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Getting on your Nerves! - Education focus: Sciatic nerve vs Nerve root pain (Radiculopathy)

Nerve/s: " a fiber or bundle of fibers in the body that transmits impulses / messages between the brain or spinal cord, and the rest of the body"

With Winter in full swing many people are feeling the resultant aches and pains brought to the fore with the change in air pressures and cold. Out come the electric blankets, bean bags and hot water bottles! The cold environment makes us all feel a little more sensitive, in our joints and "bones" but also our nerves.

General anxiety is also on the rise, it is worth noting that our nervous system is going to become more sensitive in response. This is not just a mental heath issue, but can overflow or translate into a physical issue.

Nerves are like the electrical system of our body, transporting information to and from the central nervous system (brain and spinal cord). Our central nervous system is like the processor and storage center of a computer, receiving information, interpreting and filing it for potential future use, with a unique ability to evolve its storage space and processing capabilities depending on need or use/disuse/injury.

The structure of a nerve is like that of and electrical cord too, axons grouped together and individually and collectively sheathed in a protective layer. Nerves have good blood supply too, because if they don't, they will let you know! Ischemic pain is a common reason for nerve pain. It can result from a direct trauma or persistent compression. Another cause for nerve pain is persistent irritation, this can take the form of a physical (physical injury) or chemical (inflammatory or other) irritant.

Working many years with all kinds of pains, I have learnt the subtle differences in how each feels and how people describe it. Nerve pain is by far the worst kind of pain I have witnesses or experienced. My first experience of nerve pain was from a tooth nerve root, caused unrelenting pain on the side of my face. I considered it a learning experience, because after that I had a new empathy for my clients in a similar situation. It is very important you see your doctor or physiotherapist and source the cause of the nerve pain and manage the symptoms appropriately. If you think your discomfort could be linked to a nerve you may describe the following:

  • altered sensory experience, tingling, pins and needles, burning, electrical

  • a more intense experience can be described as deep writhing pain, no positional change/movements ease it, often at rest or after an aggravating activity

  • Regular pain medication seldom works in acute nerve pain situations

  • Often causes anxiety and a sense of desperation to seek help

Chronic nerve pain can be much more challenging to beat. It is worth mentioning that anti-anxiety medication can be beneficial to chronic pain situations. Pain is a complex process in the brain, with all kinds of factors affecting the nature and experience. One thing is for sure, because the brain is an evolving organ, pain does not need to be permanent or unmanageable!

Education focus: Sciatic nerve vs Nerve root pain

One example of acute peripheral nerve pain is sciatica. The sciatic nerve is the largest nerve in the human body, made up of 5 nerve roots, 2 lumbar spine and 3 from the sacrum. It forms in lower and deeper parts of the pelvis as the 5 roots come together to form one large nerve.

Sciatic symptoms present differently to nerve root symptoms (radiculopathy) which is typically a singular nerve root from one level of the spine as it exits. By virtue of its anatomy, problems or injury of the sciatic nerve are caused from injury to the pelvis/hip and/or surrounding muscles/tissues. The symptoms are usually more diffuse and often associated with pain behind the leg (hamstring area). Assessing a true sciatica can be complex because of the variety of nerve roots made up in it as well as the number of structures in the pelvis that can cause it.

Nerve root (radicular) symptoms, (often confused with sciatic nerve symptoms), is a nerve as it leaves the spine (as opposed to the 5 making up the sciatic nerve further away). The symptoms present typically along that specific nerve path. Nerve root symptoms are caused at the spine, as the nerve exits into the body, for example a spinal disc or facet joint injury. This makes the diagnosis sometimes easier to assess.

Both nerve injuries can be severe in the symptom presentation. Just because a nerve root is smaller, does not diminish the symptoms it can produce, often times it can be more severe and you may have more than one nerve root affected at one time, often described as L4/5 to give one example, L denoting lumbar spine vertebra and 4/5 denoting between spinal level 4 and 5.

So what should you do if you have nerve symptoms in you legs?

  • Have it professionally assessed, the most effective treatment relies entirely on the correct diagnosis.

  • DO NOT try "stretch" it out, nerves do not stretch, they may become more injured if you attempt to "loosen" it and do so incorrectly.

  • A therapist may try mobilize the nerve. This must be respectful of symptoms as to not aggravate the injury, so always communicate with your therapist and don't try "suck it up" or ignore the pain. Do not attempt to do this at home. Nerve are the least forgiving structures.

  • Ice is usually aggravating, heat is usually easing. However, never apply heat on a red/hot swollen injury.

  • Walking is almost always safe and good. It is a functional way to mobilize the nerve.

  • Bed rest is NOT the best standard of practice, relative rest is recommended - keep busy and rest in-between as tolerated

  • Sitting in a deep chair is not recommended, seek advice on the best position for YOUR injury

  • Almost always, when experiencing nerve pain, DO NOT lift heavy objects or objects far away from you

  • Avoid deep bending until you seek help

I hope you will finds these tips helpful and practical. When it comes to nerves, it is recommended you do not self diagnose and manage. You need to have it professionally assessed. Nerves are not forgiving, as I said earlier. Damage to a nerve may result in permanent damage as they do not heal in the traditional sense, like a wire that has rusted or been cut, it cannot always go back to its former speed and accuracy of data transmission and will always be vulnerable to re-injury. Nerve pain that is left to long can also have long term effects that will make it much more difficult to recover from.

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