feet. The symptoms can appear on one side or both sides of the body.

What Causes Radiculopathy?

There are many things that can cause compression of the nerve roots, including:

  • Disc herniation
  • Osteophyte formation (bone growth)
  • Osteoarthritis of the joints
  • Spondylosis (degeneration)
  • Degenerative disc disease
  • Spinal stenosis (narrowing of the nerve pathway)
  • Joint dysfunction (acute injury or stiffness)

How can Physiotherapy, Chiropractic or Massage Therapy Help with Radiculopathy?

Conservative treatment such as physiotherapy and chiropractic are considered the first line of action to help treat radiculopathy. Your therapist can help diagnose this issue involved and identify the root cause of the radiculopathy to create an effective treatment plan with you. Initially, treatment may be focused on symptom relief and prescription of safe exercises to help decompress the tissue and manage your daily activities. Your therapist will use manual techniques to help reduce the compression on the nerve and restore its function, exercise to help strengthen the muscles that support your spine to help prevent recurrence of the injury, and may choose to use other modalities such as shockwave therapy, spinal decompression, acupuncture or dry needling.

What Should be Avoided with Radiculopathy?

If you are able to identify postures or movements that reproduce your symptoms, you should try to avoid being in those positions for extended periods of time or reduce the frequency of the repetitive movement as able. Try to change your position or get up and move around more often throughout your day.

It is also important to consider your sleeping position if you have this injury, as certain positions such as sleeping on your stomach or sleeping with unsupportive pillows may cause increased compression on your nerve. Try to ensure your pillow keeps your neck in a neutral position, use pillows to support your arms/legs if you sleep on your side, and use a pillow under your knees as needed if you sleep on your back.

How Long Does it Take to Recover from Radiculopathy?

Recovery times can vary depending on each case and what is causing the compression of the nerve root. If you are able to receive treatment, follow your home exercise program and modify your activities the prognosis can be very good. It can take about 6-8 weeks to recover from the condition. If your radiculopathy is caused by degenerative changes it is important to continue to make exercise and lifestyle changes to ensure the radiculopathy is managed. You may need to be seen every few weeks by a physiotherapist or chiropractor to keep you accountable for this lifestyle change and prevent a re-occurrence.

What are Safe Home Exercises for Radiculopathy?

Given that this condition can be caused by many different variables, it is best that you come in for an assessment to determine the most appropriate exercises for you. Your physiotherapist may teach you stabilization exercises, self-mobilizations of joints or nerve flossing depending on the severity of your symptoms and its root cause. Nerves are the most sensitive structures in the body so it is important to be educated on what is best for you and not push through pain with your exercises unless instructed to by your health care professional.

If you are suffering from radiculopathy and would like to see one of our registered physiotherapists, chiropractors or massage therapists, please contact us today.