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Topic 03

Nerve compression

Numbness and pulling sensations in the legs or arms have different causes depending on where the nerve is compressed, such as by a disc, a muscle, or a narrowed passage. Assessment typically looks at nerve status with sensation, strength, and reflex tests, and weakness or bladder or bowel problems call for a physician's care right away. For an accurate assessment and diagnosis, see a qualified healthcare professional.

Nerve compression Related staged image
Staged image · not an actual patient

Do you have these symptoms?

  • Numbness or pulling runs from the low back and buttock down the back of one leg to below the knee
  • Leg pain gets worse with coughing, sneezing, lifting, or sitting for a long time
  • Along with neck pain, the arm and hand feel numb, burning, or tingling
  • Arm pain eases when you rest your hand on top of your head
  • The thumb, index, and middle fingers go numb and wake you at night, and shaking the hand helps
  • The legs hurt and feel heavy when walking, and get better with rest

Causes and understanding

Disc
The soft center of a disc pushes out and presses on or inflames a nerve root. It can happen suddenly or develop gradually with degeneration.
The numb area hints at the level
A low back disc usually presses on the nerve that exits one level below (for example, the L4–L5 disc → the L5 nerve). That is why the area of numbness helps estimate the problem level.
Piriformis syndrome
A deep buttock muscle irritates the sciatic nerve. No signs of nerve damage, together with tenderness at both ends of the muscle, point toward a muscle cause rather than a disc.
Carpal tunnel syndrome
The most common nerve entrapment in the limbs, where the median nerve is compressed in the wrist tunnel. It is linked to repetitive hand use, sleeping with the wrists bent, and swelling during pregnancy.
Cervical nerve roots
The C7, C6, and C5 nerve roots are affected most often, in that order. After age 40, bone spurs and joint changes can also narrow the nerve passages.
Risk factors
Age, pregnancy, excess weight, smoking, work that involves twisting the back, prolonged sitting

Assessment from a chiropractic perspective

  1. Neurological examComparing skin sensation, muscle strength, and deep tendon reflexes on both sides is the basis.
  2. Low back provocation testsThe straight leg raise (SLR), Bragard, and Kemp tests are used to see whether symptoms are reproduced.
  3. Neck provocation testsCervical compression and distraction tests and similar tests are used to look for changes in arm symptoms.
  4. DifferentiationTelling disc problems apart from facet joint pain, spinal stenosis, and piriformis problems is important. With stenosis, nerve signs may only appear after walking.
  5. ImagingIf nerve root symptoms are clear, MRI or other imaging may be considered. Whether imaging is needed, and taking and reading the images, is decided by a physician.

How it's managed

Manual therapyCommonly described principles are to avoid the problem level and work on the surrounding segments, to adjust position and force to what is comfortable, and to minimize lumbar rotation. It is performed by professionals qualified in the relevant country, and whether it is appropriate is decided after an assessment.
Releasing muscles around the nerveApproaches that reduce nerve tension and release tension in muscles around the nerve, such as the piriformis, are used.
ExerciseGradually increasing walking within a tolerable range, then starting stabilization exercises once pain settles, is the usual approach.
Everyday precautionsEarly on, avoiding heavy lifting and long periods of sitting and finding proper lifting and comfortable sleeping positions are recommended. Quitting smoking and managing weight also help.
Tracking progressRecovery speed varies widely between individuals. If there is no improvement after a period of time, it is advisable to see a physician.

Exercise within a pain-free range, and stop if pain starts.

When to see a doctor first

  • Inability to urinate or leaking urine, reduced sensation around the anus or groin → go to the emergency room immediately
  • Nerve symptoms in both arms or both legs at the same time
  • Suspected spinal cord compression, such as muscles becoming stiff or changes in walking
  • Noticeable weakness → neurologist
  • Neck-related nerve symptoms that do not improve within 2 weeks or get worse

Related columns

Coming soonWhen leg numbness goes below the knee
Spine storiesHerniated disc vs. spinal stenosis: the symptoms differ when you walk
Coming soonLeg numbness that starts in the buttock: piriformis syndrome
Coming soonFinger numbness that's worse at night: carpal tunnel syndrome

This article is for general health information. Everyone's condition is different, so an accurate assessment requires consulting a professional.