Pinched Nerve
"Hey Doc, I think I have a pinched nerve in my shoulder". Boy do I hear that one a lot. "Pinched Nerve" is a lay term that people generally have a hard time describing and can be seriously misleading. The majority of the time, I find that people have minor strains or trigger points in the myofascial system when they claim they have a "Pinched Nerve". This is great because treatment is simple, effective, and the prognosis is very good. However, if we are indeed talking about a pinched spinal nerve, your symptoms should correspond to the dermatome chart and your nerve pain is likely coming from a disc bulge, herniation, protrusion, or worse, extrusion. Click to find more information on Disc injuries as they pertain to Low Back Pain and Neck Pain. The peripheral nerves may also become trapped or "pinched" in a condition called nerve entrapment which tends to occur in a handful of characteristic locations, for example, Carpal Tunnel Syndrome. So, there you have it, a pinched nerve is more of a consequence of another problem that needs to be addressed. Whether it is bulging disc, an overly tight muscle, or soft tissues that are "pinching" a nerve, conservative, non-surgical, non-pharmaceutical care starts here.
Disc Injuries
This is the bread and butter of most chiropractic practices. While, ordering an MRI on every patient would be great, its cost and resource prohibitive. The fact of the matter is, MRI's of the spine are rarely warranted and most of the time an MRI won't change the course of care. Exception: there are time when surgery is indicated to prevent long term nerve damage and disability. You will know if you fall in this category because I will tell you right away and set you up with a surgical consult. Back to the point here. We DO NOT need an MRI to know if your pain is coming from a disc injury. A brief physical/orthopedic exam usually does the trick. Although, it would be compelling to be able to show every patient exactly where their pain is coming from. Let's talk about a few ways that we get disc injuries.
Acute Disc Injuries
Like any other tissue in our bodies, discs can tear under strain. Sometimes it happens slowly over time and sometimes it happens all at once. It can be hard to know when you have just injured your back if you have injured a disc, ligament, muscle, bone or any combination thereof. Its usually a combination. Disc injuries are generally easy to identify in an exam and differentiate but overlapping pain from concurrent injuries can cloud the issue. The big sign is usually in the history. "How did it happen?" Believe me, I have heard it all: "I bent over to pick up a napkin", "I was riding a bull", "I was changing a tire", "I sneezed", etc.
​
The worse the injury and the more tissues involved the worse the prognosis. Generally, people heal adequately in 6 weeks from most disc injuries. Thats with care. Outside of receiving proper care many people end up with chronic pain and permanent disability.
Cumulative Disc Injuries
The old "wear and tear" adage is spot on in the context of discs. There is often a genetic component to early wear and tear of the spinal discs and a history of injuries, especially sports and motor vehicle collision, is strongly indicative of this type of disc injury. This type is generally less panful but more constant and chronic in nature. This is the type of disc injury I see in patients aged 20y - 40y. Cumulative disc injuries happen a little at a time which is unfortunate because people usually do not seek care until symptoms are severe. A 6 week prognosis is still possible but these folks usually have chronic pain underlying the disc injury which makes it much more difficult and time consuming to treat. Worse yet, this particular type generally does not make for a good surgical candidate.
Arthritic Disc Injuries
Arthritis is a general term for joint inflammation. There are two main types of arthritis: Osteoarthritis and Inflammatory arthritis. We are only discussing osteoarthritis here although inflammatory arthritis shares many of the same spinal manifestations, its origin is different and will be discussed elsewhere. Back to the subject at hand, arthritis. The main findings in arthritis of the spine are disc desiccation (drying out), disc bulging, and bone spurring. People often tell me that they have bone spurs and have no idea that they have arthritis which, I think, represents a communication problem more than just ignorance. But, let me just say it, If you have bone spurring in your spine, you have arthritis and the spurring is just a part of it. We all get osteoarthritis, like gray hair and wrinkles, 'Uncle Arthur' comes for us all at some point.
​
This type makes for the gnarliest looking MRIs and has the worse prognosis overall. Most of my patients over 50 fall into this category most of which had previously been in the Acute or cumulative disc injury categories.
Nerve Entrapment
There are a handful of peripheral nerve entrapments. Perhaps the best known is carpal tunnel syndrome where the hand may go numb or hurt with prolonged bending of the wrists (usually while sleeping) or time working at a keyboard for example. Off the top of my head we have piriformis syndrome, radial tunnel syndrome, tarsal tunnel syndrome, thoracic outlet syndrome to name a few. There are a few more but they are increasingly rare. The good news is that they are generally easily identifiable and conservative chiropractic care is often all that is needed. However, just like with disc injuries, permanent nerve damage and disability may occur if any of these conditions persist too long untreated and may require surgery.
