About Physiatry

About Physiatry

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Pinched Nerves in the Neck and Back

Condition: There are many causes of neck and back pain.  The most common cause is a muscular strain. Other common causes are osteoarthritis (wear and tear), trauma, and narrowing of the spine. Back and neck pain may also be caused by compression or irritation of bundles of nerves in the spine. When nerve irritation occurs in the lower back it is called lumbar radiculopathy which can cause leg and/or foot pain and numbness. When it is in the neck, it is called cervical radiculopathy which can cause arm and/or hand pain and numbness. 

Background: About 84% of people have neck or back pain at some point in their lives. The pain usually starts in the teens to early 40s. Your back is a complex system made of bones, discs, spinal cord, nerves, muscles, tendons, and ligaments.  About 85% of patients who seek medical attention for back pain do not receive a specific diagnosis. Neck and back pain is a symptom.  It is not a disease. Most people get better without medical treatment.  Sometimes, the pain can be caused by a serious illness. 

Risk Factors: People who work at jobs that require driving or heavy lifting are more likely to have back and neck pain. Other factors that can raise a person’s risk include tall height, smoking, mental health disease, being overweight, multiple pregnancies, being unhappy at work, and having a low-activity lifestyle. Low-impact aerobic exercise is the only proven treatment to prevent neck and back pain.

History and Symptoms:
Pain may be dull, throbbing, aching, or sharp. Tingling, weakness, and numbness may extend into the arms or legs and be part of the pain. It is important to pay attention to how long the pain lasts, how often the pain happens, if the pain starts quickly or gradually, how bad the pain gets, where the pain is, and any pain patterns. Usually, neck and back pain improves with activity modification in a few weeks. 

Physical Exam: A physical medicine and rehabilitation (PM&R) physician, also known as a physiatrist, will thoroughly check your strength, reflexes, sensation to light touch and temperature. You may be asked to walk and lift or rotate your legs and feet.  It is important to go to a doctor that will do a careful neurological and musculoskeletal exam. PM&R physicians are trained to identify and improve your neck and back pain. 

Diagnostic Process: Diagnosing back and neck pain is done mostly by asking patients questions about the pain, their ability to do their normal activities, and how well they are sleeping. X-rays may be used to rule out broken bones, also known as fractures, or abnormal movement of the bones. If symptoms do not improve after a few weeks of activity modification and/or medications, then an MRI may be used to look for problems such as bulging disc or compression of nerves; most people do not need specialized tests because most pain symptoms will improve in a few weeks.

Rehab Management:  It is important to stay as active as possible, although activities may need to be modified. Exercises to strengthen the back and stay flexible are also helpful.  Non-opioid medications, education, injections, acupuncture, massage, and other treatments are a few of the ways your PM&R physician can help to improve your pain.

Other Resources for Patients and Families:Families can encourage patients to stay active but rest when needed.  Keeping a pain diary and paying attention to the things mentioned in the "History and Symptoms" section can also help a PM&R physician treat your pain.


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