Neural Compression Tension Syndromes
Neural compression-tension syndromes (NCTS) include conditions such as sciatica, thoracic outlet syndrome (TOS), and carpal tunnel syndrome (CTS) in which tight fascia and/or muscle spasms cause peripheral nerves to be compressed or pulled taut.
The piriformis muscle is frequently tight in cases of sciatica, leading to compression of the sciatic nerve directly underneath it (refer to figure A). Thoracic outlet syndrome (TOS), on the other hand, involves the irritation of the brachial nerve plexus and/or subclavian artery as they traverse the area between the middle and anterior scalene muscles, in the region between the clavicle and ribs (subclavian muscle tension), or underneath the pectoralis minor (refer to figure B). Carpal tunnel syndrome (CTS), on the other hand, is mostly caused by tension and spasms in the flexor muscles of the fingers, as well as inflammation or restriction in the flexor retinaculum and transverse carpal ligament.
Common signs and symptoms of NCTS include numbness or tingling, muscle weakness, decreased coordination, chronic aching, and shooting pain down the affected limb. Manual therapy can be helpful in relieving the pain and dysfunction associated with NCTS. However, the therapist must recognize which structures are creating the compression-tension of the peripheral nerve and be sure to rule out more severe neurologic causes such as spinal stenosis or disc damage.
As a neuromuscular therapist, my main goal is to help alleviate my clients' sciatic nerve pain. To do so effectively, I first look for two potential causes of the pain: irritation coming from the patient's disk or their piriformis muscle (shown in the photo below).
The sciatic nerve can become compressed or irritated as it travels from the lower back down to the legs, causing significant discomfort and pain for the patient. Determining the root cause of the irritation is crucial in developing an effective treatment plan.
If the root cause of the pain is determined to be a herniated or bulging disk in the patient's spine, then specific massage techniques can help to decompress and reduce the pressure on the affected area. The goal is to alleviate the symptoms and reduce the tension while helping the patient improve their spinal alignment and overall posture.
On the other hand, if the irritation of the sciatic nerve is caused by the piriformis muscle, a variety of techniques can be used to reduce tightness and tension in the muscle. These techniques help to prevent the muscle from compressing the sciatic nerve and help restore normal mobility and function.
Signs and Symptoms
-
Local and radicular pain: pain that radiates along the dermatome of the affected nerve root. Pain is often described as shooting, burning, or electrical. When pain originates form a lumbar disc injury, it may cause pain through the buttock and down the back of the leg: this is often called sciatica, although other professionals use that term to mean irritation of the sciatic nerve elsewhere than at the spinal roots.
-
Sciatica: Irritation of the sciatic nerve. Often causes pain that radiates down the leg through the glutes.
Specific muscle weakness: weakness or even atrophy in the muscles that are affected by irritated nerves. (This is different from general muscle weakness that can arise from overall deconditioning.)
Paresthesia: "pins and needles" in the affected dermatome.
Reduced sensation: (This can also be a sign of ligament damage instead of or in addition to disc damage.)
Numbness: Total numbness is one distinguishing factor between disc problems and ligament injuries.
Treatment
The primary objective in treating disc disease is to alleviate the pressure on nerve roots. To achieve this, chiropractors and osteopaths focus on correcting bony alignment and creating optimal space for the nucleus pulposus to return to its normal boundaries. In the short term, patients may be advised to undergo bed rest or traction to facilitate healing. Traction is typically done by a manual therapist, who manipulates the body in a way to create space between joints, in this case the spine. Following this, movement within reasonable limits is encouraged. Physical therapy is also recommended, along with education on maintaining correct posture and body mechanics to aid in the recovery from disc problems
The treatment for piriformis syndrome aims to alleviate the pressure on the sciatic nerve, which is often caused by the piriformis muscle compressing the nerve. The piriformis muscle is located deep within the buttocks and can become tight or inflamed due to various factors, such as overuse, injury, or poor posture.
To achieve the primary goal of relaxing the piriformis muscle, various treatment methods can be employed by a massage therapist including stretching, deep tissue therapy, massage gun, and hot stones. Other forms of treatment include physical therapy and chiropractic care. The use of pain-relieving medication or corticosteroid injections may also be recommended to help manage the pain and inflammation associated with piriformis syndrome.
Besides relaxing the piriformis muscle, other measures that can help manage piriformis syndrome include rest, ice or heat therapy, postural correction, and ergonomic adjustments. Surgery may be considered in more severe cases, but it is usually reserved for cases that do not respond to conservative treatments.
Thoracic Outlet Compression Syndrome (TOCS) is caused by compression of the nerves, arteries, or veins that supply the arms and hands as they pass through narrow spaces called the thoracic outlet. There are 3 main areas of concern. The first is the space is located between the rib cage and collarbone, the second is between the anterior and medial scalene muscles of the neck and the third is between the pectoralis minor and the scapula.
The compression of the thoracic outlet can be caused by various factors, such as injury, trauma, congenital abnormalities, and chronic poor posture. When blood vessels and/or nerves are compressed, the patient may experience numbness, tingling, pain, or weakness in their arms or hands. In severe cases, the circulation to the affected area may be disrupted, leading to more serious complications.
The symptoms of TOCS can vary depending on the nerves, arteries, or veins affected, but commonly include pain, numbness, weakness, or a tingling sensation in the affected arm or hand. The patient may also experience a cold feeling in their hands, difficulty with coordination, and swelling or discoloration.
Treatment options for TOCS are dependent on the severity and underlying cause of the condition. Conservative treatment options include physical therapy and postural correction measures, including stretching exercises and ergonomic adjustments. In some cases, surgery may be necessary to relieve the compression of blood vessels or nerves.
Symptoms
There are three types of thoracic outlet syndrome:
-
Neurogenic thoracic outlet syndrome. This is the most common type of thoracic outlet syndrome. In this type, a group of nerves called the brachial plexus is compressed. The nerves of the brachial plexus come from the spinal cord. The nerves control muscle movements and feeling in the shoulder, arm and hand.
-
Venous thoracic outlet syndrome. This type of thoracic outlet syndrome occurs when one or more of the veins under the collarbone are compressed and damaged. This can result in blood clots.
-
Arterial thoracic outlet syndrome. This is the least common type of TOS. It occurs when one of the arteries under the collarbone is compressed. The compression may cause injury to the artery resulting in a bulge, known as an aneurysm, or blood clot formation.
Thoracic outlet syndrome symptoms can vary depending on the type. When nerves are compressed, symptoms of neurogenic thoracic outlet syndrome include:
-
Numbness or tingling in the arm or fingers.
-
Pain or aches in the neck, shoulder, arm or hand.
-
Arm fatigue with activity.
-
A weakening grip.
Symptoms of venous thoracic outlet syndrome can include:
-
A change in the color of the hand or one or more fingers.
-
Hand or arm pain and swelling.
Symptoms of arterial thoracic outlet syndrome can include:
-
A pulsating lump near the collarbone.
-
Cold fingers, hands, or arms.
-
Hand and arm pain.
-
A change in color in one or more of the fingers or the entire hand.
-
Weak or no pulse in the affected arm.
Treatment
The treatment for thoracic outlet compression syndrome revolves around relieving the pressure on the nerves, veins, and arteries that pass through the thoracic outlet. This can be achieved through a combination of non-surgical and surgical approaches, depending on the severity and underlying cause of the condition.
Conservative treatment options for thoracic outlet compression syndrome include physical therapy, chiropractic care, massage therapy, and postural correction. These approaches aim to improve the mobility and strength of the muscles and surrounding tissues, reduce inflammation, and alleviate pain associated with the condition.
Other conservative measures may include:
- Rest
- Ice or heat therapy
- Medications to manage pain and inflammation
- Ergonomic adjustments
- Lifestyle modifications to alleviate pressure on the thoracic outlet
- Avoidance of aggravating activities or positions
Carpal Tunnel Syndrome is a painful and progressive condition that occurs when a nerve (median nerve) in the wrist is compressed or squeezed. The carpal tunnel is a narrow passageway in the wrist that protects the median nerve, which provides sensation to the fingers and thumb, as well as movement to some muscles in the hand. When the median nerve gets compressed or squeezed, it can lead to numbness, tingling, weakness or pain in the hand and wrist, which can radiate up to the forearm and arm. Carpal Tunnel Syndrome is commonly caused by excessive use of the hand and wrist, leading to swelling and inflammation of the tendons and ligaments in the carpal tunnel. It can also occur due to medical conditions such as obesity, diabetes, pregnancy, arthritis, and thyroid dysfunction. Timely medical intervention can alleviate the symptoms and prevent further damage to the hand and wrist.
Symptoms
Carpal Tunnel Syndrome can cause a range of symptoms that can affect the hand, wrist, and forearm. The symptoms of carpal tunnel syndrome usually develop gradually over time and may include:
1. Numbness, tingling, or burning sensations in the thumb, index, middle, and ring fingers.
2. Radiating pain or discomfort from the hand that may gradually extend to the forearm and arm.
3. Weakness in the hand that makes it difficult to grasp or hold objects.
4. A feeling of swelling or a sensation that the fingers are swollen (even though they may not appear so).
5. Pain in the wrist or hand that can worsen at night and may disrupt sleep.
6. Shocks or electric-like sensations that can travel up the arm.
7. Clumsiness or a tendency to drop things.
If you are experiencing any of the above symptoms, then it is advisable to consult a physician or healthcare practitioner. They may advise you to undergo diagnostic tests such as nerve conduction studies or electromyography to confirm the diagnosis and determine the severity of the condition.
Treatment
Massage therapy can be a useful complementary treatment for carpal tunnel syndrome, that can accompany other medical or physical therapies. Here are some of the treatments massage therapist can use:
1. Myofascial Release: Myofascial release involves gentle pressure, stretches, and sustained pressure application to the soft tissue to release the tension and adhesions. It can help in reducing the compression of the median nerve in the wrist area.
2. Trigger Point Therapy: Trigger point therapy involves applying pressure on the specific areas of tension or knots in the muscles to release muscle spasms. This technique can help reduce pain, numbness, and tingling sensations in the affected areas.
3. Neuromuscular Therapy: Neuromuscular therapy involves deep pressure application to the specific trigger points in the muscles, ligaments, and tendons. This technique can help in releasing the tension, reducing inflammation, and improving blood circulation in the affected area.
4. Stretching: Specific stretching exercises, especially those that strengthen and stretch the wrist and forearm muscles, can help loosen the tight tissues and reduce pressure on the median nerve.
5. Scar Tissue Massage: Scar tissue massage is performed on areas where there is scar tissue or adhesions from previous surgeries or injuries. This technique can help in loosening the scar tissue, improving flexibility, and reducing the pressure on the median nerve.
Several medical treatments can be used to manage carpal tunnel syndrome. The choice of treatment depends on the severity of the symptoms and the underlying cause. Here are some of the common medical treatments for carpal tunnel syndrome:
1. Non-steroidal Anti-inflammatory Drugs (NSAIDs): NSAIDs such as ibuprofen, naproxen, and aspirin can help in reducing pain and inflammation in the affected area.
2. Splinting: Wearing a wrist splint can help in keeping the wrist in a neutral position, reducing the pressure on the median nerve and allowing it to heal. Splinting is usually recommended to be worn at night but can be worn throughout the day.
3. Steroid Injections: Steroid injections are often used to reduce inflammation and pain in the wrist area. This treatment is often recommended for people with moderate to severe symptoms that are affecting their daily activities.
4. Surgery: Surgery may be needed in severe cases of carpal tunnel syndrome, particularly when there is nerve damage or if the symptoms have persisted for a long time. Surgery involves cutting the ligament that forms the roof of the carpal tunnel to relieve pressure on the median nerve.
5. Physical Therapy: Exercises for the wrist and forearm muscles may be prescribed to improve flexibility and strength, reduce pressure on the median nerve, and prevent further injury.
Other treatments that may be recommended include ultrasound therapy, laser therapy, and acupuncture.
At the core of my therapeutic approach is an understanding of the complex anatomy and structures of the body. I am passionate about providing my patients with the customized treatment plans they need to achieve optimal health and well-being.
If you are suffering from sciatic nerve pain, I encourage you to reach out to me today. With my expertise in neuromuscular therapy and understanding of the complexities of your pain, I can develop an effective treatment plan tailored to your individual needs and help you find relief from your discomfort.
Michael Hale is an accomplished Neuromuscular Therapist, Personal Trainer, and Health Educator located in Jurupa Valley, CA, with certifications from prestigious institutions such as the National Holistic Institute (NHI) and the International Sports Science Association (ISSA). His philosophy centers around the idea that wellness stems from striking a balance between strengthening the body and relaxation to attain optimal homeostasis.
