The difference between a dream and reality is a sharp pinch away, right? There is nothing fun about tightly gripping and squeezing your skin, so much less funny to pinch a nerve. A pinched nerve in your lower back is pure agony. Nerve pain is like the worst toothache, the intensity and the way it debilitates you. Lower back nerve pain is unbearable, sharp, stabbing pain that’s like torture.
Our professionals can release the nerve and ease the pain, but first we must know which structure is compressing and irritating the nerve in your back.
What are the nerves in my back?
Your nerves function like power cables. Your nerves run from the main power supply (the brain) all the way to the tips of your toes. Like power cables, our nerves are also enclosed within a sheath, the myelin sheath. The myelin sheath protects the nerve, like the plastic around a power cable. It also enhances the speed at which messages are carried. Think broadband versus fiber. Our nerves also glide within the myelin sheath that surrounds it. This gliding ability support fluid, pain free movement.
These power cables are responsible for two way communication from the brain to the tips of the toes. The brain sends instructions to the nerves to move the muscles to walk and balance. The nerves sends information to the brain about sensation (touch, temperature, pressure, position and nociception or pain).
We have to main nerves that supply the leg. The femoral nerve is formed by nerve roots L2-4 of the lumbar spine. It services the are on the front of the thigh for sensation and power, like the quadriceps muscle contraction when kicking a ball. The sciatic nerve is formed by nerve roots L4-S3. It services the back of the thigh.
What do the nerves in my back do?
The nervous system is an intricate network that allows information to travel through your body, from the brain to the toes and from the toes back to the brain. Sensory information, of how soft the fabric is you just touched, and information regarding the position of your back (proprioception) is continuously carried through your nerves.
Your nerves also enable your brain to send messages to your muscles to move your joints. Information of which muscle to contract when is delivered to your feet when you walk or run. Damage or injury to the nerves can lead to an interruption of this communication system, with painful and debilitating consequences.
How does a pinched nerve in my back happen?
Pinched nerves in your lower back can be divided into two categories.
Nerve root irritation because of an overstretch injury (neuropraxia). When the myelin sheath is damaged, but the nerve inside is intact, the nerve may become irritated because of direct pressure and an inability to glide within the sheath, because of inflammation. This may cause a temporary interruption of the nerve impulses, leading to abnormal signals firing from the nerve. These impulses comes & goes, dependent on a specific position or movement. This usually happens when the entire nerve is pulled. Think slipping in the bath or tripping while over stretching your hamstrings.
Inflammation can accumulate around the nerve due to this type of injury or another injury to the disc or facet joint. This is a close knit space, so anything extra in the area will occupy more space around the nerve.
Nerve root compression happens if there’s pressure on the area for a long time, usually, by another structure very close to the nerve, the main culprit is a disc bulge. The entire nerve is intact, but the pressure at that point causes the signal to be diminished or lost. This can lead to numbness and an inability to move your arm. Long term compression may compromise the circulation to the nerve, which can lead to permanent nerve damage in your lower back.
Just like your heart muscle supplies blood to itself, your nerves have to know and get messages when they themselves are endangered. Because the nerves have such important functions, nerves are very sensitive to self reported messages. That’s why it hurts so much.
Causes of lower back nerve pain
- Disc bulge/herniation/sequestration
The disc tissue takes up space and puts mechanical pressure on the nerve.
- Spondylosis
Normal changes due to aging cause osteophyte, a bony, harmless protrudence on the bone. This can put pressure on the nerve.
Instability due to lamina fracture causes one vertebra to glide on top of the other leading to narrowing of the canal where the nerve exits.
- Trauma, accident, fracture
Fragments of a broken bone can put pressure on nerve roots.
Pressure is placed on the sciatic nerve from the discs or piriformis muscle.
- Overuse/stretch/muscle strain/tear
Excessive exercise or new exercise can cause a strain or tear of the muscle. The resulting inflammation can place pressure on the nerve.
Overdoing backbends or back workouts can injure the facet joints. Inflammation of the joints can pressurize the nerve.
Curvatures of the spine can take up space that the nerve needs.
- Poor posture and unsymmetrical movements, like golf swing, tennis serve
This leads to muscle imbalance or weakness that can cause pressure on a nerve.
I think I have a pinched nerve in my lower back, but how bad is it really?
Even though nerve pain is excruciating because the nerve is so sensitive to nociception or pain impulses it may feel worse than it actually is. Tingling in both arms or legs or the same arm and leg, change in bladder and/or bowel control or saddle anesthesia are signs of cauda equina syndrome and should be attended to immediately. After your neurological evaluation is done by one of our skilled physios, we will know if you need to be referred. Worsening loss of sensation and power is the first sign of deteriorating nerve function. In all earnest, a nerve sending signals, even if it is pain signals, is still working and can be treated.
Symptoms that fluctuate in intensity, are movement dependent, and allows you to sleep are treatable with physiotherapy. We will find the structure responsible for your lower back pinched nerve and treat it accordingly. We are skilled at treating muscles, joints and the nerve itself.
Diagnosis of your back nerve pain
Our Physiotherapists can determine the cause of your pinched lower back nerve. Physiotherapists are skilled to link your current symptoms with movement patterns required by your job, hobbies and exercise habits, we’ll even want to know the position you sleep in. After a detailed history of your present and past symptoms, we already have a hypothesis by the time we start your physical examination. During this assessment, we’ll find the structure in your lower back that is pinching your nerve and causing pain.
Why is my pinched lower back nerve pain not going away?
Because you haven’t addressed the root cause of your nerve lower back pain. Different things may give you symptom relief at different times of your recovery, but you need to address the cause of your pinched lower back nerve. Nerve pain takes infamously longer to heal than other soft tissue structures in the body, especially if you have had the symptoms for longer than a month.
If you only get your nerve pain when you do a specific movement, we can dissect the movement and establish which structures are giving you pain. This happens often for tall people bending over when brushing their teeth. If we establish it’s the pelvic tilt causing your symptoms we can change how you move, by engaging lazy muscle to prevent a faulty movement pattern.
Ultimately you may need to change movement patterns and positions if your pain keeps returning. It may be as simple as moving your computer screen, raising your desk or adjusting the car seat, or your may need to strengthen weak muscles.
A big problem we see with pinched lower back nerve pain
Misdiagnosis of the cause of your pinched lower back nerve. Any sharp pain gets blamed on nerves, unfortunately. Although many other structures can give you the same sensation, like muscle or joints. It is important to get the right diagnosis so that you can commit to your rehabilitation for as long as needed.
Long term use of back braces. This will actually cause laziness of your muscles and prolong your healing. A leg that has not walked for six weeks because of using crutches feels unsteady and weak when you can walk on it again. So will your back!
“My back is out”. Being “out of alignment” is not a diagnosis. How many things do you do a day perfectly symmetrical? Your body was made to move, your back is strong enough to bend. We will guide you on your recovery.
Easy and quick fixes, like most things in life, if it sounds too good to be true it probably is. There is no magic cure for pinched lower back nerve pain that you have had and neglected for months.
Physiotherapy for a pinched nerve in lower back
With our unique skill set, we can determine the cause of your lower back nerve pain. Once this is established your journey to recovery can finally start. We will guide you every step of the way, through each phase of healing for the pinched nerve in your lower back.
Phases of rehabilitation for your pinched lower back pain nerve
For explanation purposes the phases of healing are distinguished, but in reality, your recovery journey may be caught between phases, having characteristics of one, while we are actively working on the next. Don’t worry, everybody is unique and will heal at a different pace. Patience is very important when dealing with pinched nerve lower back pain.
1st Phase: Protection and initial healing
Protect
The main aim is to prevent further inflammation and pain. Offload your back and leg by using crutches or a brace for the first few days. Strapping can do the same, by limiting certain movements but allowing other beneficial movements. It is important to know what to do and what to avoid.
Information
Make sure that you get information from the person that is treating you. Its important to understand what you should and shouldn’t do. You can make better decisions if you are informed. Your body knows best, so avoid too many types of treatments at once.
Load
Let pain guide you to have an “active recovery”. Respect your pain, but do not be a slave to it. Find the balance between movement and rest that your body needs.
2nd Phase: Establish safe movement boundaries
During your examination, it will become clear what you are able to do, and what you should avoid. We identify factors that contribute to your pain. When doing a movement, like bending to pick up something from the floor you will be able to move to a certain point, before your pain starts. This is your pain-free range of movement. You are safe to move within this range and your exercises will be targeted between these boundaries, strapping is a great way to remind you of these boundaries. We aim to increase your pain free range as you progress through your pinched lower back nerve treatment progresses.
3d Phase: Neural mobility
We monitor the healing of your pinched lower back nerve. Nerves are finicky and may make you pay for moving too quickly or too far. We use nerve mobilisations, sciatic nerve flossing, to decrease nerve sensitivity, make it accustomed to the movement and increase circulation to the tissue. As healing takes place, we want to see not only improvement of your pain, but also improvement in the lower back nerve’s ability to allow movement.
4th Phase: Resolve muscle guarding and improve strength
Muscle spasm and stiffness is your body’s protective mechanism when you have a pinched lower back nerve. As the nerve heals during your pinched lower back nerve treatment, we can release the muscle with deep dry needling and massage. Now that the nerve allows the muscle to move freely active strengthening will toughen up the muscle to protect the nerve in the future. You can expect some homework and exercises during this phase of your treatment.
5th Phase: Regain full active range of motion
As the nerve heals, allows fluid movement and with your new found muscle strength and endurance we can get you to move and exercise through full range of movement. You will be able to bend forward, squat down and put on shoes and socks on completion of this phase of your pinched lower back nerve treatment.
6th Phase: Return to activity
A big part of your recovery is to gradually return to your routine again. This way, we can determine if you are ready to return to fully working and training without any flare-ups of your pinched lower back nerve. Your physiotherapist will guide you to re-engage in safe increments, and make adjustments where necessary.
Healing time for pinched nerve in lower back
Everyone’s case is unique and time plays a big role. How long you’ve had your symptoms is a good measure, recovery is double the time you’ve started feeling the pain. The quicker you seek treatment, the quicker your recovery will be. If addressed immediately you can expect eight weeks to a full recovery if you follow the home exercises and adjustments to driving, working and exercise habits.
Other medical options for pinched lower back nerve treatment
Your GP may prescribe medication to relieve your symptoms. This can be a great adjunct to physiotherapy treatment for your pinched lower back nerve, but cannot replace addressing the cause of your symptoms. Please use oral medication responsibly as prescribed because of side effects that may occur.
Infiltration is an option your orthopedic surgeon may suggest to administer a direct dose of medication to the joint and muscles.
Sports massage and stretch therapy are beneficial once the cause of your pinched lower back nerve has been identified and addressed. Be wary of treatments that promise immediate and drastic improvements. The nerve is structurally very sensitive to lengthening once irritated and may produce delayed onset of symptoms when overly stretched.
Chiropractic manipulation offers short term pain relief because of muscle relaxation post intervention. Make sure you know how and what to do at home to prevent symptom recurrence.
Wearing a brace will prevent movement of the lumbar segments. It is a great option for short term relief, but should not be worn longer than a week. With the right treatment, you should be more comfortable to move then and can wear your brace only when at work.
Topical treatments, like Voltaren, Moove, and Iceman, are beneficial for short term relief. The active ingredients only penetrate about 1 cm, but can improve circulation and give you relief for a short time.
Yoga & Pilates are great options to get you moving once your therapists give you the clear. It is also a great way to prevent pinced nerves in the future because both exercise forms emphasize breathing, core strength and better posture.
Surgery for a pinched nerve in lower back
Your orthopaedic surgeon will order an MRI to get a clear image of the soft tissue structures that are causing your lower back nerve pain. Depending on the severity and nerve health your doctor may give you the following options:
Discectomy
This keyhole procedure cuts away the disc tissue that is causing the compression and your lower back nerve pain.
Laminectomy
A certain part of the vertebrae is removed to relieve the pressure off the pinched nerve in your lower back.
Fusion
A lumbar fusion is performed where the bones are connected to one another with metal rods. This relieves the pressure of your pinched lower back nerve but ultimately limits your movement.
Your aftercare is very important. Rehabilitation starts while you are still in hospital and continues for up to three months to a year post surgery. You may be required to keep your back straight for the first six weeks after surgery, which means either standing, walking or lying down. The use of a hard or soft brace may be required during this time. You will not be able to travel or drive yourself. Specific exercises to strengthen the muscles are of vital importance during this time.
Rhizotomy
This surgical procedure is done in a theatre where the sensory nerve roots are severed to relieve the pain. Motor function and movement are kept intact.
Pinched lower back nerve is also known as:
- Sciatica
- Lower back nerve pain
- Pinched lower back nerve treatment
What else could the pinched nerve in my lower back be?
Muscle strain or spasm, after new or repetitive movements, may feel sharp and also cause numbness and pin and needles. We can determine if your pain is due to a pinched nerve in your lower back or a muscle strain with specific tests.
Nerve pain caused by pressure on the sciatic nerve by the piriformis muscle is felt more in the hip and leg. Turning toward the affected leg will aggravate symptoms.
- Disc bulge, prolapse or sequestration
A pinched nerve in your lower back caused by disc pathology is commonly more sore down the leg than in the area of compression itself. This is due to the extreme sensitivity of the nerve.
Repetitive or prolonged time spent in extension, like painting or hanging curtains, can cause inflammation of the joints in your lower back. This is commonly sorer when you bend backwards or turn sideways.
Refers to the normal, age-related changes your back goes through with time. Inflammation may cause morning stiffness that generally eases throughout the day.
Repetitive forces or a single traumatic event may cause a fracture and lead to instability of your spine. Your back may feel unstable and you may struggle to return to standing from a bent position.
