Spinal nerves exit the spine to supply the skin, muscles and joints of the respective limb they innervate for the purpose of providing sensation, strength, movement, coordination and proprioception. A nerve entrapment or known as a "pinched nerve" of the spine occurs when a spinal nerve becomes irritated and / compressed and presents with pressure symptoms; a set of conditions in which one or more of their nerve roots are affected and do not work properly known as radiculopathy. Although there are numerous causes for a nerve root entrapment, of the most common causes for radiculopathy in fit young adults is a herniated disc and in the older population spondylosis.
An intervertebral disc is a layer of strong, cushion-like pad tissue that lies between adjacent bone segments that make up the spine known as vertebrae. Each disc forms a joint, namely a fibrocartilage joint, to allow some movement of the vertebrae; acts as a ligament to hold the vertebrae together; and importantly serves as shock absorbers of the spine. A herniated disc or known as a "slipped disc" is a painful condition where the inner portion of the disc known as the gelatinous nucleus pulposes squeezes through a tear in the outer layer of the disc known as the annulus fibroses. The prolapsed disc material can cause pressure symptoms of the nerve roots below the level of the herniation, most commonly of the lower lumbar spine (low back) and the lower cervical spine (neck). A herniated disc is most commonly seen in fit young adults with a history of heavy, awkward straining or lifting, or in older people with degenerative changes of their spine known as degenerative disc disease or spondylosis.
Spondylosis can be referred to as
osteoarthritis (OA) of the spine. In the past OA was considered to be a “degenerative
joint disease” which implied a passive process with old age. This is misleading
because OA is a multifactorial and active disease that usually begins in the
middle age population, although individuals suffering from OA symptoms are usually above the age of 40 years.
OA can be classified broadly into primary and secondary.
Primary OA presents with no obvious cause for the joint disease. Secondary OA
results from abnormal wear and tear of a joint following a clearly defined
/ spondylosis is characterised by localised loss of articular cartilage /
intervertebral disc; remodeling of the underlying or adjacent bone / vertebra
by way of overgrowth known as osteophytosis or “spur” formation; and associated
inflammation and pain.
A herniated disc can cause nerve root entrapment by compressive and non-compressive neuropathy. Neuropathy refers to a problem with the nerves, predominantly of the spinal nerve roots. Spondylosis can cause compressive neuropathy and subsequently radiculopathy by way of disc herniation and / spur formation that encroaches on the spinal nerve root(s). Disk herniation is less likely in the elderly due to the thickness of the degenerated intervertebral disc that has been lessened by the desiccation of the nucleus pulposes. Intervertebral disk degeneration or injury can cause non-compressive neuropathy and contribute to radiculopathy by causing the release of inflammatory cytokines that irritate the spinal nerve roots. This is a biochemical rather than a biomechanical disorder. Inflammatory cytokines are type of signalling molecules that are excreted to promote inflammation in response to an insult and subsequently result in / contribute to pain. It is important to note, that there is often a mixed picture of compressive and non-compressive neuropathy.
The most common symptoms of nerve root entrapment include sharp, aching or burning pain in the back that may radiate along the buttock, back of the thigh and leg known as sciatica; or sharp, aching or burning pain in the neck that may radiate
down into the arm and / forearm known as brachalgia; “pins and needles” and numbness in the leg and / foot, or in the forearm, hand and / or fingers. In more
severe nerve root compression there may be strength loss of the affected
muscles of the arms / legs in the distribution of the affected nerves known as
Pain in itself
presents as a complex biopsychosocial issue in relation to a human being’s
expectation of self-efficacy, that is, the human being’s belief in their
ability to complete tasks and reach goals are adversely affected and are
associated with detrimental changes in mood, sleep, coping abilities and lower
Studies have showed that 90 % of cases respond positively to conservative management of later disc protrusion / nerve root entrapment. The referral criteria to the relevant specialist include severe, progressive and persistent pain; the presence of significant neurological deficits; and when no significant improvements are obtained over several weeks of conservative management.
At Vincere Health Chiropractic we utilize combinations of advantageous therapeutics when indicated to provide you with pain relief where other single therapeutics fail, including spinal manipulation; Extracorporeal Shockwave therapy; myofascial release / massage techniques; therapeutic taping techniques and of importance core rehabilitation and / rehabilitation of weak postural muscles of the cervical spine (neck).
A significant correlation has been established between chronic low back pain and weak core musculature. The back and abdominal muscles, especially the multifidus and transverse abdominus, can be referred to as “core muscles”. These muscles play an important role in providing strength and stability to the lumbar spine especially in the presence of degeneration or disc injuries. Core muscles can become weakened due to straining or under use. Also, these muscles tend to become weaken with age unless specifically exercised. Weak core muscles have also been showed to increase the risk for obtaining a pinched nerve / nerve entrapment of the spine.
Similarly, a significant correlation has been established between chronic neck pain and weak postural musculature of the cervical spine, especially the upper thoracic extensor and deep cervical flexor muscles. These muscles play an important role in providing strength and stability to the cervical spine and to keep the head back onto alignment over the shoulders especially in the presence of degeneration or disc injuries. Postural muscles of the neck can become weakened due to straining or under use. Also, these muscles tend to become weaken with age unless specifically exercised. Weak postural muscles of the neck have also been shown to increase the risk for obtaining a pinched nerve / nerve entrapment of the spine.
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