By David P. Brungo, PT, Expert Contributor, Summerville PT & Balance Rehab for Adults
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 ambiguous clinical term and an example of a RADICULOPATHY. This means the actual problem area is somewhere like the spine or other area like your hip wherein a nerve or multiple nerves are involved, but many of the symptoms are perceived in other areas. That is to say, some symptoms of a bulging disc or pinched nerve roots branching from your spine 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 and felt elsewhere).
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 posteriorly into the spinal or central canal and puts pressure on the front margin of the spinal cord. Other times it can push more laterally and thus cause spinal cord symptoms that are felt elsewhere. But it’s not always a bulging or ruptured disc as the culprit. Sometimes it’s an arthritic process called spondylosis in your spine that may cause your spine to crimp down on a peripheral nerve root that branches from the spine at a particular level due to a process known as spinal stenosis. This problem would cause different symptoms. 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 due to spinal stenosis or degenerative disc disease (DDD).
Treatment: That depends on the nature and 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 peripheral 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. We’re also learning more and more about 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!
