Nerve Root Irritation
Also Known As: Nerve Root Injury, Nerve Root Damage, Pinched Nerve, Nerve Root Trauma or Nerve Root Pain
Nerve root irritation can be a significant part of many conditions and is commonly left undiagnosed. If this condition is present and not identified this often results in long delays in recovery. Also, if it's not identified and a patient feels better, so returns to usual activities, often the condition recurs many times, e.g. repeated hamstring muscle tears or repeated neck/shoulder tightness and pain.
The accurate diagnosis of a nerve root irritation is extremely helpful for getting on the road to recovery as quickly as possible.
There are many conditions where nerve root irritation is the primary cause. Conditions where the primary cause is often mislabled include:
- Back or neck pain
- Local leg or arm pain/burning/pins & needles/numbness
- Radiating pain/burning/pins & needles/numbness in the leg or arm
- ‘Muscle tears’
The best method for diagnosing this condition is a gentle manual assessment test that all Northwest Physiotherapy Group Physiotherapists are highly skilled at performing.
Finding The Underlying Cause
Nerve root irritation can be quickly resolved with skillful musculoskeletal physiotherapy treatment to the nerve root and structures around it that are the cause of the problem. This is done by hands on manual therapy techniques to decrease irritation of the nerve and quickly restore its movement and reduce your symptoms. We successfully treat this condition on a daily basis, including the diagnosis's causing it (such as disc bulge, ligament strains, joint strains etc.).
How Does The Nerve Root Irritation Condition Present?
Nerve irritation is not to be confused with full ‘pinching’ of the nerve; this is further along the worst end of the scale. It is known as ‘nerve root compression’ with a loss of conduction of impulses resulting in complete loss of muscle function in an arm or leg and complete loss of feeling [in the specific areas the nerve innovates in an arm or leg]. This is a rare condition, and is important to seek immediate medical care if this occurs.
The Common Cause of This Condition
Nerve root irritation most commonly results from a structure close to a nerve, such as a joint, ligament and/or muscle, which has sustained accumulative strain which results in swelling and inflammation.
How Does the Body Respond?
The nerve root is a very sensitive structure and sends strong signals to the brain to let it know when it’s suffering. The brain interprets these signals and then creates a protective response to avoid further damage to the nerve. Everybody is different and the responses to this condition can vary. This is another reason why this condition is tricky to identify and deal with. The protective response is predominantly radiating pain down the arm or leg, with muscle tightness and guarding. Sometimes the protective response is a feeling of numbness, pins and needles, tingling, cramping, tightness or an ache [like a tooth ache].
What Can I Do About Nerve Root Irritation?
Firstly, get a good assessment to confirm the diagnosis and then receive good treatment - be very diligent with following the advice obtained during the treatment!
Nerve root irritation is problematic to deal with because it usually doesn’t follow the normal rules of rest to help the condition resolve. Rest without good treatment often delays recovery significantly. Sometimes it even feels good to try to stretch the arm or leg affected or to do some light exercise. This temporarily ‘warms up’ the condition and for this reason it doesn’t feel so bad. Unfortunately, by doing this you are actually aggravating the condition while it is warmed up and the pain comes back worse soon after you cool down, or in some cases, the next day. The sooner you get good treatment the sooner you can be back to these activities.
While you are in the process of receiving good treatment and having the nerve irritation released to allow it to glide effectively, the best thing you can do in between sessions is avoid re-aggravation. This means spending as much time as possible either up and moving around or lying down. When lying on your back try placing pillows under your knees and when lying on your side try pillows between your knees, plus, line a pillow along your rib cage [either hugging the pillow at the front or lying on it along your back].
A good rule is to minimize sitting and minimize driving as this usually aggravates the joints and ligaments that are causing the nerve root irritation.
Your physiotherapist will describe to you how severe your nerve root irritation is and it is important to follow their specific guidelines.
For most cases where the condition is easily re-aggravated the following rules apply:
- For the times you have to sit ensure you utilise the best possible ergonomic position, sit in a firm chair [like a dinning chair] and no sitting on couches.
- For the times you have to drive ensure the seat is as close to the pedals as practical and your elbows are quite bent as you drive. Where possible get someone to drive for you, especially if you are having troubles using the stick or pedals [safety first].
- When you walk take small steps and do your best to avoid limping.
The General Rules to Avoid Aggravation are:
- Minimise stretching especially stretching beyond what is comfortable.
- Minimise exercise, if you have discussed this with your Physiotherapist and this is an aggravating factor for our specific case.
- Minimise sitting for longer than absolutely necessary.
- Minimise using the arm or leg in a stretched out position eg feet up while sitting, reaching behind you in car, heavy carrying or lifting, or overstretching to reach something.
- Avoid propping your head up with pillows to read/use a computer while lying on your back [lying on your side to read or having the laptop up high enough on cushions so you don't have to prop up your head is OK].
Our aim is to ensure you get back to a healthy life as soon as possible.
There aren't many conditions where we ask you to avoid or severely limit exercise, but can be one of them. Every case is different, so make sure you discuss what is right for your case with your Physiotherapist. All going to plan, you will only have to miss a few days at most of your regular life activities.
We will guide you, your family/significant others, your trainer and/or coach on how to best help you get back to your usual routine as quickly as possible.
We also look forward to showing you exercises and activities that you can do to speed up your recovery, after the nerve root irritation is nearly 100%.
What does good treatment involve?
We work very hard to ensure our treatment is the fastest possible method of recovery from a nerve root irritation while working towards long term prevention of recurrence of the condition.
This is not a permanent condition and with effective help you can be pain free and fully active after you have gone through the three phases of recovery:
Treatment to settle the Nerve Irritation until the nerve has full mobility without restriction and this mobility remains improved for more than a day (most often 2-4 sessions in a week).
Treatment to the underlying cause of the condition to get your joints, ligaments and muscles de-loaded and moving fully with no restrictions (most often 2-4 sessions in a week or two).
Gradually returning to full activities while integrating new muscle control to ensure you minimise the risk of recurrence. In most cases this will have you performing better than you did before the condition. (most often 2-4 sessions over a few months).
The best way to remain pain free is to get regular check-ups (every 6 months) just like you would with your teeth.
How do I know how bad the condition is and how my recovery is progressing?
A sensitive manual therapy test that a good physiotherapist performs can measure the extent of a nerve root irritation condition.
Even with good treatment, pain may not initially respond proportionally to the rate of improvement. You may have to be patient for a few days until the treatment effect is nearly 100%. This means even if the nerve irritation is improving you may not 'feel' like it is getting better. The way to know for sure is to rely on the manual therapy test as this gives an accurate measure of progress and reveals how close you are to being fixed.
The treatment progress graph will also give you an good guide to how your recovery is going.
Please note this information is general and individuals vary, so it is very important you get good advice from your physiotherapist about how this condition might relate to you.
If you have any questions about this, or any other musculoskeletal condition, please feel free to ask a Northwest Physiotherapy Group Physiotherapist.