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Ouch!! Low Back Pain and the Trapped Nerve
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Low Back Pain and the trapped nerve

I thought I'd write a newsletter about Low Back Pain (LBP) and then realised how foolish I'd been to try and fit this huge subject into the confines of one article. I expect this will be first of several dedicated to the subject! My first apology is for the dramatic title straight out of a copy of the Express. Nerves don't get trapped, any more than discs can slip or bones can crumble. These unfortunate terms have found their way into our lexicon and have been reinforced by well meaning health professionals trying to provide a vivid image of the structural faults we sometimes present with. We now know this language feeds into the negative behaviours associated with pain and just don't help!
I thought I'd kick things off by talking about the role of the nerve root in LBP. As you can see in the picture, a nerve root exits the spine between each vertebra on both sides. In the lower back these nerve roots join to form the nerves that run down the legs. Some parts do  run to other parts of the abdomen and pelvis but we don't need to worry about that here.  We're going to focus on how the nerve root can be injured, that said, the nerve can be injured and often is along any part of  its pathway down the limb. I'll save that for another time.
Put simply, as the nerve root exits the spine, it can be squashed or irritated. The main culprits in this are the intervertebral disc and the bony edge of a facet joint. The space where a nerve roots sits isn't particularly large so anything that narrows the space could be harmful.
The nerve root becomes inflamed and highly sensitive to movement. This can become chronic and may remain even after the initial 'injury' causing compression to the nerve has resolved.
Movements where we bend backwards or to one side will close down this space even more. Similarly bending forwards or to the opposite side will open the space. This is an important principle to understand in diagnosing and treating a nerve root injury.  
The yellow nerve roots exit a space between each vertebrae, behind the disc and infront of the facet joint.


Key features of radiculopathy are:
  • Pain and or altered skin sensation in certain (dermatomal) patterns
  • Power loss of specific muscles or directions of joint movement
  • Altered reflex response
  • Increased symptoms when the nerve root is compressed
  • Decreased symptoms when the nerve root is off-loaded
  • Frequently sensitive to stretching of associated nerves I.e straight leg raise on nerve roots making up the sciatic nerve
Clearly understanding the signs and symptoms of this kind of problem is key in diagnosing the anatomical cause of the problem. A common area of confusion is whether the disc is irritating the nerve or the bony edge of the facet joint is responsible. In a classic disc bulge or herniation we might infact see forward bending motion increase the disc bulge causing pressure on the nerve. This of course is the reverse of what we might see in the case where a facet joint is responsible. In both cases the contrary can be argued so it is never a black or white issue.
Manual therapy and exercise therapy approaches can be varied due to the range of severity and how easily irritated these nerve root injuries can be. If forward bending or sitting leaning to one side seems to alleviate the pain than those positions and movements are best used as first line rehab. Other areas further down the nerve can often limit nerve movement and have to be 'released'. 
Do you think that you or someone you know might be suffering with nerve root symptoms? The right diagnosis and management can really make a diffrence in getting through these problems. Please feel free to call or email to discuss what can be done. Pass this newsletter on to those you think might benefit from this information or my help
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