Manual therapists often blame nerve root pressure for pain arising from spinal misalignment. Pinched nerves are commonly targeted as the reason for unexplained neck and back pain. For years, bodyworkers have blamed nerve root compression for pain due to spinal misalignment. However, today most of the medical community disregard the “pinched-nerve theory” because of an absence of neurological signs such as paresthesias, tingling, numbness, motor loss, etc.
Some researchers dismiss the nerve root as a pain sensitive structure. Most do agree that pinched nerves can occur in extreme cases of trauma, muscle entrapments, and chronic degenerative disc disease. To experience nerve entrapment… lie on your side, place an arm above your head, and rest on that arm for a few minutes. The arm will eventually lose sensation as the nerve is stretched and compressed. This is an example of ‘pinching’ of a nerve.
There is a catch (no pun intended). Severe compression of a ‘healthy’ nerve may cause paresthesias, motor loss, sensory deficits, and loss of normal reflexes…but pain is absent. On the other hand, if the compression continues and the nerve’s dural sheath is rubbed raw, becomes inflamed (intraneural edema) and then compressed…pain will be present. This “silent nerve root compression syndrome” was first hypothesized by James E. Wilberger, MD in the Journal of Neurosurgery. His research suggests that time is required before functional alterations create mechanical nerve fiber deformation and accompanying pain.
How’s it work? Compression on an inflamed sensory nerve or its surrounding capillary beds over a length of time can cause the brain to experience pain (nociception). The pressure on the tethered nerve causes muscle cell contraction which leads to altered firing order patterns, protective spasm, faulty posture, wasted energy, and pain. However, it is rare for extended pain to exist as a result of nerve compression.
Pain caused by oxygen deprivation of the sensitive nerve tissues is a far more typical occurrence. This harmless and reversible condition can be extremely painful. Chronic back pain is most commonly blamed on pathologies such as herniated discs, bone spurs, etc., The pain often results from mechanical strain on joint related tissues such as spinal ligaments, joint capsules and muscles.
Here’s the good news. There is a form of manual therapy that can effectively treat both types of problems; the reduction in nerve function (tingling and numbness) as seen in piriformis and thoracic outlet syndromes, and also pain due to nerve fiber irritation. The objective of Myoskeletal Alignment(R) is to improve joint mechanics in the affected area to allow healing of the joint and surrounding soft tissues.
In Myoskeletal Therapy, the joint is held in a specific position with one hand and the surrounding soft tissues are stretched with the other. The client/patient isometrically contracts to a count of 5 and relaxes as resistance is met. This isometric muscle contraction is followed by a pin-and-stretch articular mobilization which releases motion-fixated joints. This very effective manual therapy technique often alleviates pain immediately once the abnormal joint position is corrected. This allows better movement with less nerve pain.
There will always be a certain amount of discussion over what symptoms qualify to be called a pinched nerve. Many nerve compression experts will continue believing that neurological tissue can be only be compressed by bone. Others maintain that a herniated disc and osteoarthritis are the primary culprits leading to a weak nerve signal.