Trapped nerves?

I’ve been delving into nerve pain and sciatica recently. One of the more accessible articles that has been published recently was by a Physio called Tom Jesson which differentiates between radiculopathy, referred pain and sciatica like symptoms.  The first important point he made was that this can be a confusing topic, both clinically and academically, so there is some work to be done to clear up some of the mixed messages. 

Referred pain is a dull gnawing pain which is difficult to localise – which is quite often to do with mixed nerve messages to the brain. (it’s a bit more complex than that, but we’ll keep it simple here). 

Radicular pain is a lancing, zinging electrical pain – classically referred to as “sciatica” in the lower limbs. However it is not necessarily caused by a “disc bulge” or a “trapped nerve” which is the general diagnosis from various quarters. These images are quite unhelpful and give the idea of a very specific physical pinch point, which is highly unlikely to be the case, especially as they have considerable space to move, even when inflamed. 

The more likely explanation is that there is a compression to the nerve by some kind of inflammation somewhere along the nerve. This could be at the root, or further down the nerve – this can then lead to spontaneous and abnormal random nerve discharges along the nerve. 

Radiculopathy is a very specific diagnosis where there is a loss of power, function and reflexes – but not necessarily pain. 

Perhaps one of the most important things to note is that nerves are tough, resilient and have very slippery sheaths. Trying to pinch a nerve is a little bit like trying to pick up a teflon covered piece of spaghetti with some chopsticks. Hard, if not impossible.

Mild compression is enough to cause some pain (imagine hitting your funny bone, and the resulting pain). Yes, it is true that nerve irritation is fairly common, but nerves are not a weak point. They are soft tissue and are just as capable of regeneration and healing as muscles, tendons, bones and ligaments. Movement is good, a little stretching is good – it helps increase blood flow and will oxygenate the nerves. 

There is of course a whole lot more depth and breadth of information, but I suspect if you’ve got to here without falling asleep, then you’re more likely to want to come along for a chat, or read something else in more depth.

Anyhow- the main message- yes, nerve pain is annoying, but no, it does not mean pain forever. 

See….it’s way more complicated !

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