Scary nerve stuff

Pinched nerves are everywhere
Google ‘pinched nerve’ and there will be about a million entries. The vast majority do not tell the full story and may make you worse if you think you have a pinched nerve.  ‘Pinched nerve’ is right up there with ‘heel spur’ and ‘degenerated disc’, maybe not quite as bad as the ‘obliterated thecal sac’, or ‘desiccated disc’, but it’s still pretty scary. The diagnosis itself usually needs more management than what is actually happening to the nerve.

Let’s go to the truth of ‘pinched nerves’ first.

The truth of pinched nerves

  1. When you look up at the stars you pinch nerves a bit. We do it all the time. They are designed to be pinched, squeezed, rubbed and wriggled. Most of the time, nerves love a good old workout.
  2. In autopsies, lots of dead people have been shown to have scuffed, squeezed, frayed, obviously pinched nerves, yet in life they may have never complained of pain (Neary and Ochoa 1975).
  3. It’s really hard to pinch and damage a nerve unless you take to the nerve with some pliers or there are some really significant arthritic changes in the spine, or you are the unfortunate victim of a nasty torture.
  4. And even when a nerve is injured (this takes quite a bit to do) it still may not hurt when physically handled or it may wait until you have the flu or are really stressed before it fires.
  5. Most of the time a person thinks they have a ‘pinched nerve’ it is usually a sensitive nerve, a non or minimally damaged nerve that moves quite well.

How do you treat a pinched nerve – talk, forget the pills and move.

Talk the nerve talk
First remember that you are usually treating a diagnosis, thus a concept, and conceptual change is the major therapy. The conceptual shift that you want is towards something like “OK it’s a bit sensitive but it will settle with a bit of brain and body de-stressing.

‘Pinch’ is a mean word. Do anything to me but don’t pinch me. A few years ago,  Michel Coppieters (Coppieters and Hodges 2008) showed that people move better when they think they are being tested for a muscle problem rather than a nerve – just the name – nerve compared to muscle. When you add ‘pinch’ to ‘nerve’ it has to be worse. So go through the truths above and put it into your own words.

Pills are not usually needed. There is a pill factory in your brain which should do the trick. Knowledge creates a flooding of happy hormones down the spinal cord. You can change the chemistry around the nerve by making it more physically healthy.

 

Move
No magic here. I am convinced that most undergraduate and postgraduate schools are no longer doing the science of neurodynamics justice (Coppieters and Butler D 2007). Get to a NOI course – watch for the new neurodynamics and neuromatrix courses coming near you. It’s easy to say get the nerves as physically healthy as possible and make sure the tissues around the nerve are as healthy as possible, but this can require special skills.

 

Nerve nips
OK – sometimes there is a ‘nerve nip’ (I quite like ‘nerve nip’ – much more friendly). I did focus too much on elongation in ‘Mobilisation of the Nervous System’ and there are occasions when a nerve can get nipped – most commonly the nerve root complex in the spine on extension (Spurling’s test) or the median nerve in the wrist on flexion (Phalen’s). ‘Nip pains’ may be sudden, even shocking, and if repeated may lead to fearful avoidance of the nipping movement. Management is the same…. remember it is nearly always a sensitive nerve not a damaged nerve.

Best of luck with your nips!

There will be heaps on nipped nerves at the rapidly filling Neurodynamics and Neuromatrix conference in Nottingham. There have been many research and clinical abstracts submitted such as the study by Takasaki et al which demonstrates the potential for nipping in the cervical spine from common activities of daily living. The workshops will include: Fine handling of the median nerve, Cranial nerve neurodynamics, and a workshop with Alan Hough, Andrew Dilley and Michel Coppieters on measurement of nerve movement.

Coppieters, M. W. and D. S. Butler (2007). “Do ‘sliders’ slide and ‘tensioners’ tension? An analysis of neuyrodynamic techniques and considerations regarding their applications.” Manual Therapy 13: 213-221.

Coppieters, M. W. and P. W. Hodges (2008). Beliefs about the pathobiological basis of pain alters pain perception in diagnostic clinical tests. IASP Conference, Glasgow.

Neary, D. and R. W. Ochoa (1975). “Sub-clinical entrapment neuropathy in man.” Journal of the Neurological Sciences 24: 283-298.

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