What is a nerve entrapment?
Nerve entrapment is a condition in which a peripheral nerve becomes trapped or ‘stuck’ between other structures of the body. This is not typically a serious condition, but it can become annoying, frustratingly chronic when undiagnosed and untreated.
From the Merriam-Webster Dictionary (2022):
📚 Entrapment, noun
(medical) chronic compression of a peripheral nerve (such as the median nerve) usually between ligamentous and bony surfaces that is marked by pain, numbness, tingling, or weakness.
The Nervous System: Central vs Peripheral
The human nervous system is very complex, consisting of a Central Nervous System and a Peripheral Nervous System. Within the peripheral system, there are hundreds of nerves that course throughout our body and carry information to and from the central system. While the central system consists of the brain and the spinal cord, think of peripheral nerves as being all the nerves in the body that live OUTSIDE of the spine.
It’s these peripheral nerves that course throughout our body and can become entrapped along the way.
Nerves need to move
Peripheral nerves must be able to slide and glide to allow for human movement. Consider the upper limb – every time you move your shoulder, elbow or wrist, there are numerous nerves that glide and slide amongst the muscles and connective tissues that move with the joints.
When you drop your forehead forward, like looking down at a mobile device – there are several nerves traversing the neck and upper back that must move with you!
When you bend forward to touch your toes, the sciatic nerve in each lower limb has to glide and slide to accommodate for the change in posture.
Along the various paths that a peripheral nerve has to travel, there are numerous twists, turns, tunnels and forks in the road that are potential entrapment sites. While the pathway for a nerve may not simple as it passes through our limbs, the human body is set up well to cater of these complex twists and turns. However as modern-day humans, we frequently challenge our bodies and perform repetitive tasks that can start to disrupt the beautiful architecture of a nerve pathway.
When a nerve becomes entrapped, there is a loss of mobility; the normal glide and slide is reduced because the nerve is physically stuck. Entrapment can also disrupt the normal blood supply of the nerve tissue, leading to further inflammation and symptoms.
What causes nerve entrapment?
Entrapment is typically caused through development of an adhesion, which will effectively “glue” a nerve to nearby muscle or connective tissue.
An adhesion is comprised of fibrous connective tissue which is developed due to stress and strain over time. It is like an internal scar tissue which the body lays down, most typically due to factors of repetitive overuse, strength imbalance or constant low-level overload.
This physical tethering of the nerve acts like a piece of blu-tack, limiting the normal glide and slide that would otherwise occur with human movement, causing the nerve to be stretched. At this point, you get symptoms.
👉 For more on Soft Tissue Adhesion, see this THIS ARTICLE
What are the symptoms of peripheral nerve entrapment?
There can be several different symptoms, many of which can become chronic. The most common that we see include:
⚠️ Tension/tightness
⚠️ Aching pain
⚠️ Burning
⚠️ Tingling
⚠️ Numbness
🔥 Chronic tension/tightness
Chronic tension/tightness is one of the most common symptoms of nerve entrapment. Frustratingly for patients, this symptom has often been clinically dismissed or simply explained as a tight muscle that needs stretching.
In most cases, a muscle is tight for good reason.
What often feels like a tight muscle, is actually a form of ‘protective tension’. This is due to the body recognising that the nerve tissue cannot glide and slide as it should, so therefore the surrounding muscles become tight to prevent damage to the nerve through excessive stretching.
The human body will protect nerve tissue by making muscles tight and preventing movement. Stretching, rolling, needling and massaging will usually not provide any sustained change. The body will always win this battle until the underlying serve entrapment has been addressed.
🔥 Chronic pain
Pain can also be a symptom of nerve entrapment, which does not always present as a typical nerve-like pain sensation. An entrapped peripheral nerve can often cause pain that does not always have an electric or burning quality that most folks typically associate with a nerve.
Pain from a nerve entrapment can be dull and aching. It can feel like a muscular trigger point, or knot that needs releasing. In other cases, nerve entrapment pain can be sharp and stabbing which is better or worse depending on different movements and postures.
Diagnosis – are your symptoms caused by an entrapped nerve?
Diagnosis of peripheral nerve entrapment can be reached clinically based on the following data points
✅ Symptom quality, location and intensity
The unique factors of your case can be very specific in identifying whether it’s likely that a nerve is involved.
✅ Aggravating and relieving factors
What are the positions/postures/activities that make things better or worse? Generally when the entrapment is physically loaded with tension, it will feel worse. When it is unloaded, it will feel better.
✅ Hands-on examination
Palpation of an entrapped nerve will often reproduce symptoms, or feel sore/tender due to inflammation at the entrapment site. We also use neurodynamic testing to tension nerve tissue which will often produce symptoms if there is an entrapment.
👉 Imaging (MRI/CT/X-ray)
Peripheral nerve entrapment is typically not reported via diagnostic imaging. CT and MRI have the ability to view nerve tissue, but most reporting focuses on spinal pathology, rather than involvement of peripheral nerves. It is not uncommon for patients to have been through several rounds of diagnostic imaging without any clear explanation for their symptoms.
If peripheral nerve entrapment is involved, then we can usually make that diagnosis clinically, without the need for any further imaging.
Common Nerve Entrapments
Some nerve entrapments are far more common than others. These are some of the MOST COMMON entrapments that we see.
🔱 Sciatic nerve
Hip/buttock/leg symptoms
Lower back pain
🔱 Cluneal nerves
Lower back pain
Glute pain/tension
🔱 Occipital nerves
Tension headaches, migraines
Head/neck pain
🔱 Cervical nerve roots
Neck tightness/tension
Shoulder/arm/elbow/hand symptoms
🔱 Dorsal scapula nerve, Accessory nerve
Upper back/neck tension
Shoulder blade pain
🔱 Brachial chords
Deep shoulder pain
Chest/shoulder tightness/tension
Shoulder/arm/elbow/hand symptoms
🔱 Median/Radial/Ulnar nerves
Arm/elbow/hand symptoms
Why do many treatments fail?
Diagnosis and treatment of peripheral nerve entrapment does not form a significant portion of the current tertiary education for allied health providers (Chiropractic, Physiotherapy, Osteopathy). Post-graduate training and ongoing development is required to learn this important skillset. Therefore, many providers may diagnose and treat based on the patient symptoms, without recognising the presence of an underlying nerve entrapment.
Many treatment approaches target the SYMPTOMS, but not the underlying cause.
If a muscle is tight, stretch it.
If a movement is weak, strengthen it.
If an activity hurts, stop doing the thing that hurts it.
If there is a ‘knot’, massage it, needle it, press on it.
A single nerve entrapment could account for all of the above.
🗝️ An accurate diagnosis is key to an appropriate treatment.
Many treatment approaches are focused on the symptoms, rather than the underlying cause. Symptoms can then become chronic and even get worse over time. What we see in many of these cases is that there is underlying nerve entrapment that is yet to be diagnosed and treated.
Final Thoughts
Peripheral nerve entrapment is a common problem. In our clinical experience, it is a frequent contributing factor in chronic musculoskeletal conditions that have so far been unresponsive to care. Assessment and diagnosis of nerve entrapment is a critical part of our clinical process because when left untreated, most interventions will not provide sustainable outcomes.
If you’ve had chronic pain or symptoms for several weeks or months, with little to no relief despite everything you’ve tried so far, please consider seeking out a provider with experience in assessment and treatment of nerve entrapments.
Dr. Christopher Aysom, Principal Clinician
BChiroSc, MChiro (Chiropractor)
Apex Soft Tissue & Spine
Pymble, NSW, Australia
https://apexsofttissue.com.au
