Radiculopathy, commonly known as a “pinched nerve,” is caused by compression on the nerve root. All nerves originate in the brain and spinal cord and branch out through small spaces in the spinal column. The place where the nerve exits the spine is called the nerve root. The most common kind of nerve compression is caused by a herniated disc. The disc acts as a cushion between each vertebrae, but when damaged it can bulge out and put pressure on nearby nerves as they branch off from the spinal cord. As we age, our discs naturally shrink, bringing the vertebrae closer together and often resulting in the development of small bone spurs that can also compress nerves. Another common type of nerve compression is caused by the wrist bones and is known as carpal tunnel syndrome.
Clients often come to my office complaining of what they have self-diagnosed as a “pinched nerve,” but that is rarely the problem they are experiencing. There is a common misconception that radiating pain must be caused by nerve compression, but this is not so. It is, for example, very common for trigger points to cause radiating pain.
I believe that, for many people, the idea of what constitutes nerve pain comes from their experiences at the dentist’s office. Because of this, when they experience something like sharp pain in the neck that travels down the arm, they assume it must be nerve compression. But there is a big difference between a dental tool hitting an exposed nerve and an intervertebral disc pushing on a nerve root.
While there are many possible issues that could cause pain, nerve compression is best characterized by numbness or a feeling of pins and needles. Think of sitting or laying on an arm or leg in such a way that it goes numb. That is nerve compression. This is not to say that a “pinched nerve” can’t cause pain, it can, but that pain will be accompanied by numbness.
It is important to note that, even when nerve roots are compressed, they rarely cause symptoms. Nerves are pliable structures and the holes through which they exit the spine are actually quite generously sized so that, even if the space is compressed, the nerve is often not compromised. Most middle aged or older people have at least one area of nerve compression caused by normal aging and do not experience pain because of it.
It is also possible for soft tissues such as muscles and tendons to compress nerves and there are a few areas of the body where this is of special concern such as the sciatic nerve which runs under (or sometimes through) the piriformis muscle, or the brachial plexus nerve bundle which runs between the scalene muscles at the base of the neck. In these instances, however, we would still expect nerve compression to result in numbness.
When clients come to me complaining of a “pinched nerve,” they are almost always actually suffering from some form of myofascial dysfunction. Myofascial tension and adhesion, trigger points, and postural imbalances are substantially more common than pinched nerves, but don’t get nearly as much attention. It is very common for myofascial dysfunction to present as intense, sometimes sharp pain, that radiates and can even cause tingling or weakness.
Because myofascial pain is very poorly understood by the medical community, this pain is often misdiagnosed as nerve compression. When this kind of pain is felt, it is best to start with conservative treatment methods. The pain will often resolve with rest and ice at home. If the pain persists more then a few days, massage therapy and chiropractic care are the next options that should be pursued and these will often resolve the pain relatively quickly. Physical therapy may be needed to strengthen weak muscles and prevent the pain from recurring. Surgery should always be the option of last resort after conservative measures have failed.