pinched nerves
The nervous system is a highway system within our bodies that communicates signals from the body to the brain and vice versa. These signals include light touch, pressure, temperature and pain, as well as signals to move muscles. When a part of the nervous system is injured or affected, i.e., a pinched nerve, the signals are impacted as well. As a result, a patient may experience pain, sensation changes (tingling/numbness) and/or weakness. When referring to the spine, the two most common areas for a pinched nerve to occur is either in the neck or the low back. A patient will typically develop radiating pain down the extremity (either arm or leg) and may have the aforementioned symptoms
From a musculoskeletal standpoint, a pinched nerve is typically due to one of two causes, (1) a herniated disc or (2) arthritic changes to the spine. Discs are like jelly filled donuts that connect the vertebrae (bones of the spine). They provide stability and allow for range of motion in many directions. When a disc herniates, think of the jelly oozing out of the donut. Given the anatomy of our spine, the jelly usually oozes out in one particular direction (backwards). Unfortunately, that is the area where a nerve resides. If the herniated disc compresses the nerve, it results in a pinched nerve. When referring to the low back, the general term is sciatica.
Arthritic changes to the spine can also cause a pinched nerve. Arthritis can be age related, and it becomes more prevalent as we age. When arthritis develops, new bone can form. The new bone, however, grows wherever there is space, which is usually where nerves are located. This narrowing of space is called stenosis. With what was once ample space to transverse, the nerve is now being suffocated by the arthritic changes and can cause pain symptoms and/or other neurological symptoms such as tingling, numbness or weakness.
The recovery of pinched nerves (medically coined radiculopathy) can occur via two means, by allowing the body to try and heal itself or by surgically removing the structure that is pinching the nerve. If a patient opts to treat the condition conservatively, recovering from a herniated disc has a more favorable prognosis (because it is a soft tissue a herniated disc can shrink in size over time) than symptoms associated from arthritis (as of now, there is no current medication/technology that can reverse arthritic changes). However, one has to understand that arthritis is an ongoing process that occurs over one’s life (and patients don’t necessarily need to be symptomatic from it). There is a high likelihood that the arthritic changes that caused your pinched nerve were there at a time when you didn’t even have symptoms. From a medical research standpoint, we are trying to decipher the “on/off” switch to why/when patients become symptomatic from arthritis. The hope is that with time the body will somehow turn the switch off for pain.
Standard conservative treatment consists of medications, physical therapy and/or spinal injections; all of which can help control pain and allow the body to heal. If pain cannot be controlled, if a patient fails conservative treatment, and/or if there is worsening weakness or numbness, surgery may be the best option.