# treatment for pinched nerve?



## caedmyn (Jan 13, 2006)

I have a pinched nerve somewhere that's affecting both of my hands as well as my left elbow. I saw my chiropractor twice last week and getting adjusted helped quite a bit, but now we've moved to a different state and my hands are getting worse again. I'm not sure if chiropractic's actually going to fix the problem, not to mention I'd have to find a new chiropractor, so I'd like to try something else. Has anyone had any success in treating pinched nerves, and what did you do? Oh, and how long did it take?


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## flamingo1129 (Oct 22, 2006)

For my arm/hand pain from a pinched nerve in the neck/upper trap area, the following worked for me:
3 months of PT (moist heat, stretches, exercises, ultrasound); some variety of stressrelief tea every evening; making sure not to forget my vitamins/minerals and omega 3 EFA supplements; getting enough sleep; frequent breaks at the computer at work (move around every hour to stretch and change position)

That was last spring. Now I do maintenance exercises/stretching plus all the rest of the list. The minute I slack, I notice stuff tightening up again. Like I really should be in bed right now - lol.

Good luck - don't let it go to long without attention,
Emily


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## formerluddite (Nov 16, 2006)

sorry you're hurting. this is a summary of some advice i gave elsewhere. some of it might not apply to your situation, but some may. i condensed the person's responses into "PT lingo"/shorthand, both for privacy and to be concise. so ask if there's anything incomprehensible, and i can explain.

from your area of pain, it's probably C6, C7, C8 (the lowest 3 vert).

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someone had "pinched nerve" pain in her shoulder blade area (P1), that i suspected was neck referral. she was advised to stretch/chiro, but c/o that chiro/massage wasn't helping, too intense/"wrack and crack". stated she felt like she was going to puke +/or pass out. No position comfortable. sit/lay/stand all painful. Ice/heat little/no help.
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my response:

first rule out referred pain from your neck (this is your friendly not so local PT speaking). the C5 nerve root (what it's called as it exits the spinal column) frequently refers into the area between the shoulder blade and the spine (so frequently someone named it "cloward's" after himself).

if you feel like chiropractic and massage are not helping, maybe try a PT or an osteopath. my friend ann (my research partner in PT school) has used amazing osteopathic techniques that consist of her looking at me (still and moving), then sitting me on the plinth, palpating/feeling gently with 2-3 fingers at my back muscles (i was having referred pain into my ribcage) while she moves/guides my head gently around (and we're talking small movements). she picks a spot, tells me "hold, don't let me move you" (sometimes referred to as muscle energy techniques) and pushes gently in a very specific direction for 10-20 seconds. she's feeling with her fingers at my paraspinals, and when she feels what she wants to feel (?relaxation, ?repositioning), then she stops. then feel around some more, moves my head some more and pushes while i hold again. (with me getting off the table and moving once or twice for reassessment, if needed).

anyway, there are many gentle techniques that don't include "wrack and crack"ing. strain-counterstrain is one that aims to put the spasming muscle into a SLACK position, sort of to convince the muscle "it's all right, you can relax, nobody's gonna yank on you" (which is why sometimes stretching makes things worse).

sometimes the painful area is suffering from TOO MUCH stretching, because of another nearby tight area (say 2 neck vertebrae that are stuck together/stiff), where the next door joints are trying to do the work of 2 joints. so rather than stretching, specific loosening mobilizations (usually thumbs pressing on the spinous process, transverse process or somewhere in between, like the laminar trough) are needed to get the motion back in the stiff areas, so they'll do their job again, and let the painful level stop carrying the load. when a vertebral level tries to move enough for 2 joints, that nerve root gets overstretched (rather than pinched). then the whole surrounding muscle system spasms, to protect the injured nerve. but they (the muscles) get tired from constant effort, and start to hurt, too.

for now, until you get help:

first of all, use ice when you first flare up (2days), because heat can aggravate the inflammation. if ice hasn't helped, it may be you're not getting it cold enough (do you use a dry cloth? not cold enough!) it also may be that you are putting it on the painful area (shoulder blade), but the problem is in your neck.

use frozen peas or a water/alcohol slushie, and put it on the lower part of your neck, skewed a little towards the painful side. you can use an ace wrap in a figure 8, criss crossing over the ice pack, going across the front of your shoulder and under your arm, like a backpack strap, then across the ice pack, over the other shoulder, under the arm... until you run out of length, and tuck it under itself. this way you don't have to lie on it or hold it. if this area doesn't help, then try lower, between the shoulder blades. but i'm guessing it's your neck.

slushie recipe:

put water and rubbing alcohol (3-4parts water to 1 part alcohol) in a sandwich ziploc, then into another ziploc (because it tends to leak after a few days, i think the alcohol weakens the plastic), and toss it in the freezer. it will get very cold (zero degrees) but stay flexible like a slushie. to use it, wrap one layer of dishcloth over the side you'll put on your neck (as if you were wrapping a present), wet it on that side, then use an ace wrap (or if you don't have one, use a pair of pantyhose) to tie it securely onto your shoulder, wrapping around your trunk, so you can walk around.

it will get VERY COLD, enough to give frostbite, so only leave it on ~5min (you probably won't be able to stand it longer than that, anyway). it will hurt more for a few minutes, like painful pins and needles, then go numb. take it off as soon as it gets numb. you can redo it an hour or so later, as needed. (just remember to put it back in the freezer, unlike my dh).

depending on your view on analgesics, ibuprofen (advil) can be a wonder drug. it cuts your perception of the pain, so the muscles guarding relax, and so THEY stop hurting, and by the time it wears off, sometimes the nerve has calmed down enough that the muscles don't spasm again. we call it "breaking the pain-spasm cycle." take 600-800mg (=3-4 of the OTC 200mg talbets).

homeopathic arnica pellets and topical ointment/gel are amazing. get 30C potency, take 2 pellets, again an hour later, if it helps, then stop, if it comes back, take another dose,

homeopathic hypericum is also good for nerve injuries.

try to go for a walk, one that is steady with an even pace (so it's hard to do with kids who stop and dilly dally). the rhythmic on-off nature of the paraspinal muscle contractions (with every step) helps relax the muscles that have been "on" nonstop, and hurt. even 5 or 10 minutes will help, several times per day, if you can. if you can't leave the kids, but you have a big yard, go in circles.

try neck exercises:
chin tucks (cool, i found a video!) don't do them as aggressively as the demo does, since you're hurting. slower and less far back.

gentle active range of motion. again, don't do them as far or fast as she does, and skip flexing and extending (nodding) for now. (oh wow, this site is amazing!)(you may not need any of the other links for stretching, but i can't watch them all right now, and she's hard to hear).

stretches (when things settle down): trapezius (actually he should turn his head toward the stretching side) and levator scapula (and on this one he should turn his head away). the bottom photo here is a better stretch, but it's hard to read. this site also has good stretch info.

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my second response:

ice is better for inflammation, esp for the first 48hrs. and better for pain, if you can stand being frozen and getting to the numb phase.

remember, WET dishcloth, and only one layer of it between you and the slushie/peas. 5 min for slushie, 10 for peas (they're not as cold).

after 2 days, you can also use heat, but it's best for loosening up before exercise, and then ice afterwards when you're ready to rest.

you can try to self mobilize. first pull into a moderate chin tuck so your neck curve flattens out. then reach around the back of your neck with the less painful side's hand, put your pinky at the base of your skull, and your ring, middle and index fingers over the spinous processes. your thumb will rest on the trapezius muscle belly. feel around by sliding you fingertips up and down, pressing hard enough that the skin moves over the bones, not your fingers over the skin, so you can get a feel for the bumps. firmly set your index or middle finger over one of the lower bumps. then do a little more chin tuck, so that you can feel the bone above the one your fingertip is on slide closer to the lower one. pulsate in and release, every second or so, 5-20 times. then try another level.

you can also slide a bit further past the spinous process, but curl your finger a bit and have the first knuckle (the palm side crease) over the spinous process. this puts your fingertip in the laminar trough, near the facet joints , where the vertebrae touch each other. vertebrae are stacked up with the discs in between the vertebral bodies, but the facets are a cartilaginous joint on each side, in between the spinous and transverse processes.

if you find a level that moves freely but hurts, do a couple of gentle pulses, then leave it alone. if you find a stiff level work on it for a while. if you use the second position, with the curled fingertips, you can also aim your finger on a diagonal towards the center, or down, to really work on getting the kinks out. sometimes the facet jts. get stiff and don't allow movement (and a stretched out painful nerve results), sometimes they are moving too much (usu. to make up for a stiff jt next door) and hurt.

also look at your posture, esp with keyboarding (laptop at the kitchen table, ouch). watch that you don't elevate one or both shoulders (usually the right, is that the worst side?), or have them rolled forward. force yourself to pull your shoulder blades down/back and central (your shoulder will go back/down, too). do that as another exercise. pull down and back, hold/count to 5, release and repeat. if it's hard to isolate this movement and get the feel for it, then bend your elbows, and turn your hands around to face palm outward (hands are level with shoulders, and about 8" away, and 8" forward, mushy instructions, wish i had a link). this position helps to turn on the muscle you want to retract/depress your scapula (shld blade). pull your elbows toward your butt/spine.

this exercise works 2 ways to help. first, it strengthens the muscles that are needed to prevent forward head and shoulders (the curse of the desk/computer era). second, by actively using these muscles, it sends a signal to the opposing muscles (the ones that bring your shldrs up and fwd) to relax and allow the movement. in passive stretches the stretched muscle has a reflex that makes it want to contract to protect it from over stretching, so you have to do them slowly and sustained to get a good stretch (minimum 30" but more, even 5 min is better. hell, come to think of it i've done 15 min stretches on spastic muscles (on head injured people), trying to prevent increasing contractures of knees and elbows etc).

give some more specifics and i might be able to come up with more. which side? what motions are the most aggravating? raising your arm? turning your head? towards or away from the painful side? tilting your head? towards or away? when you lie down on your side, is it worse to lie ON the painful side, or on the other side? (so that your neck tilts too far).

sharp or dull pain? does it shoot anywhere? rate it on a scale of 0 to 10, 10 being the worst pain imaginable (which for women the reference is always "childbirth," lol, but i'lll take birth over some gas pains i've had in my life!) where did you ice? did it help? what was the pain level when you took the ice off? did you try a few places? which helped the most? could you move your head more into a painful direction after the ice?

are your pectorals tight, pulling your shoulders forward?

hope you can sleep ok tonight. tomorrow try a rolled up hand towel slipped inside your pillowcase to bolster at the curve of your neck for side sleeping or back sleeping. don't sleep on your stomach for now.

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she responded that neck rot L=R=8/10, ext=6, UE's ok to move x R shd flex 'twinges"=2/10 at P1, Laying down/Talking/Anything that requires ANY muscle movement of head is painful. dull- deep ache. stabbing shooting pain. w/guarding spasm, general stiff/tight feeling at P1. taking mm relaxants.
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my 3rd response:

ice your neck.

take arnica, rub some on.

take ibuprofen if that's ok with you (which i'd guess yes, given the muscle relaxants). eat, so it doesn't irritate your stomach. take it again before bed. every 4-6 hours, for tomorrow too, then see if you can taper off monday.

don't exercise/stretch today, just rest. except try small (infinitesimally small) chin tucks.

then later, when the ice wears off some (it takes away the pain, but makes things more stiff), try a walk. force yourself to allow your arms to relax, and swing gently.

what's the resting level of pain? (when there is the least, ie NOT moving, talking, etc).

is there any numbness or tingling in your fingers? (thumb=C6, middle finger=C7, pinky=C Cool? is your grip weaker than it should be? any dull ache in your upper arm? (C5 referral).

things are worse if they radiate (travel distally=away from the neck), better if it's mostly central (near the spine= proximal).

i'm an inpatient therapist, this is just remembered basics from school/internship 10+ years ago.

go get a good PT who does outpatient ortho, and there's a lot they (joint mobilizations, osteopathic techniques, soft tissue mobilization, craniosacral therapy...) and you (exercise, learn body mechanics: they'll watch you, correct poor movement patterns) can do.
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congratulations if you got through this. hope it helps. i stop by mdc ~3x/week, but you can pm me and i think it will send a prompt to my email (course, i check THAT only every few days, too,







), if you have questions.


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