Agggghhhhh, so another utterly cod diagnosis arrives on my mat. A friend’s son is ‘diagnosed’ with a trapped nerve. He is 8 and has pain on extension, flexion and rotation but the pain is localised and really, really nasty and with some epic muscle tightness in his lumbar region.
After a bit of questioning it is bloody obvious that he’s got a posterior facet syndrome which with a bit of care and a load of ice will come good fast – which it does and he’s ready to climb a Welsh mountain a few days later.
But it got me fuming about ‘trapped nerves’ and what an utterly piss-poor diagnosis this is, it sits up there with lumbago and ague as a really lazy bit of work. Now, I admit a nerve entrapment is entirely possible – just google entrapment neuropathy and you’ll get some real spot-on diagnosis such as medial plantar neuritis and thoracic outlet syndrome. These nerve entrapments are crackers and really obvious and clear cut once you are thinking right. However, to achieve the same sort of thing in your lumbar region is a far, far trickier thing.
Consider the anatomy and what you’d have to do to pinch or trap a nerve. The most simple to imagine would be a classic disc herniation or prolapse, the bulge in lay-terms. Now this can compress the nerve root in the back but these are rare, have a raft of pretty convincing signs and symptoms, such as electric pain down the nerve, and you don’t recover from these at all quickly. The second thing you could do is have some soft tissue structure compress the nerve root (a lateral or central stenosis) or a space occupying lesion (far more scary) but, again, this is rare and usually very obvious with a raft of red flags to watch out for.
So, if you visit your doctor with low-back pain sometimes with pain running across the width of your back and possibly some referred pain down you legs to above your knee or knees and you are told you have a ‘trapped nerve’, like my friend’s son, raise a quizzical eyebrow and say the following:
“Which nerve and where can it be trapped or are you just fobbing me off because I’ve spent more than my allocated 5 minutes in your office?”
Because I bet you have a posterior facet syndrome with widespread muscle guarding which is chiropractic business.