ESO Clinic Blog – What causes a ‘trapped nerve’ and how can osteopathy help?
Anyone experiencing a sudden sharp pain which lingers anywhere on the body, may describe their pain as a ‘trapped nerve’. Whilst this may be the case, many local pains are related to other structures such as muscles, tendons, joints, and ligaments rather than nerves.
So, what exactly happens when a nerve gets ‘trapped’? As with many lay descriptions of pain there can be misunderstandings and incorrect visualisations about what is going on under the skin. It is less common for nerves to get trapped like ‘a finger in a door’. They are more likely to be irritated or pinched to the point of becoming inflamed and swollen or they may have their passage compromised as they pass across and through bony structures, muscles, and connective tissue. On occasions a patient may have nerve symptoms without pain. One must remember that there is an amazing network of nerves which flow all around the body stemming from the spinal cord and ultimately the brain, so mild nerve symptoms are common. Osteopaths have knowledge about the common ‘entrapment sites’ around the body and tend to know where to look and what to look for.
The most common areas for compromised nerves are in the low back and buttock often giving pain known as ‘sciatica’, also nerves stemming from the lower neck giving symptoms down the arm and into the hand. For example, a patient may seek treatment for arm pain believing they have a shoulder or a wrist problem where in fact the problem may well be an irritated nerve exiting in the base of the neck. What they are experiencing is termed ‘referred pain’. Nerves can be ‘impinged’ or ‘effaced’, to use terminology used on MRI scan reports, by a variety of structures. For example, Sciatic symptoms are commonly caused by bulging discs in the lower back, degenerative changes in the spine and tight muscles such as the piriformis muscle in the buttock area.
When a nerve gets pinched or inflamed the person may experience a range of symptoms in addition to various intensities of pain. They may complain of tingling, numbness and in some cases weakness dependent on the nerves and muscles affected. If a nerve has been compressed for more than a few minutes, the person may feel like their arm or leg ‘has gone to sleep’. This may also be because the blood supply to the local tissues and nerves has been impeded. This can happen with awkward sitting or sleeping positions such as sitting on a very hard surface or sleeping with an arm up above the head or under one’s body. In most cases, a change of position and a shake of the hands or legs enables gravity to allow the blood to flow back more easily to the periphery and makes the feeling come back within seconds to minutes. A classic example of this is carpal tunnel syndrome where the patient may experience tingling in the thumb, index and middle finger as a nerve passes though bony apertures in the wrist bones. People often experience this at night when in bed and get relief from dangling their hands over the side of the bed and shaking them. Some patients gain benefit from wrist splints which hold the wrist splayed whilst asleep. This usually affects older people who may have arthritic changes in the bones in their wrist. Whilst osteopathic treatment can help alleviate these symptoms some patients eventually opt for a simple surgical procedure.
Anyone experiencing symptoms such as pins and needles and even weakness would be wise to seek a medical opinion. Osteopaths are trained to examine for many nerve related issues using their knowledge of orthopaedics, neurology, and anatomy. Although musculoskeletal specialists, they need to exclude where possible, other causes for a patient’s symptoms. For example if a patient complains of tingling in both hands and feet, this may be due to systemic conditions such as diabetes, anaemia, thyroid conditions, vitamin deficiencies such as B12 and even the effects of some medications to name but a few. In such cases osteopathic treatment may not be indicated and the patient would likely be referred to their GP for further investigation such as blood tests, imaging or electrodiagnostic testing.
Osteopathic consultations would start with a detailed case history and then a structured examination involving a thorough assessment of nerve function. This would involve a logical process whereby the anatomy and function of the affected sites would be tested. In the case of someone with neck and arm symptoms this maybe the cervical spine, shoulder, elbow and wrist and then specific neurological tests to see if nerve function to those areas is deficient. Neurological testing usually involves the taking of reflexes, checking muscle strength in key muscles relating to specific nerve pathways and sensory testing checking the sensation in key areas of the limb.
Initial treatment for most nerve issues is non-surgical and many irritated nerves can be treated effectively with soft tissue release techniques, gentle mobilisation, and decompression of affected areas. This combined with exercise prescription and tips for postural correction as required. Occasionally treatment may be accompanied using certain medications such as pain killers and anti-inflammatories as prescribed by the GP or pharmacist. Severe nerve compression can be more difficult to treat with manual techniques and stronger medications may be needed and in rare cases patients may need to be referred for a surgical opinion.
Blog created by Robert Thomas, ESO Clinic Ambassador, Clinic Tutor and Osteopath. To find out more about osteopathy and the European School of Osteopathy visit www.eso.ac.uk/clinic or call for a consultation on Maidstone (01622) 685989.