Neurogenic pain

Nervous system basics

The nervous system is an electrical system that carries information and messages throughout the body.  It can be grouped into two very broad categories:

Central nervous system (CNS): Brain and spinal cord

Peripheral nervous system (PNS): Branches from the spinal cord to the limbs and internal organs.

The brain is the computer, the body is the machine.  All information is sent from the CNS out to the PNS, and in turn the PNS feeds back information to the CNS about what’s happening at the periphery (i.e stepping on a nail = danger signal)

Symptoms of the nervous system

  • Numbness/tingling
  • Burning, sharp pain
  • Reduced strength
  • Loss of balance/coordination
  • Headache
  • Visual disturbances (blurriness, eye fatigue)
  • Poor reflexes
  • Severe pain

Common injuries

Neuropathic pain differs to neurogenic pain as it is the direct disease or damage of a nervous system structure (such as the thalamus in stroke victims).
Neurogenic pain is more common and much more treatable by an Osteopathic Practitioner.

Osteopathic Practitioners treat a range of neurogenic pain syndromes such as:

  • Nerve root compression (fig.1)
    • Pain radiates from the spine into the limbs
  • Neuropraxia
    • Blunt force injury – hockey stick to forearm causing pain/loss of sensation
  • Peripheral weakness
    • Information from the brain to the periphery isn’t being conducted adequately – generally unaccompanied by pain
  • Headaches
    • Many sources but often related to compression of nerves under the base of the skull or a source within the brain (such as the eyes)
  • Digestive issues
    • Broad diagnoses of IBS or other digestive “syndromes” that have varied symptoms without any evidence of pathology (such as a stomach ulcer) can often be attributed to a range of nervous system dysfunctions that reduce the function of the parasympathetic nervous system responsible for digestion.

Fig.1

Illustration of compression of the spinal cord by a herniated disk that will commonly cause pain to travel down the leg.

Treatment and recovery

The nervous system is incredibly complex and is still not fully understood. Testing the reflexes, muscle strength and ocular function are useful and reliable tools in identifying underlying problems that are directly related to pain production.

Conservative treatment including both osteopathy and physiotherapy can reduce symptoms (4-6 weeks) and improve function (6-12 weeks) through both manual treatment and rehabilitation programs that educate and train the sufferer to avoid future injury or relapse.

Is this a serious condition?

Treatment of the underlying cause of pain is paramount and must be assessed for severity.  Often a low-grade injury can cause severe pain if affecting the nerves.  Further investigation such as imaging (x-ray, MRI) may be warranted depending on examination findings.

Long term compression or untreated nerve damage may result in permanent loss of function and extended periods of pain.

Management

  • Initial Phase (weeks 1-4)
    • Reduce inflammation and pain. Anti-inflammatory medication may be advised.
    • Treating pain generating structure (such as a disk bulge)
  • Intermediate phase (weeks 4-6)
    • Once pain has subsided, increase load bearing and exercises as tolerated
  • Advanced phase (weeks 6-12)
    • Return to full capacity exercise, challenging injured structure (with physiotherapist monitoring)

 

 

Thoracic spine: The root of all evil

The Spine

The spine is comprised of 33 vertebrae: 7 cervical vertebrae (your neck), 12 thoracic vertebrae (your mid-back), 5 lumbar vertebrae (your low back), 5 fused sacral vertebrae and 4 fused coccygeal vertebrae.  The spine consists of natural curvature throughout its length, and the structure of the vertebrae help to contribute to natural movements of the spine.  These include flexion (bending forward), extension (bending backward), side flexion (bending to both sides) and rotation (turning to both sides).  Joints between each vertebral segment should contribute to these movements to effectively move the spine and contribute to movements of the pelvis and limbs as well.

The 21st century necessitates that we spend most of our time in excessive thoracic flexion or bending forward.  Think how much time you spend sitting at a desk, at your computer, commuting, driving, texting, watching Netflix (who doesn’t love Stranger Things??), compared to how much time you spend moving your spine.  There is likely a huge imbalance!  This is NOT to say that bending forward is bad inherently, but repetitively prolonged forward flexion of the thoracic spine can and will result in structural adaptations over time.

Limitations in thoracic mobility can limit many things:

Shoulder movement: try excessively bending your upper back forward as if you have terrible posture, and then raising your arms all the way overhead. Now try the same movement with your back straightened upright.  Feel the difference?  Imagine what a difference this can make in overhead work, serving in tennis or volleyball, throwing a ball, and many more!

Neck movement: excessive rounding or forward flexion of the thoracic spine commonly contributes to forward head posture and the multitude of dysfunctional issues that come along with this like headaches.

Squat: excessive rounding or forward flexion of the thoracic spine can limit movement of the lumbar spine, hips, and pelvis, which can affect squat technique and depth.  This, in turn, can limit the amount of weight you are able to safely squat.

Breathing: your lungs lie within your ribcage, which attaches to the vertebrae in the thoracic spine.  Excessive thoracic flexion can limit the depth to which lungs can be filled with air when taking a deep breath.

Many more!  Limitations in thoracic movement can lead to many more dysfunctional issues throughout the body, which can be discussed with your healthcare provider at Ace Sports Clinic!

What should we do?

The short answer is move!  Schedule yourself short breaks throughout the day to move your spine and body into different positions than sitting in thoracic forward flexion all day.  More specifically, here are a few mobility exercises you can include daily for thoracic spine mobility:

  1. Cat and Cow: a useful mobility drill for moving between spinal flexion and extension. Allow yourself to feel each vertebrae contributing to the movement, rather than the entire spine moving as a block.
  1. Quadruped Thoracic Rotation:
    in quadruped position, movement must come from the spine rather than the hips or pelvis. With one hand behind your head, rotate through your spine to bring your elbow across your chest, and then up towards the ceiling; repeat on both sides several times.
  1. Hang! Not only does hanging result in thoracic extension (slight bend backwards in mid-back), gravity also causes a traction force on the spine, which helps to create a bit of space between your vertebrae. You can hang from a pull up bar, tree branch, door frame, or monkey bars at the park for 10 seconds.  Ever see an orang-utan with back pain?

For further information about thoracic spine, and spinal mobility, speak to your healthcare provider.

Author: Hilary Mallinger, Registered Physiotherapist & Acupuncture Provider – Ace Sports Clinic, Toronto

Picture sources:

  1. source: http://www.firstaidforfree.com/first-aid-for-spinal-neck-and-back-injuries/
  2. source: http://www.bodiempowerment.com/neck-stiffnes/
  3. source: https://www.popsugar.com/fitness/Back-Workout-Routine-31023713
  4. source: https://redefiningstrength.com/quadruped-thoracic-rotation/
  5. source: https://blog.paleohacks.com/pull-up/#
  6. source: http://www.dive-the-world.com/creatures-orang-utans.php#prettyPhoto