Pinched nerve treatment in Toorak

What a pinched nerve is, and where it happens

Pinched nerve is everyday language for a nerve that is being compressed or irritated along its path. Most often that happens where the nerve leaves the spine, through a small opening between two vertebrae, and anything that narrows that space or inflames its contents can set the nerve complaining. A disc that has bulged, a joint that has lost its normal movement, swelling around either, or a combination of all three.

Where you feel it depends on which nerve. Nerves leaving the neck supply the shoulder, arm and hand, so an irritated nerve root there produces symptoms down the arm. Nerves leaving the lower back travel down the leg, which is what most people mean by sciatica. A nerve can also be compressed further along its route rather than at the spine, at the elbow or the wrist for example, which produces a different pattern again.

Why the pain is felt away from the problem

This is the part that confuses people most. The hand tingles, so it feels obvious that the problem is in the hand. But a nerve reports symptoms along everything it supplies, not at the point where it is being squeezed, so the loudest symptom is often the furthest from the source.

It is also why treating the sore area alone rarely holds. Rubbing a calf that is aching because of an irritated nerve root in the lower back is working on the messenger. National guidance on low back pain and sciatica takes the same view: identify what is actually driving the nerve symptoms, and be cautious about treating on the basis of where it hurts.^[1]

What a scan can and cannot tell you

Imaging is useful, and it has real limits. A large review of scans taken from people with no pain at all found disc bulges and degenerative changes in a substantial proportion of them, and the proportion climbed steadily with age.^[2] In other words, a scan finding is common and does not by itself prove that finding is what is causing your symptoms.

That is why we read imaging alongside the examination rather than instead of it. What matters is whether the level the scan flags is the level your examination is actually pointing to, and whether the pattern of your symptoms matches the nerve that would be involved.

When a pinched nerve is urgent

A small number of nerve presentations are medical emergencies. Go to an emergency department immediately for loss of bladder or bowel control, numbness in the saddle area between the legs, or weakness in both legs that is getting worse. These can indicate compression of the nerve bundle at the base of the spine, which needs surgical assessment urgently rather than any form of manual care.

Progressive weakness in a single limb, or numbness that is steadily spreading, also needs medical assessment first. We screen for all of this in the neurological examination before anything else happens.

What we do

Your assessment includes a full case history, a spinal examination and a neurological examination that tests reflexes, muscle strength and sensation, which is how we work out which nerve is actually involved rather than guessing from the map of where it hurts.

Dr Arthur Kaganovitch (Chiropractor) uses Gonstead analysis to find the specific level that has lost its normal movement, since a general area is not enough to work with when the target is one nerve root. We measure heart rate variability and run thermographic scans, which can show asymmetry in how the nervous system is regulating either side of the spine, and we refer for spinal imaging if what we find clinically indicates it.

You get the findings explained plainly before any care begins.