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Wed, Apr 23, 2014

DR. KESTNER: How do you ‘un-pinch’ a pinched nerve?

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While lunching with a physician friend last year, he told me about an interesting question he had been asked.

“A patient had come in with a history of lower back pain for several months,” my friend said. “He had gradually begun having pain radiating down into his left leg to just below the knee. I suspected that he had a lumbar disc problem and had developed sciatica. I ordered an MRI and this was confirmed.

“I followed up with the patient and explained that he had a pinched nerve and prescribed some medication for him,” he continued.

“He listened and nodded as I explained how to take the medication. When I finished, he looked down at the prescription I had just given him, then back at me and asked, ‘Which one of these medications is supposed to un-pinch the nerve?’”

“I explained that one medication was a muscle relaxer and the other was an anti-inflammatory drug. He again asked me, ‘I see, which one will un-pinch the pinched nerve?’

“I didn’t have an answer,” my friend said. “I was immediately struck by the logic of his question and couldn’t provide a logical answer. I told him that the muscle relaxer would relax the muscles and that might affect the joints to relieve pressure on the nerve. I also told him that the anti-inflammatory drug might reduce swelling around the nerve and that might help. But when I compared those answers to my diagnosis of a bulging disc putting pressure on a spinal nerve, I didn’t like the logic of it. That is when I began trying to learn more about treatments like chiropractic spinal manipulation.”

Pinched nerve is a diagnosis that is offered to millions of patients daily. In the majority of cases, the next step is exactly the same as in this case; a prescription for muscle relaxers and anti-inflammatory medication, possibly a steroid. That is essentially standard procedure for many doctors.

If the symptoms are due to tight muscles or swelling, this treatment may relieve symptoms. In other cases this frequently chosen remedy is not effective. When the diagnosis is pinched nerve there is often much more going on than tight muscles and swelling.

Your spinal nerves branch off the spinal cord and provide neurological connections with every part of your body. The nerves pass between the spinal bones (vertebrae) as they separate from the spinal cord and extend to the body parts that they supply. It is at these locations between the vertebrae that the nerves are most vulnerable to injury or compression.

Between each vertebra there is a spinal disc. This disc acts in part as a spacer keeping the bones apart. These discs are amazingly tough, but injury and certain medical conditions can result in their deterioration.

This can result in the disc bulging or degenerating. Either situation places the nerves at risk of compression, either from the disc itself or from the two bones that the disc separates. When this happens, the nerve will suffer injury and not function normally. A person might feel tingling, numbness, pain or other unusual sensations. Whatever tissue the nerve controls will not function properly.

As you can imagine, if the nerve is being compressed physically by a protruding disc or an adjacent bony structure, taking medication will not physically correct the problem. In severely degenerated cases, surgery may be required.

Although spinal surgery has become much more advanced in recent years, there is still great concern about the potential risks and possible failure of the surgery. Spinal surgery is much more involved and complicated than many other types of surgery.

Although spinal surgeons are typically very talented and well trained, the failure rate of spinal surgery is still an issue. Conservative options should be exhausted before spinal surgery is considered.

Possible conservative treatments include chiropractic manipulation, physical therapy, exercise, massage, acupuncture and other approaches.

For an actual pinched nerve it is often necessary to provide some form of treatment that physically modifies the position of the spinal structures. In order to un-pinch a pinched nerve, spinal structures must be manipulated in one way or another.

Next week: It’s true! Dark chocolate beat prescription cough medicine at suppressing cough!

Dr. Mark Kestner

mkestner@DrKestner.com
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