Nerve Pain

Nerve pain: intense discomfort that stops you in your tracks.

Nerve pain: the low grade discomfort that is simply always there, just below the surface.

Nerve pain: the seemingly never ending electrifying shock.

Nerve pain: where did this come from and why is it happening to me?

Pain and irritation to nerve tissue is something that we often treat here at the clinic. No nerve discomfort is created equal and is unique in sensation to those affected by it. In this post, we will be discussing different descriptions of pain people experience when a nerve is involved and things we may do to treat those symptoms.

There are varying degrees of pain on a pain scale when a nerve is irritated. In the most extreme

cases, patients often experience a 9/10 out of 10 pain. This discomfort quite literally stops them in their tracks and has them often times fall to the ground due to intensity. The irritation does not allow for them to stand fully upright most of the time and can cause them to be leaning or rotated to one side. In lesser intense cases, patients may feel a pain that is closer to a 1/2 out of 10 pain that is annoyingly just always present. Enough discomfort or sensation to cloud their headspace and effect how they feel overall throughout the day.

Let's start with the more intense stuff first. Picture this: it is the eve before your young child's birthday party. Last week you traveled for a holiday and slept in the worst bed on Earth at your in-laws house for 3 nights, a 3 hour car ride from home. Along with terrible sleep, you don't get in your normal step count each day, have foods and drinks that you don't typically have in large quantities, and have a work deadline to meet on Tuesday. Once you arrive home, it is crunch time for the party. You wake up to take a quick shower, bend over to put on your socks and cannot stand back up. A shock-like sensation runs down the back of your leg that makes you fall to the floor. Your mile long to do list flashes in your mind and you start to panic because you are in so much pain that you are having a hard time taking a full breath.

Sound familiar?

Some of my favorite "causes" of extremely acute pain over the years include: leaning forward to grab toilet paper after using the restroom, turning my head to look at something my toddler was showing me at breakfast, sneezing, bending down to strap my ski boot on my first run out for the day, and finally, putting on my socks.

But when we look further into what has caused the pain, it is likely many things that ended in one big event that pushed everything over the edge. In the case of shooting leg pain, tension in the hips leads to an increase in movement of the joint of the spine. With increased movement, there is more inflammation that builds up in the joints. Directly where the joints is located is where the nerve exits. If there is inflammation in the joint, that is going to effect the nerve. Then many times due to a forward leaning movement with slight rotation, the disc tissue gets inflamed which is the directly behind where the nerve exits. This is the "event" that people talk about that has caused an electrifying type of pain that starts in the hip or lower back and goes all the way down into the leg and sometimes foot.

In the case of arm pain, many of us carry our necks in a forward carrying position most of the time. Think about what your neck looks like from the side. The ear should sit over the center of the shoulder. Most of us carry our head so far forward that the ear is completely in front of the shoulder. You may see photos of yourself from the front and think, "Man, I really need to start pulling my shoulders back." But really you need to get your entire head backwards and your shoulders will simply follow. As you read this, I would encourage you to try this.

When the head is in a forward bent position, it decrease the overall space for the nerve to exit because it is not in the position designed to allow for little to no boney interference where this nerve is exiting. Over time, small amounts of inflammation builds up in the joints that will turn into arthritis because your body is trying to add more bone to prevent movement that is causing pressure on the nerves themselves. So along with less space due to a malposition, there is now less space due to extra bone in the area. Then something like a sneeze or quick rotation of the head to look at a child in the back seat, and you literally cannot move your neck. You may also be experiencing pain down the inside of the shoulder blade, in the top of the shoulder, down the arm, and into the hand.

Now the less intense stuff. As discussed above, many people are tight in their hips which creates an increased movement in the spine AND many people carry their heads in a forward position creating a malposition that decreases space for the nerve exit. Many times low grade nerve pain has been present for a long time before there is some large number of events pile up as talked about above with the travel, inflammatory foods, and stress of planning a birthday party. During the build up to a big event, there might be an annoying pain or knot living between the shoulder blade and spine that gets worse in times of high stress or increased travel. There may also be low grade, belt line type pain that has you moving slow when you get up after watching a full season of a TV show or reading on the couch in a slumped position.

These low grade discomforts are your bodies way of telling you that something is going on and that you should probably do something about it before you are in 10/10 pain laying on the kitchen floor during the morning of your kids 3rd birthday party.

Treatment in our office for nerve pain typically starts by addressing any malpositions you hold

yourself in. This may be in your office chair, when you are standing at the kitchen counter prepping food, during exercise, or while you carry a child or baby. Getting yourself properly stacked consistently is step one.

Then we address the myofascial restrictions that are holding you back from maintaining this position most of the time. This typically looks like manual therapy, dry needling, fire cupping, instrument assisted soft tissue release, and manual adjustments. In the cases of extreme nerve pain that is coming from the neck or lower back, a manual adjustment of these areas is often NOT indicated. The area has been moving too much for too long and now the nerve is screaming "PLEASE stabilize me!" And it is forcing your body to do so by making the area so tight that movement seems almost impossible.

In the extreme type of nerve pain, we start with many stabilizing types of at home exercises to ensure the nerve can fully calm down. In cases of intense nerve pain, it is normal for patients to not be fully back to daily activities for several weeks to months depending upon severity. No one ever likes to hear this but we do our best to get you moving safely as quickly as possible. Once the area is stabilized and the nerve has returned to a more normal state, then we address the biggest issue in the movement patterns that caused the pain. Tension in the hips from prolonged sitting, imbalances in the pelvis following childbearing, corrections of neck positioning and posture during daily life and exercise. Think about what your head and neck looks like when you are 30-45 seconds in to holding a plank. A worse version of the head position photographed and described at the begining of this post when looking from the side?

The biggest goal with care and treatment of nerve pain is to ensure it never happens again. Sometimes there is enough area of inflammation around the nerve root itself that certain exercises and movements are no longer possible. We always try to get you back to everything that you want to do but some of that may need to be modified plus include a proper warm up and conscious effort of posture during exercise.

Have you had any experiences like those described above? Are you still dealing with pain now?

Let us help!

Best in health,

-Dr. Kylie