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Nicholas DiSabatino DC QME
You got this nasty feeling when you turned your head while driving your car. You felt a sharp, stabbing pain which radiated down your neck, into your shoulder and down your arm and wrist. No, that's not a poker stick jabbing you! It's something going on inside your body! Something obviously is not right, and now you cannot use your arm like a normal person. At this point even gripping objects you once never gave a second thought to is a task you must be determined to make happen. If it's your back, when you drive for a while your hip area may hurt, and your leg gets a numbing pain. It's a struggle to get in and out of your car, and when you do get out, you have to shake your leg about to get the circulation going and regain some feeling. You ask yourself: “How long will it last? When it goes away, will it keep coming back? What next? Anxiety sets in as the uncertainty about your body function, and your future with respect to your most treasured object, your corporeal body, is compromised.
(Notice the red area on the picture to the right: this represents how nerve tissue is extremely sensitive to even the most delicate touch from nearby structures. In fact, the pressure from the weight equivalent of a dime could set you reeling in pain.) The Picture to the top shows an actual treatment for what is known as brachial nerve entrapment. The approach is gentle and effective.
To answer this question, I will provide for you a quick learn on neurology, (the study of the nervous system), as it relates to spinal nerves. For more in depth information you can try the following link: http://www.medicinenet.com.The nervous system controls and coordinates all functions of our body. The central nervous system consists of the brain, brain stem, and spinal cord. As you know, the brain is where all higher consciousness occurs. It is also where the master control of our body takes place. Constant orders from the brain are given to the organs of our body, like the kidney or liver, etc, and to the trillions of our bodies' cells. And of course communication is relayed from our body, back to the brain. There is a constant pathway of communication going at an utterly astounding rate. In fact it is hard for our higher consciousnesses to comprehend this level of transmission that occurs because it happens at such a high rate of speed and volume.
The peripheral nervous system consists of the 31 spinal nerve roots, which exit from the spinal cord, and through a small hole [foramen] of the vertebra bone. Each vertebra bone you have is constantly moving, as you move, the spine moves. The illustration above shows in the most basic sense a spinal nerve that is touching the vertebra bone, and is therefore irritating its owner. In a perfect chiropractic world, the bones of the spine would always be exactly where they are supposed to be. Whenever even minor injury occurs, such as that from a bone moving slightly out of its normal position, the relationships of all the structures change. Inflammation sets in too. The very small space between the spinal nerve and the bone diminishes. This is what is referred to as "pinched nerve." Pretty simple stuff really. But fixing it is more complicated. Most people would prefer to avoid the surgery involved to release the pinched nerve. This is where a dynamic approach of chiropractic treatment is so essential to correcting the problem. When I say "dynamic," I mean multi-faceted, and pro-active. A barrage of specific therapeutic modalities must be recruited to deal with the many layers of tissue dysfunction that are creating the nerve entrapment syndrome. It is important to note that nerve entrapment syndrome is the clinical term for "pinched nerve," and is really more of a physiological aberration rather than a frank anatomical abnormality. This is why spinal surgery often times has poor long-term outcomes, and most patients that undergo spinal surgery will one year later have many of the same symptoms. Surgery may help deal with the anatomical problems, such as structure "A" and structure "B" impinging on each other, but often times will not correct the physiological issues. To understand any disease process, and nerve entrapment is certainly a type of disease, one must grasp the physiology, or function, of that disease process.
Nerve entrapment will generally involve the following components: malpositioned joint with associated range of motion restriction. Localized inflammation; and muscular spasm or cramping. pain, numbing, or tingling. For example, the spinal vertebra at the lower part of the neck can be mal-positioned and out of alignment. The connection between the vertebra, their joints, are not moving well and are restricted. When a bone is turned one way, the muscle fibers on the opposite side are now being pulled on, and are tight. This causes irritation. The body responds with irritation by releasing an inflammatory process. So now there is fluid in the area, and less space for the anatomical structures to co-exist. Where you have more tissue in a smaller area you get pressure, ie, nerve pressure. Muscular spasm is also generally found with most nerve-entrapment issues. The reasons behind what causes muscular spasms are more complex, but will often simply occur as a result of faulty functioning in whatever regional muscular system the muscle works in.
A smaller percentage of nerve entrapment are caused by congenital issues that may not respond well to conservative treatment.
It has been the experience of Dr. DiSabatino, as well as many within the chiropractic profession, that the muscular component of a pinched nerve (entrapment syndrome) must be accounted for to achieve higher outcomes. To achieve optimal results, specific chiropractic adjustments may be accompanied by equally specific myofascial/muscular therapeutic treatments. Often times Dr. DiSabatino will employ a barrage of soft-tissue treatment modalities to augment the effectiveness of the specific chiropractic adjustment. Whereas the specific chiropractic adjustment serves to clear the communication loop between brain and body, as well as restoring range of motion at that level of the spine, the adjustment usually will not directly deal with associated muscular spasm. To deal with these real life conditions, Dr. DiSabatino employs in his Mission Valley, San Diego office, treatment for pinch nerves, ie, nerve entrapment syndromes, what is known as muscle stripping techniques. This is accomplished through various methods of trigger point therapy, and or muscular kinetic activity. The image of Dr. DiSabatino providing treatment at the top of this page is a form of trigger point therapy: Soft-tissue therapy which triggers symptoms in other areas, and is s sign that the practitioner is on the right tissue pathway. In fact, back in 2003 Dr. DiSabatino took his training and received his certificate in spinal active release therapy (A.R.T.). While much of what Dr. DiSabatino does in terms of restoring the full function of a muscular unit is based on that original A.R.T training, in the final analysis restoration of a malfunctioned and nerve entrapped muscular unit often involves a multi-dimensional approach, and will even include electro-therapy application, assisted active PIR stretching, specific core strengthening and nutritional instruction as well as static soft-tissue release similar to what is experienced in massage therapy.