What is a trapped nerve?
Physiotherapist Denis Murphy explains what is meant by a trapped nerve, why triathletes are particularly vulnerable to developing trapped nerves, and how you can treat them.
The term "trapped or pinched nerve" is not a true medical term but it is used to identify nervous tissue that has become more sensitised.
A trapped nerve frequently originates in the neck or lower back but sometimes also in the thoracic spine (mid-back). These type of nerve problems can be caused by inflammation or pressure on the nerve root as it exits the spine. In very rare and more severe cases this direct pressure can be caused by disc bulges which may lead to muscle weakness. This is not common, and one should not leap to this diagnosis as MRI scans of healthy symptom free people often reveal disc bulges.
What are the causes of a trapped nerve?
Trapped nerves can occur due a variety of movements, or as in Ironman competitors, after periods of prolonged training. For example, long bike sessions can lead to the athlete developing poor hip and thoracic mobility, which puts undue stress on the neck and lower back region where trapped nerves more commonly occurs. Also, sometimes poor thoracic rotation and extension (due to poor technique) in relation to body roll when swimming front crawl can cause cervical (neck) nerve irritation. Runners often can develop sciatic nerve irritation in their leg due to the athlete maintaining excessive lumbar lordosis when running.
What are the symptoms of a trapped nerve?
Symptoms of a trapped or pinched nerve include numbness, tingling or burning sensations, and sharp pain radiating outward from the spine into the arms or legs. Sometimes people can have symptoms in the hands or feet but without pain in the neck or back. Symptoms also occur locally in the elbow, wrist or ankle where the nerve is directly compressed but this is less common.
An example of this is ulnar nerve compression in cyclists displaying as little finger numbness. This is caused by the athlete supporting his body weight on the handlebars due to a poor bike fit or poor technique such as a failure to relax his handlebar grip.
Runners can rarely even develop nerve entrapments that display as achilles tendon region pain even though their tendon is quite healthy.
How can you treat a trapped nerve?
Sometimes a course of nonsteroidal anti-inflammatory drugs (NSAIDs) alone such as Ibuprofen can help to reduce inflammation so that the symptoms disappear. With more stubborn cases where medication alone cannot alleviate symptoms, treatment by a chartered physiotherapist can help.
Once the kinetic chain has been assessed and the affected area is identified, soft tissue mobilisation and spinal manipulation/mobilisation should alleviate the pain in the short term. The mechanism by which this works is not fully understood but current thinking is that it produces a temporary neurophysiological change in the tissue. Daily spinal mobility exercises can maintain improvements in between physiotherapy sessions with strength training used for treating the more chronic cases to improve the athlete’s ability to maintain proper form and avoid provocative positions. Many athletes can continue training with a modified training plan as total rest is rarely advised as treatment for a trapped nerve.
The bottom line is that while most people make a full recovery from a trapped nerve with Mother Nature alone, some need medication to treat the problem and help them, while others need therapists to alleviate the nerve pain.
Denis Murphy is a chartered physiotherapist and the founder of Physio4Richmond serving South West London. He is also a member of doctify.co.uk
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