By Debra K. Brinker, RN
Pinched and compressed nerves can produce burning and shooting pain that can range from mildly annoying to excruciating and completely disabling. The underlying reason that nerves become pinched or entrapped is often missed when patients are given only the limited options of prescription painkillers, nerve blocks, and surgical consultations. Treatment such as nerve blocks may provide initial pain relief, but is often only temporary. The missing diagnoses are almost always joint instability and ligament injury. Treatment options that address underlying joint instability can prevent pinched nerve symptoms from returning or becoming chronic. (See figure 1.)
Damaged ligaments are the missing link
Ligaments become lax after an injury, or even wear and tear, causing excessive motion in the joint. When there is instability, or extra movement, the bones slip out of place and can pinch nerves. Pain is carried by nerves to the central nervous system, alerting it to the presence of an injury or problem. (See figure 2.)
The nerve may be inflamed, entrapped, or compressed by nearby bone or myofascial tissue. With normal range of motion of a stable joint, adjacent bones normally move about 1-2 mm, an extremely small space, but one that prevents the bones from hittting the nerves as they zig zag through bony tunnels. When the joint is unstable, however, the bones move excessively, resulting in the nerve being hit or compressed, and producing zinging pain and/or numbness.
Positional pain is key indicator for joint instability
Regenerative medicine physicians can determine which nerve compressions or entrapments can be treated non-surgically! The key characteristic finding to determine that the nerve irritation is coming from joint instability is that the main symptom is positional. For example, if a person can significantly increase or decrease a symptom by changing position, such as by placing the arms or legs in a certain position, then joint instability is most likely an instigating cause of the condition and will need to be treated for long-term resolution. The compression or pinching of the nerve can be documented using musculoskeletal ultrasound or Digital Motion X-ray. (See figure 3.)
When viewing the nerve when the patient is in the asymptomatic position, one can see that the nerve is not being compressed or touched by any bone in that position. Likewise, the nerve space narrows when joint instability is present, and during symptom producing positions.
If symptoms are aggravated by a certain position or movement, treatment with regenerative injection therapy resolves the joint instability and keeps the space for the nerve open. If the symptom(s) is constant, in all positions and activities, then most likely joint instability is not the cause and a decompression surgery may be necessary. But for people who have intermittent nerve pain, an opinion from a joint instability specialist may prove helpful. Once the joints are realigned and stabilized, the nerve compression ceases.
Treating entrapped and pinched nerves naturally
Pain from a sensitized nerve may be treated with different types of regenerative injections: Prolotherapy, Lyftogt Perineural Injection Therapy (LPIT), and Nerve Release Injection Therapy (NRIT). When joint instability is the primary cause of a sensitized, compressed, or pinched nerve, Prolotherapy, including Stem Cell Prolotherapy, can be given. Prolotherapy is an injection treatment that stimulates repair of ligaments, tendons, and other soft tissues that have a poor blood supply. Blood transports the oxygen and nutrients required for healing, but after all joint injuries, as well as with aging and wear and tear, blood decreases in the soft tissue. Because of this, the body’s ability to heal on its own also decreases. Prolotherapy encourages the restarting of the repair cascade at the exact point of injury. Injured soft tissue needs to be repaired for full joint recovery and stabilization, to stop the abnormal movement, inhibit the ongoing compression of the nerves and relieve chronic pain. (See figure 4.)
Nerves are treated along with the ligaments when a person has joint instability, in efforts to speed healing. When the nerve is located superficially or is larger and easy to identify, then LPIT is given at the sites of nerve restriction and inflammation, to relieve the constriction and restore homeostasis to the nerve. When the nerve involved is deep and/or entrapped, an ultrasound-guided Nerve Release Injection Therapy (NRIT) is used to direct natural substances to the exact nerve entrapment location, to mechanically release the nerve (also called hydrodissection), and to nourish and restore homeostasis. (See figure 5.)
Pinched, irritated, compressed, or sensitive nerves can be treated with these simple, non-surgical natural injection techniques, in an effort to restore the nerve to health as well as the tissues it innervates!
Regenerative Medicine Specialists
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239-303-4546
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