"We have nerve roots that leave the spinal column at every level, and they can become impinged and trapped. It's a very common source of pain," says Zachary McCormick, a Physical Medicine and Rehabilitation (PM&R) physician with the University of Utah Health Spine Services team. "And it's most often caused by either disk herniation or spinal stenosis."
"With a herniated or 'slipped' disk, a portion of the disk bulges out, usually entering the spinal canal or the channel where the nerve root exits, and then pinches one or more nerves," McCormick says. "Spinal stenosis, on the other hand, refers to any narrowing within the spinal canal where the nerves exist, but typically refers to narrowing caused by arthritis in the spine or other extra boney growths."
Other causes of a trapped nerve include spinal cysts that press on a nerve as well as slipping between two spinal segments—called spondylolisthesis. Both can cause narrowing where nerves exit the spine. Whatever the cause, the diagnosis is confirmed with imaging, typically an MRI scan, says McCormick.
Pain Disguised as a Pinched Sciatic Nerve
"People think of sciatica as pain that radiates from the lower back and down the posterior or lateral leg. That's true, but really, it's not the sciatic nerve that's impinged or compressed as the term would suggest," says McCormick. "It's actually one or more spinal nerve roots in the lumbar spine, distributing through the sciatic nerve."
How to Get Rid of a Pinched Nerve
"Commonly, people come in with a story about moving a couch, holding something heaving out in front of their body, or a bending/twisting movement" says McCormick. "They might be loading their lower back with the weight, rather than lifting with their knees in a spine-neutral posture, and that can cause disk herniation." Treatment usually starts with physical therapy and activity modifications.
"We do a positional assessment to find what movements might reduce an individual's pain symptoms. A physical therapy program is built based on those positional preferences, to try to reduce pinched nerve symptoms." McCormick says anti-inflammatories are also used, depending on other medical conditions present and what's safe for an individual to take. "Plus, medicine to stabilize nerve membranes, reducing nerve pain signaling."
Other U of U Health pinched nerve treatments include:
- Epidural Cortisone Injections
- Minimally-invasive Spinal Decompression
- Surgical Spinal Decompression
- Spinal Fusion
"If conservative treatments aren't working, or if there's a neurologic change and developing weakness pointing to nerve damage, surgery may be necessary," says McCormick. On the plus side, U of U Health Spine Services offers minimally invasive endoscopic spine surgery, with an estimated 80 to 90 percent success rate.
Pinched Nerve in Back Treatment at Home
"For disk herniation, there are positions that reduce stress and load on bulging or herniated disks that can change the amount of pressure placed on the nerve, letting it heal" says McCormick. These may include:
- Lying flat on your belly, and pressing up to lift your chest off the floor
"This might not work for everyone, but such lumbar spinal extension-based positions can often be very helpful."
For a pinched nerve related to spinal stenosis, McCormick suggests:
- Motions or positions that bring the knees toward your chest
"That dynamic opens the central spinal canal giving the nerves more space," says McCormick. "Adequate rest, gentle movements, and over-the-counter pain relievers can also help."
McCormick notes at-home treatment isn't an option for Cauda Equina syndrome. "It's typically caused by a very large upper lumbar disk herniation, compressing multiple nerve roots such that one has significant leg and/or foot weakness, numbness in the saddle region, and potentially bowel and bladder incontinence. Lack of medical treatment can lead to permanent symptoms."
Preventing a Pinched Nerve in Your Back
Are you reading this while sitting slouched at a desk? Sit up straight to protect yourself! "Good posture, smart lifting, and keeping a strong core all help reduce the chances of developing a pinched nerve," says McCormick. "If you sit for prolonged periods, get lumbar support, and maintain your head over your shoulders while keeping your shoulders back, reducing disk load."
McCormick says it's also important to take breaks. "Get up and walk around, even just five minutes every hour or two. It can make a world of difference."