The words ‘nerve pain’ seem to sound alarm bells for many people, but there is often no reason to be any more concerned by this type of pain than other types of pain.
Nerves can get irritated and become painful but will often settle back down with just a little help and lot of knowledge.
Often nerve pain has many terms or descriptions surrounding it such as sciatica , pinched nerves , radiculopathy and other such phrases. Often they make the condition sound even scarier than it should be.
For an understanding of terms related to nerve pain check this explanation out here .
The truth about “pinched nerves”
Pinched or trapped nerves are really sensitized nerves. Lots of people have “pinched nerves” but don’t have nerve pain.
Here are some wise insights into nerves by David Butler. He’s basically a physiotherapy wizard when it comes to nerve pain and has been responsible for much of our improved knowledge in their management.
- When you look up at the stars you pinch nerves a bit. We do it all the time. They are designed to be pinched, squeezed, rubbed and wriggled. Most of the time, nerves love a good old workout.
- In autopsies, lots of dead people have been shown to have scuffed, squeezed, frayed, obviously pinched nerves, yet in life they may have never complained of pain (Neary and Ochoa 1975).
- It’s really hard to pinch and damage a nerve unless you take to the nerve with some pliers or there are some really significant arthritic changes in the spine, or you are the unfortunate victim of a nasty torture.
- And even when a nerve is injured (this takes quite a bit to do) it still may not hurt when physically handled or it may wait until you have the flu or are really stressed before it fires.
- Most of the time a person thinks they have a ‘pinched nerve’ it is usually a sensitive nerve, a non or minimally damaged nerve that moves quite well.
( Taken from ref: https://noinotes.wordpress.com/2010/12/08/scary-nerve-stuff/)
What are the symptoms of nerve pain ?
Nerve pain often has some rather “un-nerving” symptoms that are unpleasant and can sometimes be difficult to describe. Sometimes the pain follows the same path as the sensitized nerve and you could almost pin point where the nerve travels.
This is not an exhaustive list but some symptoms that people report include:
- pins and needles.
- Burning pain.
- Electric shocks.
- Sudden bursts of pain for no reason , (ectopic impulse).
- Other times we can get really odd sensations like a crawling insects or butterflies on teh skin. Even feeling like water running down the affect limb.
Quite often we see that nerve pain sufferers will get in a position of comfort but have to move a few minutes later as it starts to stir up again.
Why do my nerves get so sensitive ?
Common causes of nerve symptoms can be:
- If the nerve is stretched (such as having your arm pulled in sport) to much it can set it off,
- Your nerve is being compressed by other tissues such as tight surrounding muscles or due the space where the nerve comes out of the spine, ( the intervertebral foramen), becoming narrower due to changes in the size of that exit point.
- Sometimes an acute inflammatory / immune response will set the nerve off as well. This is not uncommon with disc related injuries in low back pain or whiplash type incidents in the neck.
In all of these scenarios, the nerve should settle back down once the irritant has been removed.
The most fascinating thing about nerves, is they have their own ‘nervous system’ called the NERVI NERVORUM. Unfortunately for us, this means the nerve can become sensitive (or sensitized) and can stay in this hyper-sensitive state for quite a while – but there are ways we can help to calm it down.
They also have their own blood supply, NERVI VASORUM, to help nourish them and keep them functioning in a healthy and happy state. In fact the nervous system accounts for around 2% of your body mass but requires around 20% of the oxygen we breathe to function well.
So nerves need to move and they don’t like stationary postures when they are sensitized or angry.
Sciatca and treatment
Nerves in the arm
In this video we look at the nerves of the upper limb and how we can test them to see if they are stretch sensitive.
What can I do to de-sensitize them ?
In many cases a thorough assessment can reveal what you need to do to settle the symptoms and also if a course of physio can help to settle the pain. Physio can help by;
- identifying aggravating postures and activities and help adapt to them.
- ,Manual techniques or acupuncture to help settle the nerve.
- Offload strapping to help ease the pain can be very effective
- Guide you on the right exercise pathway.
Feed the nerve, nourish the nerve with aerobic exercise.
I think this is possibly the most potent and simplest way to treat the nerve is to get it more blood flow and oxygen to settle it down. There is evidence in studies that working at a fairly high rate of aerobic exercise has a strong effect on reducing nerve pain.
here are our rules for finding just the right level.
Just like Goldilocks you don’t want to do too little or too much, you want to do just the right amount.
- Start slow and easy to find your ideal level of exercise and work from there. You don’t want to flare your symptoms up or push through the pain but you do need to get it moving. However you may have to prepare for an acceptable level of discomfort after exercise in the initial phase.
- The 50% rule : If you start walking 30 mins and that flares you up , try 15 mins and build from there.
- Small and regular bouts of exercise to begin with before doing longer and more vigorous sessions. Build up every few days as symptoms allow.
- Do something you enjoy or find easy e.g. going for a walk, a therapeutic splash in the pool , low back pain sufferers may find cycling easier. Just whatever works for you.
Nerve flossing exercises
Two of the common methods physiotherapist use to address these problems are ‘sliders’ and ‘tensioners’,(David Butler,2007 http://www.noigroup.com/en/Notes).
A ‘tensioner’ is when the nervous system is pulled from both ends (placing it on tension) while a ‘slider’ pulls the nervous system from one end while releasing it at the other (this is also called ‘flossing’ – think of how you floss your teeth)
The idea behind this is to restore your nerve’s movement through its natural pathway and decrease any inflammatory factors. Check out more about this here
TAKE HOME MESSAGE
If your physiotherapist gives you an exercise that makes you feel slightly ridiculous – possibly involving anything from ‘my little teapot’ to ‘kicking your head off’ – go with the flow – these are neurodynamic exercises – designed to make your nerve happier.
Here’s the great man David Butler taking nerve flossing to its most dynamic and fun !