Neuropathy "The Painful Enigma"

The nervous system communicates with the entire body and reacts to internal and external changes using electrical and chemical impulses to send and receive messages. Messages travel/synapse from one neuron to another using specialized chemicals known as neurotransmitters.

Paresthesia refers to sensations of numbness, tingling, prickling, skin crawling, itching, or burning, usually in the arms, hands, legs, and/or feet, but can affect other areas of the body. 

Chiropractic care, massage therapy, decompression therapy, and functional medicine can relieve tissue and nerve compression, improve flexibility, range of motion, and mobility, and strengthen the muscles surrounding the affected nerve to maintain optimal health and prevent worsening or further injury.

Paresthesia

The sensation comes on without warning and is usually painless and described as tingling or numbness. There are different causes of paresthesia, including:

• Compressed or pinched nerve.
• Nerve injury.
• Nerve damage from diabetes.
• High levels of vitamin D or other vitamins.
• High blood pressure.
• Infection.
• Fibromyalgia.
• Multiple sclerosis.
• Stroke.
• Tumor in the spinal cord or brain.

Some individuals have chronic or long-term paresthesia, which can be a sign of a more serious nerve injury or condition. Added physical stress can cause surrounding tissues to irritate or entangle the nerve leading to building pressure. This pressure causes paresthesia in the area interrupting circulation and function. A pinched nerve can happen anywhere in the body, like the neck, shoulder, wrist, back, and face.

• A herniated disc in the lower spine can cause back pain and paresthesia in the leg or foot on the affected side.
• Carpal tunnel syndrome is a pinched nerve in the wrist that causes numbness and tingling in the hand and fingers.
• Pinched nerve symptoms can be intermittent or constant.
• Usually, a temporary sensation is caused when pressure is placed on the affected nerve.
• Once that pressure is relieved, the discomfort goes away.

Individuals with an Increased Risk

Overuse Injury

• Individuals with jobs or hobbies requiring repetitive motions are at a higher risk for nerve compression, paresthesia, or injury.
• Anyone can get a pinched nerve, and most individuals will experience paresthesia at some point.

Prolonged Lying Down

• Lying down for extended periods can cause nerve compression.

Obesity

• Extra weight places added pressure on nerves.

Diabetes

• Diabetes can cause nerve and tissue damage.

Pregnancy

• Weight and water gain can cause swelling and increase pressure on nerves.

Thyroid Disease

• This puts individuals at risk for carpal tunnel syndrome.

Rheumatoid arthritis

• This causes inflammation, which can also compress nerves in the joints.

Diagnosis

To diagnose paresthesis, a doctor will look at the individual's medical history and ask questions about the symptoms. They will perform a physical examination and, depending on the findings, may recommend tests that can include:

Nerve Conduction Study

• This measures how fast nerve impulses travel in the muscles.

Electromyography - EMG

• To look at the electrical activity of how nerves and muscles interact.

Magnetic Resonance Imaging - MRI

• This looks at the different areas of the body in high definition.

Ultrasound

• Used to produce images, this can be applied to the smaller areas to look for nerve compression or damage.

Chiropractic

Treatment options depend on the cause of the paresthesia. Body misalignments can cause nerve interference that can lead to health problems such as migraines, or can disrupt nerve communication and block proper circulation. Chiropractic care focuses on treating the nervous system and is a safe and effective method for treating nerve problems that cause discomfort and sensations. After a thorough examination of problem areas, massage, decompression, and chiropractic adjustments will:

• Realign and restore proper nerve function.
• Restore proper blood circulation.
• Increase the function of the body's systems.
• Promote optimal levels of health and wellness.

The Science of Motion

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 various 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

Bova, Joseph, and Adam Sergent. “Chiropractic management of a 24-year-old woman with idiopathic, intermittent right-sided hemiparesthesia.” Journal of chiropractic medicine vol. 13,4 (2014): 282-6. doi:10.1016/j.jcm.2014.08.002

Christensen, Kim D, and Kirsten Buswell. “Chiropractic outcomes for managing radiculopathy in a hospital setting: a retrospective review of 162 patients.” Journal of chiropractic medicine vol. 7,3 (2008): 115-25. doi:10.1016/j.jcm.2008.05.001

Freihofer, H P Jr. “Parästhesien” [Paresthesia]. Schweizerische Monatsschrift fur Zahnheilkunde = Revue mensuelle suisse d'odonto-stomatologie vol. 89,2 (1979): 124-5.

Karne, Sampada Swapneel, and Nilima Sudhakar Bhalerao. “Carpal Tunnel Syndrome in Hypothyroidism.” Journal of Clinical and diagnostic research: JCDR vol. 10,2 (2016): OC36-8. doi:10.7860/JCDR/2016/16464.7316

Neuropathy is a painful condition that causes tingling, numbness, burning sensations in the hands and feet, and other symptoms throughout the body. Neuropathy can make life difficult. There is no cure for neuropathy, but symptoms can be managed with medications, antidepressants, anticonvulsants, and pain relievers. Another treatment option to help relieve neuropathy symptoms is chiropractic.

Symptoms

Symptoms vary from individual to individual depending on their health condition and how the nerves have been impacted. Common symptoms include:

• Pain
• Numbness
• Tingling
• Pins-and-needles feeling when touching something hot or cold.
• Some individuals lose the sense of feeling like clothing on their body, even though it's rubbing against the skin but feel as if it is not there.
• Other changes can be familiar objects looking different than usual.
• Lessened or heightened sense of smell.
• Negative impact on mood.

Protective Sheathing Of The Nerves

Neuropathic pain is caused by damage and degeneration to the nerves or the protective covering/sheathing of the nerves. Various causes include:

• Diabetes.
• Injury.
• Infections.
• Medication side effects.
• Exposure to toxins.

Stages

The symptoms of neuropathy depend on the location and severity of the nerve damage. The stages include:

Numbness and Pain

• Stage one consists of numbness and pain.
• Some individuals describe a tingling or numbing sensation.
• What feels like pinpricks in the hands and/or feet.
• This stage can last for months, but most individuals recover within a year.

Constant Pain

• Stage two is characterized by continuous pain.
• Some individuals may experience shooting pains that come and go.
• Intense burning sensations around the waistline.
• Numbness on one side of the body with stabbing pain.
• This stage can last for a year or more and worsen until the individual is incapacitated.

Nerve Degeneration

• Stage three is when nerve degeneration sets in.
• Loss of feeling on both sides of the body.
• Loss of motor skills like walking and falling over.
• Doctors treat the symptoms so they don't get worse.

Loss Of Sensation

• The final stage is the loss of sensation.
• This occurs when the nerve endings are destroyed and can no longer send messages to the brain.

Treatments To Help Relieve Symptoms

Treatments usually involve:

• Antidepressants.
• Pain medications.
• Anti-seizure medications.
• Pain-relieving creams.
• All can help manage pain and inflammation.

Chiropractic Can Also Help Relieve Symptoms

Chiropractors use hands-on methods to adjust and realign joints, muscles, spinal discs, and ligaments to function more efficiently and bring relief from pressure on the nerves. Neuropathies are often caused by nerve compression in body areas that have been altered by injury or disease that affects ligaments, discs, spinal muscles, sacroiliac joint dysfunction, hip adhesions, leg length discrepancies, etc. These can contribute to pain and numbness in the peripheral nerves that supply the legs, feet, arms, hands, and neck. While a chiropractor cannot cure neuropathy, they can help relieve symptoms, make it much more manageable, and improve quality of life.

Body Composition

Common Cold

The common cold, also known as upper respiratory tract inflammation, is the most common infectious respiratory disease because of its effect on the nose and throat. The average adult will catch 2–3 colds a year, according to the CDC. A virus that causes a cold can enter the respiratory tract directly when inhaling droplets expelled from an infected person or by direct skin contact, like touching the face with a hand that came in contact with the virus. Cold symptoms vary but usually include:

• Runny or stuffy nose
• Sneezing
• Coughing
• Headaches
• Body aches

The duration of a cold differs; however, most individuals with a healthy immune system recover in 7–10 days. However, individuals with a compromised immune system, asthma, or COPD have an increased risk of developing more serious illnesses like bronchitis or pneumonia. Hundreds of viruses can cause colds. Human Rhinoviruses are common culprits and are constantly mutating, which is why there is no cure. Several medications or natural treatments help alleviate cold symptoms; it is recommended to combat the illness effectively through a healthy immune system response. Doctors recommend proper rest, eating a nutrient-rich diet, and maintaining proper H2O hydration to boost the immune system.

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care 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 support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has 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

D'Angelo, Kevin et al. "The effectiveness of passive physical modalities for the management of soft tissue injuries and neuropathies of the wrist and hand: a systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) collaboration." Journal of manipulative and physiological therapeutics vol. 38,7 (2015): 493-506. doi:10.1016/j.jmpt.2015.06.006

Kissel, Jaclyn A, and Cristina Leonardelli. "Isolated musculocutaneous neuropathy: a case report." The Journal of the Canadian Chiropractic Association vol. 63,3 (2019): 162-170.

Passioti, Maria et al. "The common cold: potential for future prevention or cure." Current Allergy and asthma reports vol. 14,2 (2014): 413. doi:10.1007/s11882-013-0413-5

T Francio, Vinicius. "Chiropractic care for foot drop due to peroneal nerve neuropathy." Journal of bodywork and movement therapies vol. 18,2 (2014): 200-3. doi:10.1016/j.jbmt.2013.08.004

Neck injuries and whiplash symptoms can be minor and go away within a few days. However, whiplash symptoms can manifest days later and become varied and chronic, ranging from severe pain to cognitive problems. These are collectively called whiplash-associated disorders because of the varied complexity of the symptoms. A common condition is a whiplash nerve injury. These injuries can be severe and require chiropractic treatment.

Whiplash Nerve Injury

Surrounding muscles, tissues, bones, or tendons can cause a whiplash nerve injury. The neck's spinal nerve roots become compressed or inflamed, leading to cervical radiculopathy symptoms of tingling, weakness, and numbness that can radiate down the shoulder, arm, hand, and fingers. Typically, cervical radiculopathy is only felt on one side of the body, but in rare cases, it can be felt on both sides if more than one nerve root is affected.

Neurological Cervical Radiculopathy

• Neurological problems can become severe and can reduce the ability to perform many routine tasks, such as gripping or lifting objects, writing, typing, or getting dressed.

Cervical radiculopathy involves one or more of the following neurological deficiencies.

• Sensory - Feelings of numbness or reduced sensation. There can also be tingling and electrical sensations.
• Motor - Weakness or reduced coordination in one or more muscles.
• Reflex - Changes in the body's automatic reflex responses. An example is a diminished ability or reduced hammer reflex exam.

Symptoms

Because every case is different, symptoms vary depending on the location and severity. Symptoms can flare up with certain activities, like looking down at a phone. The symptoms then go away when the neck is upright. For others, symptoms can become chronic and do not resolve when the neck is resting and supported. Common symptoms include:

Fatigue

• Decreased energy levels could be related to sleep problems, depression, stress, pain, concussion, or nerve damage.

Memory and/or concentration problems

• Cognitive symptoms could involve difficulty with memory or thinking.
• Symptoms can start shortly after the injury or not appear until hours or days later.
• Cognitive problems could be from a brain injury or related to various types of stress.

Headaches

• This could be neck muscles tightening or a nerve or joint becoming compressed or irritated.

Dizziness

• Dizziness could be from neck instability, a concussion/mild traumatic brain injury, and nerve damage.

Vision problems

• Blurry vision or other visual deficits could result from any number of causes, including concussion or nerve damage.
• Vision problems could also contribute to dizziness.

Ringing in the ears

• Also called tinnitus, this can be ringing or buzzing in one or both ears and can range from intermittent and minor to constant and severe.
• Whiplash complications such as injury to the brain region that controls hearing, nerve or vascular damage, jaw injury, or stress can lead to tinnitus.

Chiropractic Care

The appropriate chiropractic treatment is unique to each whiplash nerve injury and is directed at the primary dysfunctions detected during the initial examination. A personalized treatment plan addresses factors in an individual's work, home, and recreational activities. Treatment includes:

• Massage manual and percussive for nerve and muscle relaxation
• Decompression therapy
• Nerve release techniques
• Targeted stretches and exercises
• Ergonomics
• Health and nutritional recommendations

El Paso's Chiropractic Team

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

Goldsmith R, Wright C, Bell S, Rushton A. Cold hyperalgesia as a prognostic factor in whiplash-associated disorders: A systematic review. Man Ther. 2012; 17: 402-10.

McAnany SJ, Rhee JM, Baird EO, et al. Observed patterns of cervical radiculopathy: how often do they differ from a standard "Netter diagram" distribution? Spine J. 2018. pii: S1529-9430(18)31090-8.

Murphy DR. History and physical examination. In: Murphy DR, ed. Conservative Management of Cervical Spine Syndromes. New York: McGraw-Hill, 2000:387-419.

Shaw, Lynn, et al. “A systematic review of chiropractic management of adults with Whiplash-Associated Disorders: recommendations for advancing evidence-based practice and research.” Work (Reading, Mass.) vol. 35,3 (2010): 369-94. doi:10.3233/WOR-2010-0996

Travell JG, Simons DG. Myofascial Pain and Dysfunction: The Trigger Point Manual. Vol. 1, 2nd ed. Baltimore, MD: Williams and Wilkens, 1999.

Burning, numbness, tingling, and pain can be felt in the back, lower back,  legs, and into the feet. A lot of times these symptoms spread out/radiate from one part of the body into another area. Sciatica is an example of pain that radiates into an extremity, in this case, the back of the leg. Nerves originate from the spine and are divided/separated into sensory and motor nerves. The sensory nerve/s give the sensation to the skin known as dermatomes. Dermatomal patterns act as a map on the body.

Example: Dermatomes on the torso of the body react to the thoracic spinal nerve roots, the arms react to the cervical spine nerve roots, and the legs react to the lumbar spinal nerve roots.

Dermatome Location - Corresponding Spine Level

• Shoulders - C4, C5
• Inner/Outer Forearms - C6, and T1
• Thumbs and Little Fingers - C6, C7, C8
• Front of Thighs - L2
• Middle, Sides of Both Calves - L4, L5
• Little Toes - S1

A physician might use a piece of cotton, a swab, pin, or paperclip to test the symmetrical feelings in the arms and legs. Abnormal responses could be a sign of a nerve root problem.

Tendon Reflexes

Most individuals have experienced a physician tapping the knees with a rubber hammer. The normal response is a kick. This is a reflex, which is an involuntary muscular response generated by the hammer tapping the tendon. When the reflex responses do not present, this could mean that the spinal cord, nerve root, peripheral nerve, or muscle has been injured/damaged in some way. Absent reflexes are also clues to other conditions/injuries. An abnormal reflex response could also be caused by a disruption of the sensory (feeling) or motor (movement) nerves and sometimes both. Determining where the neural problem might be, a physician will test reflexes in various parts of the body.

Reflex Tested Areas - Corresponding Spine Level

• Upper Arm Biceps  - C5-C6 Cervical Spine
• Forearm Distal Radius - C6-C7
• Elbow Triceps - C7
• Abdominal - T8, T9, T10, T11, T12, Thoracic
• Knees/Thighs Patellar, Quadriceps -  L3, L4 Lumbar
• Ankles - S1 Sacral

Neurological Exams for Neck/Back Pain

Muscle Strength/Tone

Muscle strength and tone measurements are another way to diagnose nerve deficits. Depending on the symptoms/condition/injury/s there are different ways to evaluate muscle strength:

• Stepping on a stool
• Standing on the heels
• Standing on the toes
• Hopping in place
• Performing knee bends
• Gripping an item in each hand

Muscle strength is graded and recorded in the patient’s chart.

A physician will test the body's muscle tone by passively flexing and extending the arms and legs. Normal muscle tone will respond with a slight resistance to passive motion. Other movements test for proximal (trunk/torso) and distal (distant) weakness. Muscle symmetry is also taken into account.

Neurological Tests

If necessary a spine specialist might order neurological studies like a Nerve Conduction Study (NCS) or Electromyogram (EMG), to measure nerve performance.

Imaging Studies

MRI and/or CT scans of the spine can be ordered to help the spine specialist/chiropractor make a correct diagnosis, as well as help in creating a plan of treatment.

Conclusion

A neurological exam, along with a mechanical examination consisting of movement of the arms, legs, and torso, can significantly help doctors in making the correct diagnosis. Examination results are then correlated with the patient’s history, illness, and diagnostic studies. Once the diagnosis is made an appropriate treatment plan is discussed. This will begin with non-surgical strategies but if those fail, then surgical intervention could be considered.

Peripheral Neuropathy Relief & Treatment