Friday, November 9, 2007

Pinched nerves

In neurodynamic theory, much emphasis is placed upon testing nerves via elongation. The vascular, mechanical and emotional challenges of a neurodynamic test are likely to reproduce symptoms from active impulse generating sites in peripheral nerves. However, perhaps forgotten, is the effect of a pinch on nerves. For example, sometimes cervical extension and lateral flexion can pinch nerve roots (Spurling’s test), and wrist flexion can pinch the median nerve (Phalen’s test). Hip flexion pinching the femoral nerve is another example.

If you note pinch based symptoms in your patients, which can be reasoned to be peripheral neurogenic in origin, then it is logical that the structure around the neural structure may be unhealthy. This could be facet joint arthritic changes in the case of nerve roots, or swollen carpal canal contents in the case of median nerve changes in the carpal tunnel. The surrounding tissues would be logical targets of therapy.

'Pinch pains' are often very sudden, even shocking, and if repeated may lead to fearful avoidance of the pinching movement. Secondary changes in other tissues and brain representations may follow.

The public often talks about 'pinched nerves' and the notion may be worth a rethink by clinicians.