My Numbness and Tingling Continue, but My Testing Does Not Show Anything!
Post by Brian Yee, PT, MPhty, OCS, FAAOMPT
Many times we get patients in our clinic who experience ongoing or unresolved nerve symptoms. This can include things such as tingling, numbness, a pinched nerve in the neck, herniated disc, or burning pain that they know is coming from a nerve condition, such as sciatica. The patient may go through exhaustive testing by MRI, which rules out significant involvement from a herniated disc. Or they could participate in an EMG or Nerve Conduction Study which shows the nerve is conducting fine. And yet, the patient still has nerve-like symptoms.
This results in the health practitioner sending the patient to physical therapy to try something like traction, whick does not help long term either.
So what else could the nerve symptoms be from?
Well, two main things:
1. Nerves can be compressed, stretched, and injured just like any other connective tissue in your body. For example, when a person has a sprained ankle it swells and as it settles, the ankle can become stiffer and lose its mobility. Nerves undergo the same problems after they become injured. They may still conduct, as shown with non-problematic nerve conduction tests, but when the nerve loses mobility and stays irritable from repetitive injury, the nerve can continue to be irritated. This results in ongoing symptoms that the patient experiences, even though all medical diagnostic testing is negative.
2. There is a diagnostic way of visualizing nerve dysfunction, not by conduction or directly by a static MRI at the spine level, but just as importantly through real-time dynamic ultrasound imaging of the peripheral nerve as it courses away from the spine and down the arm and leg. There are many areas in the body that a nerve can become entrapped, compressed, or injured- not just at the spine. This is shown in this link by one of my mentors, Michael Shacklock, whom I teach for with Neurodynamic Solutions from Australia.
Michael shows how ultrasound imaging reveals how muscles like the serratus anterior can cause nerve compression of the brachial plexus. What this means is that if a person has abnormal muscle imbalances, it can place increased stress to the nervous system, and possibly lead to injury and symptoms.
Right now, specialized physical therapists who understand the dynamics of how nerves work throughout the body may determine that a patient’s ongoing nerve symptoms are not just from a herniated disc, but may be a manifestation of an overall dynamic problem in how your body moves and functions.
If you know someone who has ongoing nerve problems, and it not getting proper diagnosis and treatment, we recommend you find a physical therapist that can understand how nerves relate to overall functional movement. Please let us know if we can assist.