Peripheral nerve pain may result from what is commonly referred to as “Trapped Nerves.” In this blog, I have outlined a few key points in relation to peripheral nerve pain and what to expect in relation to recovery and symptoms.
The nervous system in the body is divided into two parts the central nervous system and the peripheral nervous system. The central system consists of the brain and the spinal cord. The peripheral system is made up of the peripheral nerves. The peripheral nerves exit the spinal column at the various levels from the spinal cord and each nerve supplies a different part of the body i.e. a muscle, area of skin and/or organs. The peripheral nerves send sensory information to the brain and spinal column to tell the brain - for example the hands or feet are cold, that the object touched is sharp or that a joint or muscle is sore. The peripheral nerves also send signals to the muscles from the brain and spinal cord in order to generate an intended movement, for example, writing or walking. So basically the peripheral nerves communicate information back and forth from the muscles and organs to the central nervous system in order for tasks and functions to be carried out.
(Image courtesy of: Häggström, Mikael. "Medical gallery of Mikael Häggström 2014")
There are many causes of peripheral nerve problems. Injuries or physical damage can injure the nerves such as in a car accident, a fall or sports injuries where the nerves may become compressed or over-stretched. Repetitive stress or repetitive movements in awkward positions for prolonged periods of time can also cause injury to the nerve.
Peripheral nerve injury occurs due to injury to the nerves themselves and not the structures they innervate such as muscle and joints (Injuries to muscles and joints create a different type of pain known as nociceptive pain).
There are two types of peripheral nerve injury which are classified according to location.
In most cases of peripheral nerve problems occur as the nerve exits from the spine may be pinched or trapped or impinged. This may occur if the space in the spine where the nerve exits has been reduced or narrowed. This could be due to local swelling due to an injury, a disc protrusion or due to wear and tear changes resulting in a bony osteophyte (also known as a bony overgrowth). So although the symptoms may be in the foot or hand the source of the symptoms may be from the spine where the nerve exits resulting in 'referred pain'.
The peripheral nerves can also be compressed or impinged by a tight muscle or joint. For example compression of the sciatic nerve as it runs though the buttock region by a tight piriformis muscle or at further location as it continues down the back of the legs.
Peripheral nerve pain can feel like sharp shooting pains or darts of pains that are intense but short lasting usually in the legs or arms. There may also be some loss of sensation to temperature or touch, pins and needles, numbness, pricking sensations, weakness in the arms or legs or a feeling of “heaviness”. This can all be explained as injury to the nerves affects their ability to convey normal sensation back to the brain and carry signals to the muscles instructing them to contract and relax as needed for every day function.
Symptoms may be worse at night time. In severe cases there may be an inability to sleep due to the pain. In less severe cases there may be wakeful nights. Pain may be also be worse on coughing/sneezing or on certain movements where the nerve can be trapped or impinged further. Daytime pain may be fairly constant or intermittent depending on the sensitivity of the nerves.
Gentle manual therapy techniques may be used to mobilise joints in the spine where the nerve may be trapped or reducing tightness in the muscles and related fascia. Physiotherapy can also help reduce the pain levels and sensitivity by using medical acupuncture, electrotherapy as well as other specific manual techniques. Activity and lifestyle advice can be provided in order to help offload and reduce tension on the nerve which will also help to reduce pain and allow for healing. In addition, an individualised exercise programme will help to restore mobility of the affected areas and restore function.
Everyone responds differently to treatment and lifestyle factors also impact on recovery. Therefore the length of time it takes to improve depends on the quality of treatment received as well as lifestyle. In general, it can take 6-12 weeks to be completely pain free or in some cases longer depending on the severity of the nerve injury. The good news is that symptoms do and will settle. There may be improvements with good periods followed by bad but as time progresses these flare-up times will become shorter and less severe.
Depending on the severity and intensity of the pain and symptoms your GP can assist in the medical management and prescribe appropriate supplementary medication for pain relief should they be needed. Your Chartered Physiotherapist would arrange a GP referral if required.
An X-ray or MRI may be needed if the symptoms are very severe, or worsening over a short period of time or if there is rapid loss of muscle function. If there are any other presenting symptoms such as recent unexplained weight loss, bowel and bladder symptoms, severe loss of motor or sensory function, further investigation would be needed. If your pain symptoms are not settling in response to treatment, further investigation may also be needed. Your Chartered Physiotherapist would arrange a GP referral if required.
Peripheral nerve pain can be painful and debilitating in the short term. A good understanding of what is causing the pain and managing the symptoms correctly will aid in recovery. An accurate diagnosis, careful physiotherapy management with appropriate medication and investigation if needed has been shown to be effective in the successful treatment of peripheral nerve injuries.