I recently came across this full-page advertisement in National Geographic magazine:
“Do you feel burning pain in your feet?” the ad asks. “Or uncomfortable tingling, numbness, stabbing, or shooting sensations? If so, you may have nerve pain.”
Yes, you might. But it’s not bloody likely! The clinical reality is that neuropathy is a lot less common than nearly all patients and most doctors believe.
Nerves have a mystique
Nerves make people nervous! So to speak. The whole idea of nerves gets people anxious. Could it be a nerve? people ask. Is this a nerve problem? What if it’s a nerve? Is something pinching my nerve? Something must be pinching a nerve.
The kind of advertisement with the stinging ants you see above greatly aggravates our society’s general anxiety about nerves. Pfizer and other pharmaceutical companies spend about a gazillion dollars on marketing that can create more worry about nerve pain in a year than I can counteract in an entire lifetime of low-budget public education! Bummer.
EXCERPT This article is a condensed excerpt from three of PainScience.com’s advanced tutorials about low back pain tutorial, neck pain, and myofascial trigger points. It’s also discussed in a more basic sciatica tutorial. But it’s also interesting enough to be worthy of its very own page.
Nerve root wiggle room
It’s amazingly difficult to actually pinch most nerves, or nerve roots (as they exit the spine). In general, nerves have extremely generous “wiggle room.” For instance, in the lumbar spine, the holes between the vertebrae that the nerve roots pass through can be more than a couple centimetres at their widest, while the nerve roots themselves are only about 3-4mm thick.1 If you stretch or compress the spine, the holes do change size a little — as much as 70–130% in the looser neck joints,2 a little less in the low back.3 But even at their smallest, there’s still plenty of room.
Schematic of nerve root wiggle room
On the left are the approximate proportions of a healthy nerve root & the hole it passes through (intervertebral foramen). When the spine is pulled or compressed, the holes get a little larger or smaller, as shown on the right … but there’s still lots of nerve root room.
There’s so much space for nerve roots that even dislocations routinely fail to cause impingement.4 Once again, I invoke the example of a patient with a severe lumbar dislocation … and no symptoms at all, not even symptoms of pinched nerve roots. Her nerves seemed to be fine, even in an anatomical situation most people would assume to be extremely dangerous.
A young woman with “sciatica” (hint: not actually sciatica)
I worked with a young woman who had “sciatica.” Allegedly, her sciatic nerve was pinched by her piriformis muscle — a reasonably common scenario — and sending hot zaps of pain down her leg. She came to me with this diagnosis already in place. She also had some tingling in her feet. The description of her symptoms did, indeed, sound a lot like a nerve impingement problem. On the face of it, it did seem likely that her sciatic nerve was being pinched.
However, a couple things didn’t add up. For instance, she had no numbness at all — no dead patches of skin, which are highly characteristic of true nerve impingement. Instead, she had a lot of “dead heaviness” in the leg, a different kind of numb feeling that is much more closely associated with muscle knots than nerve pinches — and a lot more common.
I quizzed her carefully about the quality of her pain. She assured me it was “zappy” and “electrical” … just as you would expect of nerve pain. Yet something didn’t seem quite right. I couldn’t shake the impression that she was interpreting an intense non-neurological pain as a “zappy” pain simply due to her strong belief that she had a nerve problem. When you think a pain is nervy, you’re going to interpret, feel and describe it in nervy terms.
So I did some experimenting, and clinched the case:
This young woman’s “nerve” pain could be perfectly reproduced by prodding muscle tissue that was nowhere close to the sciatic nerve. Pressing on the side of her hip, on the gluteus medius muscle, several centimetres away from the sciatic nerve, she reported the same “electrical” pain flowing down her leg. It even stimulated the weird, tingling sensations in her foot.
This largely eliminates a diagnosis of sciatic nerve impingement.
A more likely story
In spite of spending most of my career trying to explain to people that this sort of thing is common, I was surprised myself — fooled, really. Muscle knots are always fooling patients and professionals alike. Vastly more common than nerve problems, and often more painful, they nevertheless get upstaged and misdiagnosed by another phenomenon.
Do you feel burning pain in your feet? Or uncomfortable tingling, numbness, stabbing, or shooting sensations? If so, you are more likely to have “muscle knots” than nerve pain.
For more information about muscle knots, see The Complete Guide to Trigger Points & Myofascial Pain For a detailed discussion of nerve pain overdiagnosis in the context of neck pain, see The Complete Guide to Neck Pain & Cricks Low back pain? I’ve written a book about that, too: Complete Guide to Low Back Pain
About Paul Ingraham
I am a science writer in Vancouver, Canada. I was a Registered Massage Therapist for a decade and the assistant editor of ScienceBasedMedicine.org for several years. I’ve had many injuries as a runner and ultimate player, and I’ve been a chronic pain patient myself since 2015. Full bio. See you on Facebook or Twitter.
More articles about back pain, spines, and nerves …
- Don’t Worry About Lifting Technique — The importance of “lift with your legs, not your back” to prevent back pain has been exaggerated
- Chronic Low Back Pain Is Not So Chronic — The prognosis for chronic low back pain is better than most people realize … especially for Australians in Australia!
- The Mind Game in Low Back Pain — How back pain is powered by fear and loathing, and greatly helped by rational confidence
- The Tyranny of Yoga, Meditation, and Mindfulness — Do you really need to try them? How much do they matter for recovery from conditions like low back pain?
- Spinal Subluxation — Can your spine be out of alignment? Chiropractic’s big idea has been misleading patients for more than a century
- Does Spinal Manipulation Work? — Spinal manipulation, adjustment, and popping of the spinal joints and the subluxation theory of disease, back pain and neck pain
- Organ Health Does Not Depend on Spinal Nerves! — One of the key selling points for chiropractic care is the anatomically impossible premise that your spinal nerve roots are important to your general health
- The Complete Guide to Neck Pain & Cricks — An extremely detailed guide to chronic neck pain and the disturbing sensation of a “crick”
- The Chiropractic Controversies — An introduction to chiropractic controversies like aggressive billing, treating kids, and neck manipulation risks
- Torun F, Dolgun H, Tuna H, et al. Morphometric analysis of the roots and neural foramina of the lumbar vertebrae. Surgical Neurology. 2006 Aug;66(2):148–51; discussion 151. PubMed #16876606 ❐ This was exasperatingly hard data to find for some reason, and the paper abstract begins by saying so: “There have been few anatomic studies on the foramina and roots of the lumbar region … .” This is in a 2006 paper! Hardly ancient.
- Takasaki H, Hall T, Jull G, et al. The influence of cervical traction, compression, and spurling test on cervical intervertebral foramen size. Spine (Phila Pa 1976). 2009 Jul;34(16):1658–62. PubMed #19770608 ❐
- Sari H, Akarirmak U, Karacan I, Akman H. Computed tomographic evaluation of lumbar spinal structures during traction. Physiother Theory Pract. 2005;21(1):3–11. PubMed #16385939 ❐
- Ebraheim NA, Liu J, Ramineni SK, et al. Morphological changes in the cervical intervertebral foramen dimensions with unilateral facet joint dislocation. Injury. 2009 Nov;40(11):1157–60. PubMed #19486975 ❐
Researchers dislocated neck joints in corpses to measure the effect on the size of the intervertebral foramina. (Interesting chore!) Dislocation made the spaces quite a bit larger, indicating that any nerve root pain associated with these injuries “is probably due to distraction rather than due to direct nerve root compression.”