Nugget 1 “Pinched nerves don’t have to hurt”
“Pinch” – the word can makes you recoil a little. Apply it to a nerve as in “pinched nerve” and it’s not a healthy metaphor. “Pinch” means different things to different people. Scary stuff sometimes –after all, you wouldn’t pinch a live electrical cable. There is lots of scary pinched nerve stuff on the web as well.
We have known for years that peripheral nerves, nerve roots and sympathetic rami and ganglia can be flattened and a bit ratty yet the owner has no idea of his/her battered looking nervous system – kind of like arthritic change in joints don’t have to hurt either, which is something we are more familiar with..
Juicy info to add:
We all have pinched nerves. They do it all the time –flex your elbow and your median nerve almost bends on itself and still works. It probably enjoys the workout.
The reason we sometimes think a nerve is pinched is that they can become sensitive to various stress and mechanical stimuli and they sometimes react with a “zing or zap”. They usually get better with a some knowledge and encouragement to keep wriggling. A true mechanical pinch is quite rare.
This links into Neuroscience nugget 2 “There is plenty of space where nerves join onto the spinal cord”.
The emerging nerve root complex only takes up about one third of the diameter of the space in the intervertebral foramen. Blood vessels and adaptable fat take up the rest. People are rarely told that. It’s hard to squish them and the root complex loves a bit of a wriggle and “floss” to let a bit of air and light in (as an old anatomy teacher told me once).
Here is hoping someone will find the nuggets useful. We have plenty more to come
David Butler
www.noigroup.com
“Neuroscience nuggets”
Neuroscience nuggets are information nuggets – pieces of biological information based on statement or metaphor that can be used as educational analgesia, explicit education or part of overall story telling. We have collected over 100 of these for a book and will release one or two a week with a short description and references if appropriate.
Explain Pain 2nd Ed, the Graded Motor Imagery Handbook and all noigroup courses are all bursting at the seams with the latest and greatest neuroscience nuggets; click on the links to get your hands on a copy or to find a course near you
I wonder if MRI or even autopsy studies in “normal” folks with no pain are available? Any sources would be helpful. Keep up the great work. It just makes too much sense!!
Henry, this chiropractor has done a really nice job compiling some research on disc bulges which includes some data on nerve root compression. Scroll down to the tabulated data.
http://www.chirogeek.com/000_MRI-Abnormalities_Asymptomatic-Pats.htm
Educational analgesia……. What a wonderful phrase, if two words is enough to be one. This ” treatment modality ” has to be the most powerful song in our repertoire…… It has to be a neuroscience nugget……… “Educate to medicate”……
If only this was included in those MRI and CT scan reports that mention a disc “impinging on the emerging nerve root” or other scary sounding finding…
An absolute golden nugget, used almost daily in my practice. Reactions vary but generally fall under the category of “things that make you go hmmm…”
Thank you David for this NOI neuroscience nugget. I reposted to my practice blast email referring patients back to NOIjam
Just to be sure: if someone has nerve-y symptoms on the side where they have quite the squashed disc (according to their doctor) at the apex of scoliosis (I want to say 40 degree curve)—could then the nerve root be sufficiently squashed to explain symptoms?
Hi there.
The words “squashed disc” and “squashed nerve” by themselves may be enough to cause symptoms! I have conjured up this imagery of a squashed tomato or a big black spider I have just smushed!
My answer is that it could be, but it wouldn’t be that common and it would have to be a very strategic disc injury. Things to consider are that nerve roots only take up a third of the intervertebral foramen, so there is plenty of room to “escape”, this escaping feature enhanced by nerve root mobility. Nerve roots can adapt over time to a ribbon like shape and still not discharge oddly and finally there would likely be some chemical irritation to go along with the physical insult. And of course its up to the brain to decide if information signalling from the rest of the body is worth constructing into a pain production.
Thanks for your query
David
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