By David Brungo, PT, Expert Contributor, Summerville PT and Balance
Many of my clients tell me they have burning pain, numbness and tingling, or just a feeling of weakness in their shoulders, upper torso, down their arms or into their hands and fingers; or maybe in their buttocks, portions of their thighs or lower legs, sometimes all the way down to their feet and toes. Just about everybody, I’d guess, has heard of the term, “sciatica,” but many people don’t understand what it really means. Sciatica is an example of a RADICULOPATHY. This means the actual problem area is somewhere in the spine, but many of the symptoms are perceived in other areas. That is to say, some symptoms of a bulging disc or pinched nerves in the neck or back are felt in places other than the neck or back (i.e., some symptoms of the problem are not necessarily felt at the actual site of the problem– instead, they are radicular in nature).
A very important point to understand is that not all radicular symptoms are alike. The reason for this is simple: a bulging or herniated disc can push into different parts of the spinal cord and/or the spinal nerve root(s) that branch off the spine at that level(s). Sometimes a bulging disc pushes forward and puts a midline pressure on the back margin of the spinal cord. Other times it can push more off center and thus cause different spinal cord symptoms. But a bulging disc can also put pressure away from the central spinal cord and instead push into the nerve roots of the peripheral spinal nerves that branch off at that level. This problem would cause different symptoms as well. Simply stated: it’s not a “one-size-fits-all” kind of thing when it comes to radiculopathies, so let the experts identify the problem so you don’t chase your tail thinking you’ve got it figured out. You could be suffering needlessly.
Here is a really common example of a cervical (i.e., neck) radiculopathy and note that this is not intended to be an all-inclusive list of symptoms– nor a diagnostic recipe– just an example of a common clinical presentation along with typical treatment options:
Case Example: Your symptoms include aching pain radiating down your right arm, numbness and tingling in your right thumb, index and middle fingers, noticeable weakness in your right arm and hand with a weak grip or handshake, and the reflexes in your right arm are less strong than they’re supposed to be when they’re tested.
Clinical Presentation Interpretation: The above host of clinically tested signs (R arm weakness and diminished reflexes) and patient-reported symptoms (numbness, tingling, feeling of weakness in the right arm and hand/fingers) are consistent with a bulging disc pushing against the right side of the spinal cord at the base of your neck or perhaps peripheral nerve root compressions at the 6th and 7th spinal levels as these nerves branch off the spinal cord and pass through the foraminal “tunnel” spaces that are created by bony projections from each of the two adjacent vertebral bones. These tunnel spaces can get smaller and smaller and eventually irritate if not compress the nerve roots at those levels through arthritic processes such as spinal stenosis or degenerative disc disease (DDD).
Treatment: That depends on the severity of your signs and symptoms. Conservative treatment should include physical therapy for traction, stretching and postural retraining with the goal of reducing or eliminating the bulge of the bulging disc or to relieve pressure on the spinal nerve roots that are being irritated so as to reduce or eliminate the patient’s symptoms as quickly as possible in the short term, but as well keeping it that way for the long term via the process of skilled interventions that improve posture and overall spinal alignment in the neck. More advanced cases might be treated with steroid shots to reduce inflammation and pressure on the nerve roots in conjunction with physical therapy for longer term improvement. The worst cases usually require surgery, like removing the bulging disc and potentially needing to fuse that level of your spine, after which the patient pursues optimal outcomes through physical therapy. However, technology and technique advancements are providing better, less invasive options that don’t always require sacrificing some movement due to a permanent spinal fusion.
In my 30+ years of experience treating adults, the best outcomes are usually associated with timely identification of the problems, a highly motivated and compliant patient and working collaboratively
with highly skilled medical and rehabilitation pros, such as your Orthopedic doctor, Neurologist and Physical Therapist. Pain Management experts are often involved and instrumental in reducing the severity of symptoms, which can really go a long way to buying time before needing to consider more advanced interventions. It’s also becoming more and clearer the potential benefits available from holistic practitioners such as most Chiropractors, Massage Therapists and Acupuncturists.
Fortunately, there’s a lot of really good help out there!
One thing’s for sure, though – it’s never a one-size-fits-all kind of thing, so resist the temptation of making self-diagnoses because you know someone with similar symptoms, and don’t wait until you can barely sleep or stand up straight or tolerate your work due to your symptoms. If you’re experiencing symptoms such as those described above, you may be suffering from a cervical or lumbar radiculopathy and should follow up with your doctor or favorite PT sooner rather than later and get started on the work involved in fixing the problems before they advance to the point of having very limited options.
It doesn’t have to be ridiculous!