2013, Year of the Pinched Nerve

Pain takes over. It rules what you do during the day, keeps you from sleeping at night, and changes your day-to-day behavior. It tosses all your plans, replacing your to-do list with one line: “Stop the Pain!”

As you might guess from this seemingly over-the-top opening, 2013 was not one of my better years.

The first time I experienced pinched nerve pain was back in 2009. My primary doctor at the time insisted that pain pills and alternating hot and cold pads was all I needed. The pain pills did nothing to stop the pain, and there was no continuing relief from applying heat and cold. I was stuck in a chair with my arm raised over my head unable to move. I managed to do some activities on occasion by grimacing and just accepting pain as a fact of life. After suffering for a few months, out of desperation, I started seeking alternative treatment plans. These included seeing a chiropractor and various forms of traction. The pain lasted about six months total the first time. I slowly found relief after traction, and figured I had my future cure should it ever kick in again. This was not to be the case.

Back in 2009 I realized the pinched nerve started up after having joined a gym. I decided weight lifting was probably not the best form of exercise for me. Luckily, the gym moved and required everyone to rejoin. I didn’t. All was fine pinch-nerve-wise for a few years until I did a charity photo shoot for which I lugged a bunch of heavy lighting equipment to and from a hotel. It was a bad move: I’d gone from months of inactivity to heavy lifting in the middle of the winter and the pinched nerve pain was back again.

When the pinched nerve struck this second time (insert dramatic music here) two weeks into 2013, I decided I would make the medical system work for me this time. I had changed doctors since the first time. I liked the new guy. I had high hopes for a quicker recovery. Many months later I decided this obedience had been a bad idea. Under standard medical care I made little progress.

As of today I am totally pain free. I’m convinced I would not have been had I relied on standard medical treatment. Instead, I would have been begging for surgery, and based on talking to others, it was likely that surgery would have been a failure. My positive outcomes all came from listening to what the medical expert said, some chance meetings, and figuring out different therapies than what the hospital was offering. The huge leaps in progress I experienced took place when I left their protocols and followed my own intellect.

I offer this as my observations dealing with my pinched nerve, explaining what did and didn’t work for me, just in case it’s of interest to others.

INITIAL INFO AND HOME THERAPY ATTEMPTS

In the beginning I had no useful information other than the pain itself. Both times it kicked in my doctor’s told me they were not sure why it hurt as much as it did. An MRI showed some minor disk bulging and small amount of mild arthritis, but I was told that plenty of people had much worse of both without having any symptoms. Both times this nerve pain struck there were comments made about patients often just wanting narcotics. Perhaps this explains why the standard treatment for nerve pain is to hand out pain pills rather than actually trying to diagnose the cause of the pain? Perhaps the first assumption many doctors make is there is no pain. A friend who is an ER doctor confirmed this in comments I’ve heard him make about his patients. This seems to be obstacle number one in seeking help for pain management. Convincing doctors you actually are in pain and not just after narcotics.

The initial medical advice, both times, was to go home and take pain relievers while using hot and cold pads. This time, instead of going to the chiropractor I insisted I be sent in for physical therapy. My doctor wanted me to wait another month before seeing a therapist, but said that if I was still in pain he would send me. I spent that time sitting in a chair watching TV and taking naps because it was too painful to sleep at night.

Traction had been the only thing that had helped the first time around, so while waiting I tried using two different home traction devices to see if they would relieve any of the pain. The pain continued.

One obvious problem I was having was that being in constant pain caused my muscles to tighten up in my shoulder and neck. I assumed these tight muscles were holding the vertebrae in a compressed position and this might reduce the ability for the traction to work. I asked my doctor to prescribe muscle relaxants to see if they would help. My doctor prescribed them. They did not have any effect on me of any sort. The muscles remained tight and did not release.

Hot and cold, pain relievers, home traction, and muscle relaxers were all failures. All I knew was I had some mild disk bulging, mild arthritis, and muscles that would not relax due to the pain.

SYMPTOMS & SPECIALISTS

One of the interesting things about a pinched nerve is that the pain is in locations other than where the nerve is pinched. This is known as referred pain. There may not be any pain at all in the location where the nerve is actually trapped. While the pinch is typically in a vertebrae, the pain is felt in other parts of the body. Sometimes what feels like pain in a muscle can actually be pain from a nerve being pinched a half foot away.

You’ll be able to tell that you have a good physical therapist or chiropractor by how easily they can determine which vertebrae is pinched. A skilled professional can ask a few questions and do some quick muscle weakness tests and know exactly which vertebrae are involved. The specialist I was sent to really knew his stuff. In my case he determined the problems were between the C5 and C6, and the C6 and C7 vertebrae within the first minute of the exam. That’s right near top-of-shoulder level. My neck didn’t hurt. The worst stabbing was across the left shoulder, under the blade. Over time it had spread into the shoulder joint, then down the arm, and eventually into my left hand. The sensations were mostly stabbing needle-sharp pains (what you might imagine an ice pick in the back would feel like), but also included aches, twitches, cramps, tingling, and numbness. I describe the sensations as a toothache shooting through your shoulder and down your arm. The pain was too intense to focus on anything. Over time I also developed numbness in the thumb and index fingers of my left hand due to the nerve’s myelin sheath being worn away.

It hurt too much to hold a book, and hurt too much to focus for more than a sentence even if I could. Even lifting a coffee cup was difficult. The only way I could relieve the pain most of the time was to keep my arm over my head. I drove with my arm up. I watched TV with my arm up. It didn’t fully take the pain away, but it did decrease it.

All of these descriptions left the specialist nodding his head. He, at least, seemed to accept the pain as real. He found evidence of muscle weakness and mild nerve damage. I was disappointed that he would not be the one actually treating me. That’s not how the system works. Experts don’t treat patients, they only recommend treatment.

PHYSICAL THERAPY

Eventually I was sent in for physical therapy and traction at the hospital.

The hospital set me up with four billable steps:

The specialist noted that I was “chasing relief from the pain” by holding muscles tight. It was throwing my body out of alignment. Part of the plan was to release the muscle. The way the hospital did this was to have an unskilled assistant use an electronic device that sent mild shocks into the muscles on the shoulder. The idea was that it would tell the muscles to release. This treatment went on for a few months, twice a week, and it had absolutely no effect. It reminded me of violet ray devices quacks used on people 100+ years ago (they apparently still get sold as sex toys these days.)

Second, I would get a quick examination by a physical therapist. The therapist would fill out a chart of the pain levels. The physical therapists were hands-off. They would do an examination, have me move and measure the movements, but they did not do any actual hands-on therapy.

Third, I was given traction by a machine. I would lay on a cot with the device attached to the head. It was set to about 10 lbs of pressure. The human head weighs 9 lbs, so the weight was not much more than you would get hanging upside-down  on an inversion table. At 10 lbs, I didn’t feel any tugging. I wondered how this could possibly help with vertebrae bundled under muscle at the base of the neck? It made me think of a slinky and it seemed this would more likely just stretch the middle of the neck where there was loss resistance. The chiropractor did the traction hands on, and it seemed he had been able to better targeted which vertebrae were manipulated rather than just doing them all. All I know is after months of this I was still in pain.

Fourth, they took me into an exercise room and had me spend 10 minutes doing some very simple motions like lifting my arms up and down, pressing against a wall, moving a loose bicycle-like peddle with my hands.

I obediently went in two times a week for a few months and saw no progress. I used my visits to ask lots of questions.

The issue that I found myself focused on was the concept of the muscles tightening to chase the pain. I asked if those muscles might be clamping down and compressing the vertebrae and not allow the pinch to release. The therapist was non-committal about this, neither agreeing nor disagreeing. They left me with a sense that they didn’t know.

I tried going in for a standard deep-tissue massage from a masseuse I’d gone to before. It didn’t help.

The physical therapist kept noting on my chart that my left shoulder was considerably higher than my right due to “chasing the pain.” She had me trying to stretch the chest muscles by pushing my arms against walls and doorways at home. She said the chest muscles needed to be lengthened and the back muscles shortened, and this was common for people that worked on computers all day. She had me use an elastic band to try and tighten the back muscles. I did these exercises as prescribed, but continued to be in pain.

One day luck struck. I had to switch the day of my physical therapy due to a conflicting appointment. They had to use a fill-in physical therapist. This woman actually used hands-on therapy. She applied pressure point therapy on the muscles of the bad shoulder. I was surprised, as for the first time in months I suddenly had my first relief. The intensity of the pain was cut in half.

I requested that physical therapist again. The hospital refused. They said patients were not allowed to change therapists. Since they wouldn’t allow me to change therapists, I canceled my physical therapy sessions. I signed up again at a different building hoping I would get a better therapist. While I liked the new therapist better on a personal level, the therapy was still very hands-off and there was no more progress over the following weeks.

It was obvious that physical therapists in the hospital were not trained in muscle-work. It seemed to be a fluke that I was assigned someone who had been trained in muscle techniques. Insurance companies in the USA will not pay for any form of massage therapy, so my assumption is this is the fault of our insurance industry playing doctor, and a hospital system designed to only provide what is covered. Cynical perhaps, but it would explain why the hospital assigned untrained personnel with a medical device rather than a trained hands-on professional.

The pain was half of the prior levels, but I was still in pain. The new therapist still noted that my left shoulder was considerably higher than my right shoulder because the muscles were now shorter on the left than the right due to my trying to control the pain.

ROLPHING EXPERIMENT

A friend of mine had gone through a full body rolphing process the year prior. Rolphing is a manipulation of the connective tissues to try and release built–up knots and tension in order to realign the skeletal system. I honestly thought it was total baloney until my friend reported back that it did wonders for some issues she’d been living with for decades. She is a science journalist, so I decided to trust her observation.

Rolphing is typically only done as a 10 visit package where they do a different part of the body each time. I found someone online who worked just a few miles from me. I requested a single session. She agreed. She worked on my left shoulder for about an hour.

At my next physical therapy appointment the therapist was confused. My left shoulder was no longer higher than the right. The muscles had released.

At this point I’d been doing physical therapy for three months, not to mention the months lost before physical therapy started. I was losing an entire year in pain. The only progress had been from people not following the hospital’s protocols.

CHIROPRACTOR

I made an appointment with my doctor to discuss the next step we should take. It would take a few weeks to see him. I decided that since the chiropractor and traction had helped the first time, I would try doing that route again while waiting for my appointment. Over the two weeks I didn’t get any further relief. Once again I was stuck going in multiple times a week. The copay was $20 each visit, and it was adding up since I wasn’t able to do much paid work this year.

I wondered if a few times a week wasn’t enough, so I bought various traction devices bought off Amazon and tried using them. While they sometimes seemed to help a little for a short time, the pain was not continuously decreasing. I was tired both mentally and physically.

STEROID INJECTIONS

Next up on my doctor’s list was x-ray guided steroid injections. They get you on a cot and use an x-ray machine to carefully guide a needle as close to the vertebrae as possible and inject steroids to reduce inflammation. A few days after the procedure the pain was gone. Totally gone. It lasted two weeks and then the pain slowly started returning. They instructed me to repeat the procedure. I did. Same result. I was then told that three times a year was the maximum amount that was safe, but if I wanted a fourth session they would make it happen.

It became obvious steroid injections was not a solution, only a way to temporarily force the body to shut down inflammation. It was also obviously not safe as a long term solution.

SWIMMING

By the time the third injection was starting to wear off it was mid-summer. Since I’d spent most of the year barely able to move, and I was only in mild discomfort at this point, I decided to try swimming laps at the city pool for some exercise before the pain set back in. I’d spent half a year unable to move much, so exercise was desperately needed.

The first time I swam there were a few short moments where it felt like cartridge was crunching. This worried me at the time, yet the next day there was no pain. Huh? After a day or so went by without swimming the pain started to return. I hit the pool again, swim some laps, and the pain was gone the next day.

I started swimming a few times a week. This seemed to keep the pain at bay. If I didn’t go three days in a row the pain would start to return.

The summer ended and the pool closed.

NAPROXEN SODIUM

Throughout the year I had a visit with my primary physician every three months. In my next visit we discussed pain relievers. I wanted to try to use medication and exercise rather than another steroid injection. In that visit he mentioned that the only good pain reliever for inflammation was naproxen sodium, like in Aleve.

Years earlier I had problems with gout. It had slipped my mind, but high doses of naproxen sodium were one of the main methods used for stopping gout attacks. With gout uric acid crystals trigger an inflammation process, and the inflammation itself would keep the attack from subsiding. The treatment was mainly a way to halt the inflammation process while you used diet or drugs to dissolve the uric acid crystals. As uric acid crystals dissolve they often trigger another attack, so with gout the cure often increased the number of attacks due to inflammation cycles, so anti-inflammatory drugs were used to keep this process under control. I wonder if component of my pinched nerve was also an inflammation cycle.

I started using naproxin sodium every time I felt a twinge of pain. It helped knock the pain back, but I worried that my gut might not handle constant NSAID use, especially with having used them as much as I did in the past. Like the steroids, these are not considered a good long term solution.

KRILL OIL

Not related to the pinched nerve, I decided to get back on fish oils. My doctor, and nearly everyone else, recommended them. While shopping I discovered Krill Oil capsules. Many people were saying they also helped with arthritis. I decided to experiment with taking these instead of naproxin sodium, though I was very pessimistic that they would work. Interestingly, they did work. If the pain started kicking in I would pop one or two and a few hours later the pain was gone.

For a month I took these regularly.

WINTER SWIMMING

In November of 2013 I decided to try one last experiment. I joined the Y and started swimming three times a week. What I found was I no longer needed to take the sodium naproxin or krill oil as long as I swam regularly. From the first day I started doing this I stopped having pinched nerve pain. I’ve gone well over two months now totally pain free.

I swim a little differently than the lap swimmers. My method is to swim a lap and then stop and stretch the muscles. I’m using the information I learned to try and stretch the chest muscles while shortening the back muscles. On the rare occasion I sense some pain I will take an Advil or Krill oil to head it off.

2014 IS OFF TO A GREAT START

So, 2013 basically didn’t exist for me. I’m starting 2014 with all the goals I had set for last year and then some.

I plan to keep up the swimming up, going at least two or three times a week. I may try shaking it up with some Yoga. No weight lifting. I mentioned swimming to my doctor at my yearly checkup, explaining it seemed to be working great. He replied that it sound like it would take too much time. My thought was it would take way less time than being in agonizing pain.

Interestingly, I was recently told that a report aired on NPR that discussed research that found that the best cure for a pinched nerve was… exercise. Duh.