3 Quick Tips About Pinched Nerves
Pinched nerves can literally be a pain in the butt….or shoulder; learn what causes pinched nerves and how they are treated.
Today’s topic is the dreaded pinched nerve in the back. I’ll tell you what it is, what causes it, how to diagnose it, and how to fix it.
What is a Pinched Nerve?
So what exactly is a “pinched nerve?” The term generally refers to damage of the nerves near the spinal cord. Doctors (of course) have a fancy word for it, calling it a radiculopathy. When I say “pinched nerve,” what is the symptom that comes to your head? “Back pain” would be the most common answer, and it would be wrong. The radiation of the nerve pain, or radiculopathy is not felt in the back but instead hurts where the damaged nerve travels to: the shoulders, arms, legs, and of course the butt.
Nerve Roots
As I said in my back pain article, the spine consists of a stack of bones, called vertebrae, that surround a bundle of nerves known as the spinal cord. The most important parts of the spine are the neck (called the cervical spine), which supplies nerves for the arms, and the lower back (called the lumbar spine), which supplies nerves to the legs. The vast majority of trouble happens in these two locations.
All the action we are concerned about today happens at the place in the spine where the vertebrae, or bones, come together–a place known as the intervertebral space. It is here that the intervertebral discs lie, acting as cushions between the bones; and it is here where the nerve roots are–you know, those things that keep getting pinched.
What Causes Pinched Nerves?
There are a number of things, including arthritis, that can cause damage at the nerve root, but I am going to focus on one: the herniated disc.
The intervertebral disc (the one that acts as a cushion between the vertebra) is a round piece of cartilage with a tough outside and a soft and gooey inside – kind of like a Skittle, except it isn’t filled with fruity goodness. Weakness of the disc coating accompanied by some sort of stressor can cause the goo inside the disc to be pushed out. When it does come out, it often ends up pushing against the nerve root coming out of the spinal cord. It’s this pressure on the nerve root that causes the classic “pinched nerve.”
Symptoms of Pinched Nerves
Herniated discs usually come on a abruptly–over the course of hours—and the pain is continuous, although sometimes a position change makes it feel better or worse . When a herniated disc happens in the neck, it causes pain that starts in the shoulder and goes down the arm. In the lower back, it causes pain in the buttock that goes down the leg. Since the main nerve going down the leg is called the sciatic nerve, pain caused by a pinched nerve in the lower back is often referred to as sciatica.
The pain is often hard to describe; it is not particularly sharp, nor is it dull. Most people describe it as a “hard pain” or as a “toothache pain.” It makes sense that it would be called a toothache pain, because the pain from toothaches is also nerve pain.
Let me emphasize once again that this pain is not usually in the back.
How is a Pinched Nerve Diagnosed?
I usually get a good idea of the diagnosis by listening to the story. The description of the pain is unique, and so usually points to its cause.
To definitively make the diagnosis, however, the test of choice is the MRI scan. This scan identifies which nerves and the discs causing the trouble and what level of the back they are doing their dastardly deeds.
How are Pinched Nerves Treated?
Most pinched nerves get better without significant intervention. I usually prescribe a steroid medication like prednisone, and I also often send patients for physical therapy. These two treatments will fix over 90% of those with a pinched nerve.
Those who don’t get better are candidates for more aggressive treatments, including injection of the nerve root with anti-inflammatory medicine and surgery. Surgery on the back is a big deal, and so is approached with great caution. There are two main reasons to get surgery done for a pinched nerve: severe pain that won’t go away, and progressive damage to the sensory and motor function of the nerves.
Do You Need an MRI?
Which leads me to one of my most important points. MRI scans are ordered way too often, and often expected by my patients coming in with back pain or sciatica. That is a mistake. The only reason I want an MRI scan is if I am considering surgery, or at least an injection of the nerve root. If someone isn’t a surgical candidate, MRI scans don’t give any useful information. It’s not only an unnecessary expense, it can lead to misdiagnosis and unnecessary procedures.
Quick and Dirty Tips for Pinched Nerves
So, here are my quick and dirty tips for today:
- Pinched nerves often cause pain that goes down your arm or leg.
- An MRI scan isn’t necessary so you shouldn’t insist on it and should question why you are getting it if you don’t think you need surgery.
- If you are a surgical candidate, don’t wait too long to get it done. Waiting can cause permanent damage to your nerves. If you aren’t sure about what the surgeon is telling you, get a second opinion. It’s your back; it’s worth the extra time.
If you haven’t already become a fan of my Facebook page or a follower of me on Twitter, you should hang your head in shame. Show me support. We’re having a contest to get as many people to sign up for Facebook and Twitter as possible this month. I want to show those other Quick and Dirty Tips hosts who is boss!
Let me once again remind you that this podcast is for informational purposes only. My goal is to add to your medical knowledge and translate some of the weird medical stuff you hear, so when you do go to your doctor, your visits will be more fruitful. I don’t intend to replace your doctor; he or she is the one you should always consult about your own medical condition.
Catch you next time! Stay Healthy!
Pinched Nerve image courtesy of Shutterstock
