What Éric-Olivier loves most about physical therapy is his ability to have the chance to truly learn about his patient beyond the body mechanics. Getting to know patients allows him to better tailor h...
I've been having burning pain down my whole right leg for the last two weeks. I've tried stretches, muscle relaxants, but nothing helps. I don't know if I should laugh or cry at this point….
I'm exhausted! My left foot feels frozen, but is warm to the touch! Has anyone found a way to relieve this feeling? It's driving me insane…
Time for painkillers…
I'm having problems walking for any sustained amount of time. It's getting worse…
I'm starting to lose hope. This is so frustrating. I can't work anymore because my pain stops me from sitting for more than 15 minutes. The worst thing for me is not being able to pick up my kids. It makes me feel awful and so helpless. I don't want my kids to think that mommy/ daddy is boring…
‘I feel like people have got no understanding of just how painful it can be. I don’t think it’s taken seriously enough. It is excruciating pain, constant…’(3)
Did you find yourself sharing any of the thoughts from the paragraph above? If yes, it's no surprise, these come directly from people on social media and patients I had the chance to guide. After reading too many of these in forums, I’ve decided that I must help spread adequate information to all that need it to help them find the path to recovery as early as possible.
Hopefully, you are not at this stage with your pain, but if you are, know that I've heard you and am here to help you regain control over your life!
Nerve pain can hurt a lot. Some people feel a sharp stabbing pain going down the leg, which is frustrating because they might be unable to walk/ sit for extended periods of time. Other people describe the pain as feeling an electric shock or a lightning strike going to the tip of their toes, the only relief being to lie down. Some other people wake up at night with numbness and pain in the arm, because of which they can't sleep well. As a result, they feel more irritable and snappy even if they don't mean it. This is, unfortunately, far too common, which is why I decided to write this article.
This article aims to give you the tools and knowledge to enable you to take control of your pain. The goal is not only to help you manage and control your pain but to help you find a way (by yourself or with the help of a health professional) to resolve the cause of your problem (nerve pain/sciatica). As long as we don't fix the cause of your pain, the pain will keep coming back no matter how many painkillers you take. This is to help you regain control over your life!
Most of us know that our nerves allow us to feel (have sensations) in our bodies. But did you know that your nerves can also be the origin of your pain? Indeed, our nerves can get irritated, inflamed, damaged, compressed (pinched) like any other tissue in our body. Just like your muscles and tendons in your shoulders, sometimes nerves become sore and sensitive.
Our nerves are one of the most important things our body has. They allow us to feel and control our muscles. Without nerves, our body wouldn't be able to move. As you can imagine, we have a good alarm system for our nerves to make sure that if ever something undesired was to happen to them, we would know. The body's alarm system is… PAIN!
The pain system is made of tiny receptors that send signals when there is potential or actual damage to the nerves (1). When the small receptors of the nerves send signals to the brain, the brain's responses tend to be: burning sensations, electric shocks going down (radiating), and sometimes some numbness. These are incredibly unpleasant for the simple reason that we can't afford to have damaged nerves.
The body makes sure it is painful enough to stop you from repeating or sustaining the movements or positions that stress the nerve. The best way to experience this is by hitting your elbow, or the funny bone. We all know what this feels like. It hurts! When we hit that funny bone, we compress a nerve (ulnar nerve), which leads to the painful reaction, which is typical of when nerves are disturbed. Depending on which nerve is being irritated/compressed, we will experience different symptoms.
As you can see, when we "damage" a nerve, the pain is not local to where we hit it. It can also go all the way to where the nerve ends. For instance, if you hit your elbow hard enough, it can hurt down to your pinky and ring finger (4th-5th fingers) because of the ulnar nerve. This nerve gives sensation from your neck, which travels to your elbow, and all the way down to your pinky and ring finger.
Our nerves can send signals in a downstream manner. To illustrate, let's think of the nerve as a garden hose. Just like a hose, our nerves are somewhat supple. When there is a knot in a water hose, whatever is below the knot level will have very little water in it because the flow is blocked by the knot from going beyond. The only way to bring the flow back to normal is by undoing the knot.
If you don't know where the knot is, maybe it is blocked on the part of the hose on the other side of the wall. You might start turning around the hose, moving the knot up down right and left, trying to undo the blockage. If we turn in the correct direction, the knot will untie itself, and the water will flow properly. However, if we turn the wrong side, we will increase the compression on the tube and further decrease the water flow.
Let's say you have a big garden. You have vegetables, fruit, and crops in there. One hose waters veggies, one waters the fruit, and one waters the crops. What happens if the hose watering the veggies has a knot in it? Well, there will be less water going to the veggies of course!
Depending on where the knot is on the vegetables hose, all vegetables or only some could be affected by the knot. The ones with their sprinklers above the knot level will be just fine and receive enough water. On the contrary, the ones that have their sprinklers below the knot will be lacking water and will likely be damaged and have a tougher time growing.
The same happens with our nerves. We send electricity down our nerves to our fingers or toes, depending on what nerve it is. Just like the water from the water hose feeds the plants, the electricity from the nerves “feeds” and activates our muscles and provides us with sensations. Some nerves help to provide sensation to the side of the arm, some to the middle of the arm, some to the thumb, etc. So, as you can imagine, depending on which nerve is involved (pinched and irritated), we will have symptoms in different body regions.
Most of us have heard of the sciatic nerve before. It is a long nerve that goes from your lower back down to your big toe, passing by the back of your thighs and down your calves. We often hear that sciatica gives you pain, especially in the back of the leg and the calves. (2)
With sciatica, the sciatic nerve is usually compressed and irritated just as it comes out in our back from our spine (spinal cord). That is why most of the time, the pain in the leg is far worse than the one in the back; it is the section of the body that is below the “knot”, and therefore suffering the most.(3) Everything below isn't receiving an adequate amount of "nutrients and water," which is why the alarm system (pain response) starts.
For our nerves, the “water” is electrical inputs, blood, nutrients and oxygen. If just the alarm system of where the knot is was to go off, it would be too late; by the time you process the pain, the regions below the knot have failed to get “water” for some time, making it quite tricky to recover from fully.
This explains why sometimes, even though you feel pain in your hand, the issue can actually be something else altogether. For example, many individuals diagnosed with carpal tunnel have a problem in their neck, not in their wrists. The nerves that go to the wrist come from the neck and travel all the way down to the fingers. So, if you get a "blockage" of a nerve around the neck that goes down to your wrist, your wrist isn't very happy that it is not receiving its "nutrients." This is why individuals with sciatica will have exercises for their back (and not so much for their legs). Even though the pain is greater in the leg, the source of the problem is higher up in the back. Treat the back and the leg will follow!
In the same way, even if you change the hose to face the dry vegetables, there wouldn’t be much water going to them unless you’ve already undone the knot in the main hose.
In the same way as the water hose, moving in specific ways might cause more or less pain depending on if the size of the knot is increased or decreased. The fact is that we may be turning the water hose the wrong way to undo the knot when we do certain movements. This is why it is so important to understand how our movements affect our spine and nerves. By knowing this, we can target certain exercises that will help untie the knot and minimise the ones that will further tighten it. The best thing would be to try moving as much as you can in ways that don't make your symptoms increase and stay worse even once you've stopped the activity. Stopping all movements is usually more detrimental than beneficial.
When this happens, we tend to see other symptoms emerging. Like with our veggies, if the broccoli is well irrigated but the peppers aren't, the broccoli will grow to normal size. In contrast, the peppers will either not grow or slowly dry off and die. Similarly, our nerves irrigate our muscle cells (strength) and our sensory cells (feeling). When these cells are not adequately irrigated, just like our peppers, the cells will have a tough time, especially if sustained for prolonged periods.
We start to experience weakness in the muscles irrigated by the involved nerve, as well as numbness and tingling. It becomes essential to act and find a way to fix this since nerves don't recover very well. We want to make sure to bring back water for all plants before long term consequences take place.
If you feel like you would benefit from an evaluation to identify and treat your pain from a health professional, you are welcomed to take an appointment with me. It will be my pleasure to guide you and answer your questions.
For more information, make sure to read my other articles which you can easily find on my profile. To discuss the information disclosed in this article, or if ever you believe a statement is outdated or not evidence based, please feel free to reach out and let me know, I am always eager to learn. To do so, you can contact me by email at firstname.lastname@example.org
Giuffre BA, Jeanmonod R. Anatomy, Sciatic Nerve. [Updated 2020 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482431/
Goldsmith, R., Williams, N. H., & Wood, F. (2019). Understanding sciatica: illness and treatment beliefs in a lumbar radicular pain population. A qualitative interview study. BJGP open, 3(3), bjgpopen19X101654. https://doi.org/10.3399/bjgpopen19X101654
Randall Wright MD, Steven B. Inbody MD, in Neurology Secrets (Fifth Edition), 2010 Radiculopathy and Degenerative Spine Disease Available from: https://www.sciencedirect.com/topics/neuroscience/lumbar-nerves (last accessed 23.1.2020)