Pinched nerve

How common it is

Nerve related symptoms are common enough to have their own place in national guidance. The clinical care standard describes nerve related leg pain that starts in the back and is felt in the legs, and notes that for acute leg pain without severe or progressive motor weakness, initial management should be the same as for acute low back pain. ^[1]

In the neck the equivalent is arm symptoms, and many people come to us describing a hand that has gone numb overnight without any injury they can name.

What can be behind it

A nerve root leaves the spinal canal through a small opening between two vertebrae. Anything that reduces the room at that opening, or inflames what is inside it, can produce symptoms along everything that nerve supplies.

The crowding can come from a disc protrusion, from arthritic change at the joints, from narrowing of the canal, or from swelling after a strain. The direction the symptoms run tells us which level to examine first.

• A disc protrusion at one level
• Arthritic narrowing where the nerve exits
• Swelling and guarding after an acute strain
• Restriction above or below loading the level involved

How we assess it

The neurological screen carries most of the weight here: reflexes, muscle strength tested group by group, sensation mapped along the arm or the leg, and the tension tests that put the nerve under load. Findings that agree with each other point at a level.

Guidance is explicit that emergency assessment or referral is indicated for clinical signs of spinal nerve root or spinal cord compression with rapidly progressive neurological signs or symptoms, suspected spinal infection, spinal tumour, trauma or fracture. ^[1] Specialist review is indicated for severe or progressive back or leg pain unresponsive to other therapy, or progressive neurological deficits. ^[1] Weakness that is getting worse week on week is a referral, not a course of care.

What care looks like

Where the findings are stable and the examination points at a joint restriction, we adjust that level specifically and set you up so the irritated root is not loaded on the way in. Technique is adapted, and low force instrument adjusting is available where it suits better.

Manual therapy, including spinal manipulation and mobilisation, is suggested as something to consider for low back pain with or without sciatica, but only as part of a treatment package including exercise, ^[2] so home work is part of it from the start. We re-test the neurological findings at review rather than relying on how you feel on the day.

When to seek urgent care

We are not an emergency service. If you have loss of bladder or bowel control, numbness in the saddle area, weakness in both legs, or pain after a serious accident, call 000 or go to an emergency department.