What Are Pinched Nerves?

• A pinched nerve or nerve compression occurs when the surrounding tissue of a nerve, such as bones, muscles, tendons, etc. apply too much pressure on that nerve. Common cases of pinched nerves are herniated disks and carpal tunnel syndrome

What Are Some Symptoms?

Symptoms vary but generally, the following are experienced:

• Sharp, aching or burning pain
• Paresthesia
• Muscle weakness (feeling like the area “fell asleep”)
• Numbness
• Decreased sensation

In most cases, as long as treatment is sought and completed, nerve compression is alleviated with no side effects. If not addressed, permanent nerve damage is a possibility.

What Causes Pinched Nerves?

• Injury, arthritis, repetitive motion, specific activities (aka typing), obesity, some sports may lead to pinched nerves in the exercises muscles

What Are The Risk Factors?

1. Sex

Women are at a higher risk of some nerve compression types, such as carpal tunnel due to having smaller carpal tunnels among other possible factors.

2. Bone Spurs

Bone spurs lead to bone thickening, causing any opening where nerves to travel to become narrow, increasing the possibility of a nerve being compressed

3. Health conditions

Some health conditions that are associated with inflammation such as arthritis and diabetes

4. Excess weight gain (obesity and pregnancy)
5. Prolonged bed rest
6. Overuse

Treatment… Can Active Therapy Help?

In some cases, the pain is so extreme individuals may prefer surgery. Before anyone chooses that route, few things are recommended:

• When diagnosed, the first option is to stop intense exercises or any activities that may aggravate the area further. Your family doctor may also recommend anti- inflammatory over the counter pain relievers to aid with the pain.
• Heating and icing the area in small intervals over the course of that day will aid in relieving some of the symptoms and underlying inflammation. Steroidal injections are another option for the ongoing inflammation.
• Physical therapy should be started shortly after as long as the exercises prescribed do not lead to a spike in pain intensity. Physical therapy will be started off as stretches and simple range of motion exercises, followed with strengthening exercises few weeks into your recovery.

The sooner individuals seek medical attention and start their suitable aid program, pinched nerves symptoms will start resolving within 6-12 weeks.  This is an estimated timeline as each body and injury differs. If the symptoms have not improved by then, individuals may have to discuss surgical options with their family doctors.

Future Tips for Prevention:

1. Exercise: focus on strengthening and flexibility into daily life activities
2. Lessen and control the frequency of cyclical activities
3. Take breaks if activity nature is repetitive
4. Good posture and positioning
5. Maintain a healthy weight

Sources:

https://www.mayoclinic.org/diseases-conditions/pinched-nerve/symptoms-causes/syc-20354746#:~:text=A%20pinched%20nerve%20occurs%20when,many%20areas%20throughout%20the%20body.

https://www.newjerseyspinesurgeon.com/blog/why-is-physical-therapy-an-effective-treatment-method-for-a-pinched-nerve/

https://www.health.harvard.edu/pain/treating-a-pinched-nerve

https://www.spine-health.com/blog/how-long-does-pinched-nerve-last

By: Shahd Nabhan

What is Tendonitis?

Tendons are thick fibrous tissues made that connect muscle to bone, they are elastic in nature and have to “stiffen” when our muscles contract. For example, to move your shoulder, the tendon that connects your shoulder muscles to your shoulder joint stiffen as a response of the muscles contracting resulting in movement. Tendonitis is when this fibrous tissue becomes inflamed.  Inflammation of tendons ca n be expressed as pain, tenderness or mild swelling initially, if left untreated, tendonitis could lead to the need of surgical intervention.

Where could Tendonitis happen?

Tendonitis can occur wherever tendons are, the most commonly affected areas are shoulders, elbows, wrists, thumbs, hips, knees and heels as those tend to be the most commonly used joints

What causes Tendonitis?

1. Age

Tendons are made up of collagen, the production of collagen decreases with increasing age. This causes tendons to be less flexible and more prone to injuries; this is often seen in people over the age of 40.

2. Activity

Specific sports or repetitive movements are another cause. If the nature of sport or work includes repetitive and/ or forceful movements, it leads to recurring high loads of tension on a specific joint/ tendon. Overtime, this leads to the tendons deterioration which is exacerbated as inflammation of the tendons in its early stages. Golfers and overhead reaching during work are examples of such activities that include forced repetitive movements, potential incorrect posture and body movements are other causes. Furthermore, the incorrect equipment, for example non-supportive shoes or uneven and hard surfaces such as running on gravel could lead to tendonitis.

3. Medications and Health

Some medications such as antibiotics or corticosteroids might elevate the risk of developing tendonitis. Diseases such as diabetes also increase risk of developing tendonitis.

How to Treat Tendonitis?

Early intervention is the best for tendonitis, if tendonitis is left without treatment and injury pertains, it could develop into a tear that may need surgical intervention. Treatment can be broken into passive and active phases:

Passive Treatment:

Prescribing anti-inflammatory medication to help reduce the inflammation of the tendon is usually one of the early steps to treat tendonitis. When treating acute tendonitis, treating therapists follow the P.R.I.C.E principle, which is

• Protection: use devices or tools to prevent further injury, for example splints, protective tape and ace bandages.
• Rest: stop activities that have lead to the overuse of the tendon. Determining the cause and resting are the major steps of preventing further inflammation and deterioration of tendons.
• Ice: ice the injured area for 20 minutes at a time; this is hugely beneficial in the initial weeks of the injury to reduce inflammation levels.
• Compression: after icing the area, a compression wrap should be applied to act as a mechanical barrier reducing any ongoing swelling.
• Elevation: similar to icing, elevation has great benefits when applied immediately post-injury. Elevation helps reduce blood flow to the injured area reducing swelling and inflammation.

Other than PRICE and anti-inflammatory medication, Inferential current therapy (IFC), Transcutaneous electrical nerve stimulation (TENS), ultrasound treatment and other physiotherapy modalities can be used to aid in the process of recovery.

Active Treatment:

Passive Treatments on their own are not enough to fully treat musculature injuries, hence why active physical therapy treatment should always be coupled with passive treatment when possible. When it comes to tendonitis injuries, it varies among individuals, based on the degree of the injury but also how long has it been since the tendons started being affected.

Exercise within the early stages of the injury could lead to more strain and inflammation of tendons, hence should be avoided. Once cleared by the treating therapist, strengthening the muscles surrounding the joint and connected to the injured tendon is the goal in order to prevent future injury.

Active recovery focuses on improving range of  motion (ROM) of the joint and stretching potential of the tendon itself. Once patients improve in those aspects, strengthening exercise of the muscles will be incorporated. Stretching and ROM exercises insure that not only the muscle, but the tendon itself is getting accustomed to a healthier range of motion. Strengthening exercises lead to better muscles connected to the injured tendon, better and stronger musculature decrease the risk of injury greatly.

Future Tips for Prevention

After passive exercise has begun, active recovery must always be incorporated. Once you think you are done treatment, stretching and warming up before any exercise or strenuous activity should always be the first step. To avoid future injury after recovery:

• Rest when in pain and discontinue cause of injury.
• Warm up and stretch thoroughly before sports and exercises, cool down after and stretch again.
• Stretch before beginning work, and take mini breaks to move your muscles around to give them a break from repetitive movements at work.
• Focus on building muscles strength and flexibility.
• Use the correct equipment and proper range of motions for activities.

Sources:

https://www.mayoclinic.org/diseases-conditions/tendinitis/symptoms-causes/syc-20378243

https://www.sportsmd.com/sports-injuries/knee-injuries/how-to-treat-tendonitis/

https://www.sportsmd.com/acute-sports-injury-treatment-using-p-r-c-e-principle/

https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=1&contentid=739

https://www.webmd.com/fitness-exercise/arthritis-tendinitis

https://www.endeavorrehab.com/2020/07/17/treatments-for-tendonitis-with-physical-therapy/

https://www.mayoclinic.org/diseases-conditions/tendinitis/symptoms-causes/syc-20378243

Dr. Asaro , Doctor of Chiropractic, who has joined our Main Street Health team of health professionals, has 15 years of experience providing patient centric, quality chiropractic care with an emphasis on prevention, multidisciplinary rehabilitation and patient education.

A spine specialist, advanced practitioner for low back pain and sciatica working for a the hospital program at HHS with surgeons, pain specialists and family doctors.

He has extensive experience in working with patients with musculo-skeletal conditions and inflammatory and non-inflammatory conditions and is highly trained at identifying the signs and symptoms of undiagnosed medical conditions.