The spine is made up of 32 vertebrae, each one articulating with the one above and the one below. The Cervical, Thoracic, Lumbar and Sacral vertebrae all have slightly different angulations of attachment to their above and below vertebrae according to their functional level in the spine. Between each cylindrical shaped vertebral bone is a disc, which acts as a hydraulic absorber of compression down the spine. The disc absorbs shock just like your car suspension, to protect the nerve roots which emerge from gaps between each vertebra. These gaps are called intervertebral foramina. The foramina are mightily under strain with our activities of daily life and are susceptible to arthritic forms of wear and tear which may be related to occupations requiring heavy lifting such as a builder, engineer or extreme sportsman.
Under heavy loading, the outer edges of the foramen gap may start to produce “osteophytes” which are bony spurs and can grow enough length to impinge upon the sensitive nerve root exiting from the spine between the vertebrae.
Another cause of nerve root irritation is the notorious “slipped disc”.
A vertebral disc has a fibrous outer layer surrounding a gelatinous interior. The disc not only absorbs shock, but it also acts as a pivot between each vertebra. The disc does have a limit of strain it can take before the outer layer splits, allowing the jelly-like interior to ooze into the space reserved for the nerve root. The cause of this may not necessarily be long term wear and tear and could also be from a heavy lift or continued compression such as motor-cross, horse riding, jet-skiing, or a fall.
When a Patient exhibits signs of nerve root irritation it is very helpful to see an X ray, although X rays cannot show us ligament or disc damage, they do show the posture of the spine, osteophyte formation and arthritic or loading wear and tear. Although we cannot see the discs themselves, any narrowing of the gap between each vertebra gives the Physio a good idea as to which nerve root we are dealing with.
Hopefully an X Ray will be sufficient for physiotherapy treatment to continue however if there exists sensory, muscular, or reflex deficiency, then the Patient will be referred for a Magnetic Resonance Scan.
Nerve root irritation tends to occur in the neck (cervical spine) and lower back (lumbar spine). Cervical nerve root impingement causes symptoms in the shoulder, shoulder blade arm or hand, while the lumbar spine gives rise to symptoms in the buttocks, legs and feet.
Symptoms include pain, numbness and tingling. In more severe cases there will be loss of function, muscle weakness and occasionally paralysis.
The distribution of the pain indicates the vertebral level of the nerve impingement. This is known as the dermatome. The symptoms may only be felt in the dermatome as although nerve root irritation originates in the spine there may not necessarily be any back pain.
Accurate diagnosis for Nerve Root Irritation will cover many medical departments. Radiology for X Ray and/or MRI, Orthopaedic and Neurology consultations and ultimately Physiotherapy for hopefully a non-surgical resolution.
By Tracey Evans
The Physiotherapy Centre
C/ Joan de Saridakis, 1
07015, Palma de Mallorca
Tel: 971 405769 609353805