Living and Dealing with a Pinched Nerve – Understanding Your Condition
If you’re experiencing the symptoms of neural compression, or a “pinched nerve” as the condition is commonly known, you likely have a number of questions running through your mind: Are my symptoms normal? Why and how did this happen? Will I ever be free of this pain? You’re not alone in asking these questions; millions of people, especially those who have reached middle age, are afflicted with this condition. You’re also not alone if you have feelings of depression or anxiety, or if you’re feeling hopeless about ever finding relief.
However, many people who suffer from this and other spine conditions find comfort in learning more about their ailment and its symptoms, causes, and treatments. If nothing else, educating yourself about pinched nerves can put your mind at ease as you discover the answers to your many questions.
Anatomy of Pinched Nerves in the Spine
Spinal nerves can become compressed, or “pinched,” as a direct result of an injury that has occurred within the spinal column, or due to one of a number of degenerative spine conditions. You may already be somewhat familiar with a few of these conditions that can lead to neural compression. For instance, you’ve probably heard of a herniated disc, but you may not know exactly what this condition is or how it can affect the nerves in the spine. We’ll explain what many of these conditions are and how they can lead to a pinched nerve, but the first step is getting an overview of the spinal anatomy and a basic understanding how the spine operates. Below are a few of the anatomical components of the spine that are often affected by many common spine conditions.
· Spinal cord – The centerpiece of the spine is the spinal cord itself, which is responsible for transferring information from the brain to the rest of the body. This bundle of nerves is usually about 17 or 18 inches long, spanning from the base of the skull to the top of the lower back. Along the way, numerous nerve roots branch off from the spinal cord and travel to various parts of the body, transferring motor and sensory signals to different muscle groups and the extremities. Without the spinal cord and its nerve roots, we would be unable to walk, sit, stand, brush our teeth, comb our hair, breathe, or perform any other basic function, whether it is voluntary or involuntary.
· Vertebrae – As one of the most important parts of the human body, the spine has a number of built-in protectors. One such security system is the vertebral column, or the stack of bone structures (called vertebrae) that house the spinal cord and act like a sheath. Most individuals have 33 vertebrae, though it is not uncommon for some to have either one too many or one too few. The nerve roots that branch from the spinal cord travel through small openings on the right and left sides of the vertebrae called the vertebral foramina. The majority of our vertebrae articulate (move back and forth), allowing us to bend, twist, and otherwise move freely. Most people have 24 articulating vertebrae that are located in the neck, upper back, and lower back. The remaining vertebrae make up the tailbone and sacrum and are fused together, permitting no flexibility in these areas.
· Facet joints – Like other articulating parts of our bodies – such as our elbows, knees, and ankles – the spine contains hinge-like structures called facet joints. These joints are only found in the articulating areas of the spine, with two located on each side of a vertebra (two at the top and two at the bottom). In addition to affording us the ability to move about, the facet joints are also what connect the vertebrae to one another.
The facet joints are synovial, meaning they are surrounded by capsules that contain synovial fluid. This natural lubricant prevents a joint’s bones from grinding against one another when we move our necks and backs. The joints’ bones are also covered in a thin layer of cartilage that, like the synovial fluid, helps to reduce friction.
· Intervertebral discs – The intervertebral discs are positioned between each of our articulating vertebrae and are also part of the spinal cord’s security system. These cushion-like structures are tasked with easing the stress that is placed on the vertebrae when they articulate or bear weight. Discs are structured somewhat like jelly-filled donuts: a thick outer shell (annulus fibrosus) surrounds a soft, gelatinous material (nucleus pulposus). The annulus fibrosus is made of fibrocartilage and other fibrous tissues that allow the disc a certain degree of elasticity. The nucleus pulposus helps to evenly distribute the impact that is placed on the discs and is made of collagen and a variety of other substances, one of which retains and attracts water.
Causes and Risk Factors for a Pinched Nerve
Simply put, getting older is the primary cause of a pinched nerve, in most cases. This is because gradual deterioration of the spine’s various anatomical components generally coincides with the natural aging process. As we previously discussed, vertebrae, facet joints, and intervertebral joints are each tasked with supporting a large amount of the body’s weight and for facilitating a certain degree of the body’s movements. Continually carrying out these responsibilities can take a toll and lead to the gradual deterioration of the anatomical elements of the spine. It is this deterioration that is often responsible for the aches, pains, and “bad backs” you often heard your parents and grandparents complaining about and that you may now be experiencing yourself.
But what actually causes a nerve to become compressed? Some congenital defects (such as spina bifida and scoliosis) can lead to neural compression, as can tumors and other growths, but a pinched nerve most commonly occurs because of a degenerative spinal condition, or one that gradually develops over time. These conditions result in the development of abnormalities in the spinal anatomy that can invade the space a spinal nerve travels through, causing it to become pinched and irritated. Here are a few of the most common culprits:
Spinal arthritis – Also called facet disease or facet syndrome, spinal arthritis occurs when a facet joint’s cartilaginous lining wears away. This can cause the two articulating bones to painfully rub against one another, leading to inflammation and a crunching or popping sound known as crepitus. In an effort to stabilize an arthritic joint, the body sometimes produces osteophytes (bone spurs), which are smooth protrusions on a joint’s natural bone structure. If an osteophyte extends into the spinal canal, it can come into contact with a nerve root or even the spinal cord itself.
Herniated discs – The annulus fibrosus can sometimes weaken to the point that it cracks or ruptures under the strain of its weight-bearing and impact-absorbing responsibilities. The nucleus pulposus is then able to escape through the tear in the disc’s outer wall and invade the spinal canal, sometimes leading to a pinched nerve.
Bulging discs – Though sometimes confused with a herniated disc, a bulging disc is actually a unique ailment. In the case of this spinal condition, the annulus fibrosus remains completely intact but weakens to the point that it is no longer able to maintain its shape. This can allow the nucleus pulposus to shift to one side of the disc, causing the entire disc to become misshapen and to bulge to one side. The misshapen portion of the disc can then extend into the spinal canal and compress a nearby spinal nerve or nerve root.
Spondylolisthesis – Simply described as vertebral misalignment, spondylolisthesis occurs when an articulating vertebra slips forward and over the vertebra located directly beneath it. This usually occurs because the affected vertebra is not receiving proper support, either because of a bulging or herniated disc or because of spinal arthritis. Depending on the extent to which the vertebra has shifted out of place, a nerve root can become compressed by the misaligned bones.
Younger individuals can sometimes develop degenerative spinal conditions that can cause neural compression, and some people experience premature deterioration of the spine due to genetics, but normal wear and tear associated with the natural aging process is the most common cause of the conditions that can lead to a pinched nerve. While you obviously can’t stop from getting older or prevent age-related changes to your spinal anatomy, there are a number of risk factors that have been shown to accelerate or exacerbate spinal degeneration.
· Obesity – Being overweight not only forces the spine to work extra hard to facilitate movement, but it also places excess pressure on the facet joints and intervertebral discs. This added strain can exacerbate the deterioration of the spine’s components and can also intensify the pressure that is being placed on a pinched nerve. Maintaining a healthy body weight is not only essential for a healthy cardiovascular system, but it is also necessary for a strong and well-supported spine.
· Sedentary lifestyle – Many people associate a sedentary lifestyle with obesity, but this risk factor can apply even to individuals who are of a healthy weight. Remaining mostly stagnant for a significant portion of the day can cause the muscles in the neck, back, and abdomen to weaken or atrophy. Without ample support from these muscles, the various components of the spine are tasked with supporting more weight and are forced to work extra hard to facilitate movement. If you are healthy enough to exercise, you and your doctor can work together to develop an exercise regimen that includes walking, swimming, yoga, or a variety of other low-impact exercises to avoid the weakening of muscles and ligaments in the back and neck.
· Tobacco use – As if tobacco users need any more incentive to quit, this unhealthy habit can not only affect the lungs, mouth, and esophagus, but it can also prove detrimental to spinal health. Toxins found in tobacco products – such as nicotine and carbon monoxide – interfere with the body’s ability to distribute and absorb oxygen and a variety of essential nutrients. Without ample nourishment, the intervertebral discs, vertebrae, and various soft tissues are prone to quicker deterioration.
· Participation in high-impact sports – Any hockey player can tell you about the lingering back pain that follows an open-ice hit. Likewise, any football player can tell you about the sore muscles that follow a game filled with tackling, diving, and jumping. Over time, these rigorous activities can damage the spine and cause a variety of its components to deteriorate and become damaged. While exercising is an essential component of maintaining optimal spinal health, you may be best served to stick to sports that place less strain on the spine and have a lower risk of injury.
Symptoms of a Pinched Nerve
When a degenerative spinal condition leads to neural compression, pain and discomfort can travel along the length of the affected nerve. This happens because the nerve roots that branch from the spinal cord travel throughout the body and eventually culminate at different points. As a result, the location where symptoms are felt will vary depending on which nerve is being compressed.
Cervical compression – Many of us take for granted the degree to which we depend on our cervical spines. This area of the spine, found in the neck, is not only responsible for supporting the weight of our heads but is also integral to many of the movements we make and everyday tasks we perform. For example, the cervical spine is responsible for our ability to nod our heads yes or no, scan for oncoming traffic, and check the sky for rainclouds. Because of the amount of weight the cervical spine supports and movement it is tasked with enabling, this is a high-risk area for developing the many degenerative conditions that can lead to neural compression.
The cervical spine contains eight nerve root pairs that are labeled “C-1” through “C-8,” with C-1 located closest to the base of the skull and C-8 located toward the upper back. These nerve roots are positioned between adjacent vertebrae; C-1 is positioned between the C-1 and C-2 vertebrae and C-8 is located between the C-7 and T-1 (first thoracic) vertebrae. If compression occurs along the cervical spine, you may experience symptoms in the neck, upper back, shoulders, arms, or hands. Many patients also experience headaches and some even suffer from vertigo and dizziness.
Thoracic compression – The thoracic spine in the middle back is the least likely region to contain a pinched nerve, in part because ten of the region’s twelve vertebrae are attached to the ribcage. This provides additional support to the area, meaning the thoracic vertebrae have less weight-bearing responsibility than the other regions of the spine. The thoracic region is also much less flexible than the neck and lower back, which helps to prevent deterioration of the thoracic vertebrae, intervertebral discs, facet joints, and other anatomical components. Though uncommon, neural compression can still occur in the thoracic spine and may cause you to experience symptoms in the middle back, ribs, torso, and what may feel like the inner organs.
Lumbar compression – Like the cervical spine, the lumbar region in the lower back is also tasked with supporting a significant amount of weight and facilitating a great deal of movement. Sitting, standing, bending over, walking, and all other movements that require use of the lower body would not be possible without the aid of our lumbar spines. The majority of the body’s weight is also supported by this area of the spine, making it especially prone to developing degenerative spinal conditions.
Though the lumbar spine supports the majority of our weight and facilitates many essential movements, it actually contains fewer vertebrae and spinal nerve roots than any other region. The nerves in this area are labeled “L-1” through “L-5,” with L-1 positioned between the last vertebra in the thoracic spine and the first vertebra in the lumbar spine. The L-5 nerve is located between the last vertebra of the lumbar spine and the top of the sacral spine, which contains the fused vertebrae that make up the sacrum and the tailbone. If any of these nerves become compressed, you may experience symptoms in the lower back, hips, buttocks, legs, or feet.
Lumbar compression and sciatica – It should also be noted that the lumbar spine contains the sciatic nerve which, when compressed, can lead to sciatica. Many people refer to sciatica as a spinal condition, but it is actually a term that is used collectively to describe the set of symptoms that occurs when the sciatic nerve is compressed. This nerve is the body’s largest and runs from the lower back, through the hip and buttock, down the back of the leg, and into the foot. Spondylolisthesis, herniated and bulging discs, spinal arthritis, and other degenerative conditions that result in neural compression are all potential causes of sciatica.
Compression of the sciatic nerve causes many of the same symptoms that occur when other spinal nerves are compressed. However, there are other symptoms of sciatica that are unique. Many patients experience a sharp, burning sensation that shoots down the leg. Others report difficulty walking, standing, and sitting, while some find that their pain intensifies when they sneeze, cough, or laugh. In most cases, those with sciatica only experience symptoms on either the right or left sides of the lower body, but it is not entirely uncommon for some to experience bilateral discomfort.
Though symptoms can vary from patient to patient depending on the location of their pinched nerves, the degree to which the condition affects everyday tasks typically remains consistent. Those with neural compression in their necks may not only be reminded of their condition every time they turn their head, but may also find it painful to type on a keyboard due to sore hands or tingling in the fingers. If a pinched nerve is located in the lower back, an individual may experience nagging pain every time they sit down and they may also sometimes find it difficult to walk. No matter which part of the body is affected, a pinched nerve can have a dramatic impact on a person’s quality of life.
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