The spine consists of several distinct areas–the cervical spine (neck), thoracic spine (mid back), lumbar spine (low back), sacrum and coccyx (tailbone). The spinal cord travels the length of the spine and is housed and protected by the bony vertebrae of the spine. The spinal cord is part of the central nervous system. It carries vital information to and from organs, muscles, skin and other tissues and the brain. Spinal nerves exit the spinal cord through small openings created by adjacent vertebrae. These are part of the peripheral nervous system and travel throughout the body to bring information to and from local tissues and the brain and spinal cord.

Signs and symptoms of nerve compression differ depending on whether the compression affects the spinal cord (central nervous system) or peripheral nerves. Characteristics and location of symptoms allow a therapist or doctor to localize the affected nerve. Sometimes imaging like a CT scan, x-ray or MRI or tests like EMG or nerve conduction velocity are utilized to determine exactly which nerves are involved.

If you are experiencing any of the following signs or symptoms you might have a pinched or compressed nerve in your back:

• Pain that is aching, dull, sharp, shooting or burning in the back
• Pain that is aching, dull, sharp, shooting or burning that radiates into the buttock, thigh, lower leg or foot
• Sciatica
• Numbness or tingling in the back, buttock, thigh, lower leg or foot
• Weakness in the leg or foot
• Increased or decreased muscle tone in the leg
• Abnormal reflexes
• Changes in gait or walking
• Drop foot or tripping when you walk
• Changes in bowel or bladder control
• Changes in sensation around the groin or genitals

Symptoms that are severe, bilateral (on both sides), are accompanied by night pain or fever, or include changes in bowel or bladder control are considered red flags that can indicate a medical emergency. If any of these symptoms arise after an injury you should also seek emergency medical care right away as it could be a sign of a serious spinal injury. Severe spinal nerve compression or direct injury to the spinal cord can cause permanent paralysis.

The collection of lumbar and sacral nerves at the end of the spinal cord is called the cauda equina because it resembles a horse’s tail. These nerves innervate the lower limbs and pelvic organs. Compression or injury to the cauda equina can lead to cauda equina syndrome. Symptoms of this syndrome include:

• Urinary retention, urinary or fecal incontinence
• Numbness around the anus, genitals or buttocks
• Weakness or paralysis in the legs
• Pain in the back or legs
• Sexual dysfunction
• The presence of any of these symptoms is also considered “red flags” and medical evaluation to rule in or out cauda equina syndrome is needed emergently.

CAUSES OF A PINCHED NERVE IN THE BACK

• Bone spurs on the vertebrae
• A herniated disc
• Fractured vertebrae
• Spondylolisthesis
• Back muscle sprain/strain with swelling
• Back ligament sprain/strain
• Movement pattern dysfunction in the spine
• Spinal stenosis
• Spinal tumors

If you decide to work with a physical therapist to help correct your pinched nerve in back, your entire treatment plan could consist of around 8-20+ different physical therapy sessions that will each last 60-90 minutes. Once you complete your customized rotator cuff physical therapy treatment plan, you will be able to continue to do the prescribed stretches and exercises utilized during your rotator cuff PT sessions yet in the comfort of your own home.

WHAT PHYSICAL THERAPY TREATMENTS ARE BEST FOR NERVE COMPRESSION IN THE BACK?

After identifying a nerve compression in your spine, the goal is to reduce irritation or compression in the affected nerve which can relieve your symptoms. In cases where conservative treatment like physical therapy cannot fully address the nerve compression or the spine is injured, surgery may be recommended by your doctor instead.

While physical therapy for a pinched nerve in the back will always be individualized to your specific needs, below are some common goals and treatments of physical therapy to manage nerve compression in the back:

TREATMENT TO REDUCE INFLAMMATION: Modalities like ice, ultrasound, taping, laser therapy, electrical stimulation or gentle motion may be used to reduce inflammation

NERVE AND TISSUE MOBILITY EXERCISES: Nerve and soft tissue mobilization techniques are often used to ensure good tissue and nerve mobility

JOINT MOBILIZATION AND MOBILITY EXERCISES: Passive joint mobilizations performed by your therapist or specific spinal mobility exercises performed by you such as spinal extension exercises following a disc herniation may be prescribed to reduce compression on nerves in the back

BIOMECHANICS AND MOVEMENT TRAINING: In cases where mechanical compression or irritation of a nerve occurs due to faulty or non-optimal movement patterns, your physical therapist can teach you to move more optimally, and sometimes use supports like taping or bracing, to help lessen the stress on your nerves.

STRETCHING: Muscle stretching is often prescribed to improve muscle length if this is a factor contributing to your symptoms

STRENGTHENING: Strengthening of muscles affected by the pinched nerve or contributing to the pinched nerve are often prescribed

GAIT TRAINING: If nerve compression affects your ability to walk then gait training may be utilized to restore walking mechanics

NEUROMUSCULAR OR FUNCTIONAL ELECTRICAL STIMULATION: Electrical stimulation applied to muscles can help retrain muscles weakened by nerve or spinal cord compression.

While nerve compression in the back can significantly impact your function and quality of life, physical therapy can be a first-line treatment to reduce compression and alleviate symptoms or address the after-effects of nerve compression treated by surgery. If you are experiencing pain, weakness or paresthesias in the back, buttocks or leg, call Evolve Physical Therapy today to schedule an initial evaluation. Remember to visit the emergency room first, however, if any of the red flag symptoms noted above are present.