Neuropathy "The Painful Enigma"

Nerve irritation occurs when the nerves exiting the spine become irritated and sensitized. Also known as nerve gliding restriction, it is a condition whereby a nerve becomes irritated by inflamed swelling of structures close to the nerve, such as joints, ligaments, muscles, or discs, that have sustained an accumulative strain which results in swelling and inflammation. A thorough chiropractic assessment and examination can diagnose the extent of the irritation and develop a personalized treatment plan.

Nerve Irritation

When swelling and inflammation interfere with the nerve root, the nerve transmits signals to the brain to let it know there is a threat. The brain interprets these signals and creates a protective response to avoid worsening the damage to the nerve. The protective reactions vary from person to person but can include the following:

• Muscle tightness and guarding
• Aching sensation
• Cramping
• Radiating discomfort or pain
• Pins and needles
• Tingling
• Numbness
• Nerve root irritation also inhibits the body from recovering as fast as it should.

Nerve irritation is not to be confused with nerve root compression or radiculopathy. This is when the nerve becomes compressed/pinched, resulting in the loss of its functions like muscle strength and sensation. Sometimes individuals with nerve irritation can also experience increased neural tension. The nerves adapt to the mechanical loads placed on them through regular movements. Restrictions to neural mobility can cause symptoms to worsen along the pathway and distribution of the nerve.

• The nervous system consists of the brain, spine, and nerve branches.
• The branches, similar to electrical cables, cannot stretch.
• Tension is generated when straightening out body areas, creating a pull and gliding of the nerve to the spinal cord.
• When nerve irritation occurs, signals are sent to protect the body, brain, spine, and branches.

Causes

Most commonly, nerve irritation occurs when a structure adjacent to the nerve; this could be a joint, ligament, and/or muscle that accumulates strain and becomes dysfunctional, swollen, inflamed, and/or spasms resulting from protective guarding.

• Mild nerve irritation can include accumulated strain from postural overload and swelling from a minor tear in an adjacent ligament.
• Often nothing shows as a problem on an MRI scan.
• Severe nerve irritation can include disc herniation and shows up on an MRI scan; surgery could be required in some cases.

Symptoms

• Stiffness
• Tightness
• Aches
• Pains
• Persist even after days of rest, stretching, targeted exercises, avoiding movements, etc.
• Stretching feels good at first, but the pain returns or worsens a few hours later or the next day.
• The irritation blocks the effective recovery of muscle, joint, tendon, and ligament discomfort symptoms.

Chiropractic Care

Treatment involves various therapies and strengthening the supporting structures while relaxing and releasing tight structures to avoid recurring injuries. Chiropractic care realigns the spine, corrects joints that have shifted out of place, helps to regulate the nervous system's function, and relieves irritation and inflammation. Whether in the form of an adjustment, traction, or guided exercise, all systems in the body are moved closer to a balanced state. This includes the:

• Nervous system
• Immune system
• Respiratory system
• Circulatory system
• Endocrine system
• Skeletal system
• All help support the body's self-healing process and increase the nervous system's function.

The chiropractic team will guide the patient through the rehabilitation process to get back to full strength.

Peroneal Nerve Irritation

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, don't hesitate to get in touch with Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Ellis, Richard F, and Wayne A Hing. "Neural mobilization: a systematic review of randomized controlled trials with an analysis of therapeutic efficacy." The Journal of manual & manipulative therapy vol. 16,1 (2008): 8-22. doi:10.1179/106698108790818594

Gibson, William, et al. "Transcutaneous electrical nerve stimulation (TENS) for neuropathic pain in adults." The Cochrane database of systematic reviews vol. 9,9 CD011976. 14 Sep. 2017, doi:10.1002/14651858.CD011976.pub2

O'Shea, Simone D et al. "Peripheral muscle strength training in COPD: a systematic review." Chest vol. 126,3 (2004): 903-14. doi:10.1378/chest.126.3.903

Rozmaryn, L M et al. "Nerve and tendon gliding exercises and the conservative management of carpal tunnel syndrome." Journal of hand therapy: official Journal of the American Society of Hand Therapists vol. 11,3 (1998): 171-9. doi:10.1016/s0894-1130(98)80035-5

Sipko, Tomasz, et al. "Mobility of cervical spine and postural equilibrium in patients with spinal overload syndrome." Ortopedia, traumatologia, rehabilitacja vol. 9,2 (2007): 141-8.

Spinal nerves send motor, sensory, and autonomic signals between the central nervous system and the body and are part of the peripheral nervous system. They are essential for carrying information that controls body movements and sensations to the brain. When a nerve gets injured, compressed, or damaged, it can cause discomfort, increased sensitivity, numbness, muscle weakness, and pain.

Damaged Nerve Roots

Nerve root pain is often caused by other underlying conditions that have caused compression or damage to the nerve root. Causes of nerve root pain can include:

• Herniated discs
• Spinal injury
• Spinal stenosis
• Arthritis
• Spondylosis
• Spinal infection
• Bone spurs
• Inflammatory disease
• Spinal tumors
• Spinal cysts

Spinal nerves impacted by injuries or infection can lose their ability to control the body areas, lose their functional capacity, lose sensation, and die.

Spinal Imaging

Nerve damage can be diagnosed on a neurological exam and correlated with MRI and X-ray imaging. Conditions that MRI can identify include herniated discs, spinal cord compression or fracture, arthritic development, tumors, or cysts pressing on a nerve.

• MRI images are obtained with a magnetic field and radio waves.
• MRI shows spine images from the side/sagittal view and cross-sectional/axial views.
• This allows the chiropractic doctor to see the vertebrae and discs and identify abnormalities.
• The spinal cord is a gray area in the middle surrounded by the spinal fluid, which appears white.
• Little white channels on either side of the spinal cord are where the nerve roots branch off.
• X-rays can show the alignment of the bones along the spine and determine any narrowing or damage to the discs.

It is important to be evaluated and diagnosed for signs and symptoms of nerve injury as soon as possible, as nerve damage accelerates and worsens.

Function Restoration

Sometimes, the symptoms improve by themselves and do not require treatment. Nonetheless, physicians begin with conservative, non-surgical approaches to treat nerve root pain. Chiropractic and physical massage therapy involves specific movements, stretches, and exercises to keep the affected muscles and joints active, prevent stiffness and help restore function and feeling. Treatment can include:

• Therapeutic massage
• Manual adjustment/resistance treatment
• Trigger point therapy
• Instrument-assisted soft tissue therapy
• Decompression
• Traction
• Joint stretching
• Electrical stimulation
• Ultrasound
• Specialized exercise
• Activity modification
• Anti-inflammatory diet

Nerve Chiropractor

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make your own healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Liu, Yan, and Huan Wang. “Peripheral nerve injury-induced changes in the spinal cord and strategies to counteract/enhance the changes to promote nerve regeneration.” Neural regeneration research vol. 15,2 (2020): 189-198. doi:10.4103/1673-5374.265540

Menorca, Ron M G, et al. “Nerve physiology: mechanisms of injury and recovery.” Hand clinics vol. 29,3 (2013): 317-30. doi:10.1016/j.hcl.2013.04.002

Shehab, Safa Al-Deen Saudi. “Fifth lumbar spinal nerve injury causes neurochemical changes in corresponding and adjacent spinal segments: a possible mechanism underlying neuropathic pain.” Journal of chemical neuroanatomy vol. 55 (2014): 38-50. doi:10.1016/j.jchemneu.2013.12.002

Stoll, G, and H W Müller. “Nerve injury, axonal degeneration, and neural regeneration: basic insights.” Brain pathology (Zurich, Switzerland) vol. 9,2 (1999): 313-25. doi:10.1111/j.1750-3639.1999.tb00229.x

Ye, Xuan, et al. “Nerve fascicle transfer using a part of the C-7 nerve for spinal accessory nerve injury.” Journal of neurosurgery. Spine vol. 28,5 (2018): 555-561. doi:10.3171/2017.8.SPINE17582

Noninvasive treatments like chiropractic care, non-surgical decompression, massage therapy, non-steroidal anti-inflammatory drugs/NSAIDs, targeted/specific exercises, and ice/heat therapy successfully treat most cases of sciatica. However, more aggressive treatment could be necessary for severe cases, and this is where sciatica nerve block injections come in. The Injury Medical Chiropractic team can help you understand the diagnosis and explain the benefits.

Sciatica Nerve Block

Sciatic nerve block treatments can provide profound relief for intense, non-stop symptoms. The procedure can also provide important diagnostic information to help the spine specialist locate the exact nerve fibers contributing to the symptoms.

• The nerve block stops sciatic pain signals from transmitting.
• The procedure involves injecting an anesthetic and a steroid into the nerve roots.
• The steroid reduces inflammation.
• The anesthetic prevents nerve impulses from reaching the central nervous system - CNS.
• If the procedure is successful, surgery could be avoided altogether.

What to Expect

Individuals undergoing a sciatic nerve block will be awake during the procedure. Individuals that rather be sedated are recommended to speak with their healthcare provider during the planning phase.

• When the procedure begins, a nurse sterilizes the area around the injection site and applies a local anesthetic.
• The nurse will check the injection area for numbness.
• Then the spine physician inserts a needle using direct visualization from an ultrasound, fluoroscope, or CT scan and then injects the medications.
• After the procedure, the individual is moved to a recovery area and monitored.
• Most individuals can walk almost immediately after the injection, and vigorous exercise can be resumed a few days following the procedure, depending on the injury and what the spine specialist recommends.

Possible Complications

The procedure is done under direct visualization to minimize the risk of complications. However, possible complications could present and are usually linked to the needle insertion into the spinal column. These include:

• Bleeding
• Nerve Injury
• Infection

Complications are rare, but side effects like soreness around the injection site, nausea, and a headache are common and only last a little while.

Candidates

Individuals with underlying conditions and that are taking various medications may not qualify for a sciatic nerve block or have to consult their doctor for reasons that include the following:

Long-Term Anticoagulant Use

• Individuals taking blood thinners like daily aspirin, Plavix, or coumadin, will need to stop taking these medications before the procedure.

Allergy to Contrast Dye

• Sciatic nerve blocks are done using contrast dye or ultrasound.
• Individuals with an allergy to contrast dye will need to verify with their doctor or surgeon the feasibility of only using ultrasound guidance.

Abnormal Spinal Anatomy

• Individuals with abnormal spine anatomy have an increased risk for complications and are recommended not to have the procedure.

Morbid Obesity

• Morbid obesity is a significant risk factor for developing sciatica.
• The pain and symptoms often improve with weight loss.

Infection

• Inserting a needle with an injury, wound, or active infection near or around the injection site could cause spreading.

Treatment Duration

There is a wide range of responses to sciatic nerve blocks.

• Most individuals experience pain and symptom relief between two weeks and two to four months.
• Some individuals have a long-term resolution of their symptoms.
• However, it is also possible for the nerve block to be unsuccessful.

Unsuccessful Outcomes

The sciatic nerve is the longest in the body, and there are multiple potential sites for an anesthetic blockade.

• If a sciatic nerve block does not work, the spine specialist will reanalyze the diagnosis and see if the injection site was correct.
• Identifying the exact section of the nerve to anesthetize can be difficult and may require multiple nerve block attempts.

Individuals who continue to experience debilitating sciatica symptoms after a sciatic nerve block could be recommended to undergo surgical procedures.

• Sciatic nerve ablation is a procedure that destroys nerve pathways identified to cause pain and can provide long-term relief.
• If sciatica is caused by misalignment of the vertebrae or intense external pressure on the sciatic nerve, surgery to correct the underlying cause could offer a permanent solution.

Sciatica Syndrome

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

5 Questions to Answer Before Considering Sciatica Surgery, Johns Hopkins Medicine, accessed September 28, 2022, https://www.hopkinsmedicine.org/health/conditions-and-diseases/back-pain/5-questions-to-answer-before-considering-sciatica-surgery.

Jönsson, B et al. “Diagnostic lumbar nerve root block.” Journal of spinal disorders vol. 1,3 (1988): 232-5.

Kanaan, Tareq, et al. “The Efficacy of Therapeutic Selective Nerve Block in Treating Lumbar Radiculopathy and Avoiding Surgery.” Journal of pain research vol. 13 2971-2978. 18 Nov. 2020, doi:10.2147/JPR.S276331

Rodziewicz TL, Stevens JB, Ajib FA, et al. Sciatic Nerve Block. [Updated 2022 June 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470391/

Sciatica: Harvard Health Publishing, (2016, February 19), accessed September 28, 2022, of all the nerve https://www.health.harvard.edu/pain/sciatica-of-all-the-nerve.

Senthelal S, Dydyk AM, Mesfin FB. Ablative Nerve Block. [Updated 2022 April 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499975/