Understanding Nerve Pain
There are many types of nerve related pain, sciatica and carpal tunnel syndrome are perhaps the ones that we most commonly come across.
It can sometimes be difficult to establish whether your pain is due to a nerve, but often there are some tell tale signs….
Burning pain, electrical type pain, pins and needles and numbness are perhaps the most common features of nerve pain.
However there are some other symptoms which suggest that a nerve is involved. Pain that runs in a line down a limb or an itching sensation (like ants crawling) can also be indicators of an unhappy nerve.
What causes nerve pain?
Before we get in to the causes of nerve pain it might be useful to take a moment to consider what a nerve is and what it does.
Nerves transmit signals to and from the brain.
Lets take the example of your leg:
Nerves take signals from your brain to you leg so that it can move
Nerves also take signals from your leg to your brain to let the brain know what is going on with the leg, things like…
Is it hot?
Is it cold?
Is it moving?
Is it injured?
To function well, nerves need oxygen and a blood supply. And, much like other areas of the body they also like to move. If any of these are compromised then the nerve will not be able to perform the above jobs as well.
A nerve that is lacking in oxygen or blood (or even a nerve that hasn’t moved enough) may end up giving false reports to the brain. An unhappy nerve may end up telling the brain that a leg (or an arm) is injured when there is actually nothing wrong. The result of this is…..PAIN!
Is nerve pain due to the nerve being ‘trapped’?
Not exactly. It would be next to impossible to trap a nerve. By their very design nerves are able to bend and slide which makes them very difficult to trap or pinch, because of this there are no structures that would be able to physically trap a nerve.
Nerves can however be compressed, the areas in which they slide can become overcrowded due to swelling or other structures (such as spinal disks). Nerves can also become irritated due to mechanical stretch and/or load.
When a nerve is compressed the increased pressure restricts its blood supply. With a reduced blood supply the outer layer of the nerve can start to break down.
This can result in the nerve ‘mis-firing’ - sending the false signals to the brain (mentioned above).
However what we also need to be aware of is that something needs to clear up the debris from this break down of the outer layer. With nerve compression we see an activation of immune cells throughout various parts of the nerve as the body works to clear up the debris.
This immune reaction places the nerve in an inflammatory environment which in turn creates a cycle where:
Inflammation leads to increased swelling in the nerve
Increased swelling within the nerve leads to less clearance between the nerve and surrounding structures
This leads to further compression of the nerve
This compression causes further breakdown of the outer layer of the nerve
Which then leads to an increased immune response…..
…which then continues to feed the above cycle
It is worth noting that the severity of nerve symptoms does not correlate with the amount of compression a nerve is experiencing.
Nerve pain is a health issue
We need to think of nerve pain is a health issue, not a mechanical issue. At the centre of all nerve pain is an unhealthy nerve.
This may be explain why some people take such a long time to recover from the pain (for example many people with sciatica will take over 12 months to recover). Health changes take time.
We can see an example of this connection between nerve pain and health in the diabetic population. People with diabetes have an 85% chance of developing carpal tunnel syndrome at some point during their lifetime!
The healthier we are, the healthier our nerves will be and the quicker they will recover from nerve injury and irritation.
The key to solving nerve pain
Whilst mechanical factors such as compression of a nerve certainly contribute to nerve pain, addressing them is only a small part of treatment/recovery.
The key to solving nerve pain is improving nerve health, primarily we have to reduce the inflammation within the nerve.
So yes we may have to address the mechanical ‘insult’ that caused the injury/compression/irritation, however often these mechanical factors self resolve. Nerves however can stay inflamed for significant amount of time after the original insult (due to the cycle outlined above).
Disc bulges are a classic example of this. Over 60% of disc bulges will resorb. This can often leave people with sciatica somewhat confused - their scan will show a normal disc yet they may have significant sciatic pain from a previous bulge that the body has rectified.
How to improve your nerve health
Improve your overall health. The health of your nerve will most likely reflect your overall health. Health is the foundation for recovery from nerve pain.
Exercise. Exercise is a great tool for reducing nerve inflammation and improving nerve health, but there are some things that we have to get right.
Exercise has to be performed regularly to help so get yourself into a routine and stick to it. Sporadic bouts of exercise would appear to irritate an unhappy nerve rather than help it.
Choose light to moderate exercise. Light to moderate exercise performed frequently has both an anti-inflammatory effect on the body (and our nerves) as well as a positive effect on our immune system.
Avoid high intensity exercise. High intensity exercise creates an inflammatory response within the body which may contribute to nerve inflammation. High intensity exercise also places the immune system under greater load which may in turn delay nerve healing.
Any exercise will do! General exercise programmes for the management nerve pain have been shown to be as effective as specific/targeted exercise programmes.
Manual therapy. Manual therapy techniques have been shown to help in the management of nerve pain (but we don’t know why they help or how they help).
Nerve (gliding) exercises. Nerve gliding (or flossing) exercises have been shown in animal studies to assist nerve regeneration. Human studies have shown that regular nerve gliding exercises have been shown to reduce swelling within a nerve. Similar to manual therapy we don’t know why.
There are lots of complicated theories as to what nerve gliding exercises do and how they work. The most likely explanation is also perhaps the simplest, nerve gliding exercises just get the nerve to move and this in turn helps to improve the health of the nerve.
Simple nerve gliding exercises for arms and legs
Always seek professional advice before undertaking any exercises/exercise programme for pain and/or injury.
Take away tips for nerve pain:
Improve your overall health:
Sleep
Stress
Nutrition
Smoking/Alcohol
Exercise regularly at a light to moderate intensity
Avoid high intensity exercise
Try manual therapy
Try 1-2 sessions with a therapist you trust
If you feel that it helps then continue with it
If it doesn’t have any impact after 2 sessions then it is unlikely that it is going to help
Try nerve gliding exercises
To reduce swelling these need to be performed regularly throughout the day (10 repetitions 5-10x a day)
Continue these for 2-3 weeks before deciding whether they are helping or not.
Have realistic expectations, many people sadly take over a year to recover from nerve pain. Recovery takes sustained time and effort. The better your overall health, the less time it is likely to take you to recover.