Check out the video above to see how I address the neck alignment of one of my patients to help alleviate his nerve symptoms!
If you're experiencing numbness, tingling, or weakness in your arm, it's natural to fear that you may have a herniated disc. However, I'm here to inform you about a much more common cause that I often observe for these symptoms.
*Before we begin, I must provide a clear disclaimer: if you are experiencing any of the nerve symptoms mentioned above, it's crucial to seek evaluation from a healthcare professional. Do not attempt to self-diagnose. Additionally, be aware that numbness or weakness in your arm could be indicative of serious, life threatening condition such as a stroke. This is not meant to cause fear but to inform you. You should not rely on this blog or any other information found on the internet to diagnose or treat your specific condition as a replacement for care from a health care provider who has evaluated your specific condition.
How can a Physical Therapist determine the cause without imaging?
In the state of New Jersey, patients can come directly to a physical therapist first, before seeing a physician. This is usually recommended as it can save you time and get you started with treatment more quickly. During a physical therapy evaluation, if I observe specific signs or symptoms that are a cause for concern, I will refer my patient to an Orthopedic Doctor for further testing and imaging. However, if you are in severe pain, it's advisable to see a physician first.
When evaluating a patient, I start out by asking a detailed history of the injury. Some key questions include:
When/How did it all begin (if known)?
What movements or activities exacerbate or alleviate the symptoms?
Where exactly are the nerve symptoms are located?
After delving into a comprehensive history, I proceed to assess posture, range of motion, strength, sensation, nerve tension, and conduct specific tests designed to either confirm or rule out certain conditions, such as a herniated disc. Following these evaluations, I delve into the examination of the neck, checking the alignment of the vertebrae. Even if you believe your neck appears straight in the mirror, there could be a slight shift in one vertebra that is only detectable by touch. I also evaluate the tightness of muscles around the neck and throughout the arm.
Finally, I put together all the information and arrive at a conclusion regarding the involved structures and pinpoint which nerve is involved and where it is being irritated.
As a general overview, here's how some of the symptoms and history can differ between a herniated disc and alignment issues:
What is a herniated disc?
Between each vertebra of the spine, there is a soft, disc-like material in the middle. Picture this disc like a jelly doughnut. When the walls of the jelly doughnut get injured, the jelly can protrude outward and press against a nerve. When this occurs, you typically experience severe pain in the neck due to the injury, along with nerve symptoms traveling down the arm along the specific pathway that each nerve supplies.
What is poor alignment in the neck?
Now, imagine how each vertebra is stacked on top of the other throughout the spine. If the spine is crooked or shifted in any way, it can compress a nerve. This may not cause any discomfort in the neck, but nerve symptoms will be present in the arm. Conversely, you can also experience it the other way around: you may have neck pain due to an alignment issue, but it's not yet pinching on a nerve, so you don't have numbness and tingling.
How Alignment goes off:
Alignment being off in the neck is something I see very often. It is common simply because most people do not live their day-to-day lives in a perfect posture, nor is it reasonable to expect someone to do so 100% of the time. However, you should make an effort to correct some poor postures that may be significantly affecting your alignment. Ignoring it may likely lead to future injuries.
See the picture below for reference. All it takes is one muscle to be tight or in spasm, pulling the neck in one direction and causing the vertebrae to be crooked. It could be a more general curve, or it could be that only one vertebra is affected. If you imagine below, the right upper trapezius muscle is tight, thus causing the neck to bend to the right. This, in turn, closes down the space on the right side of the vertebrae and may compress a nerve, leading to numbness or tingling in the right arm.
Why does this happen?
Here are 3 of the most common reasons:
Let's dive into each one.
1. Sleeping Position
Your body adapts to the stresses you place on it. If you lift weights in the gym, the usual result is larger, stronger muscles. If you sleep with your neck bent to the right, you will likely walk around with your neck bent to the right. If you consistently maintain the same posture for 8 hours every night, your muscles will adapt by either shortening or lengthening to meet the needs of that posture.
Below are some tips for back and side sleepers. If you notice, stomach sleeping is not included simply because, unless you have a hole in your bed to look straight through (similar to a massage table), you have no choice but to turn your head to an extreme level when sleeping on your stomach, which can certainly create muscle imbalances and strain the joints that are jammed all night. I don't advise sleeping on your stomach at all.
2. Sitting Posture
Same concept as above: the postures you spend the most time in are what your body will adapt to.
Below is an image to help you understand what to avoid and what is correct. There's a lot of information out there on how to set up a proper workstation, but in general, follow these tips:
Keep your shoulders back and away from your ears.
Set your computer display at eye level. If you only use a laptop, consider getting a separate keyboard and mouse.
The height of your desk should be where your elbows rest when you are sitting tall with good posture.
Have both feet flat on the ground in front of you. If your feet don't touch the ground, consider placing a book or something to raise the floor up to you.
3. A Traumatic Event
Sometimes, you just can't avoid it, whether it's whiplash from a car accident or getting thrown around in sports such as Jiu-Jitsu or football. The way you end up and how your body spasms may cause some shifting in the neck to occur, either immediately or overtime from a spasmed muscle.
How is neck alignment corrected?
First off, I understand it can sound scary if your neck is shifted or a vertebra is out of place. But fear not! It has a very easy fix. I start by loosening up the muscles that are in spasm and causing the shift. This is usually done through trigger point work (sustaining pressure on a muscle which forces it to relax). Then, once the muscles are not in spasm, I gently push on the vertebra to position it back in place. Sometimes, the alignment actually corrects itself once the muscle is relaxed, and I don't even need to make any adjustments. If you missed the video at the top of this blog, be sure to check it out to see me treat my patient.
Why does all this matter?
If you're dedicating 1-2 minutes per day to stretching your upper trap muscle, but then you revert to the same sleeping position for 8 hours a day which made your upper trap tight in the first place, which do you think will win?
You might have the perfect rehab plan, but if you return to the postures and positions that contribute to the issue in the first place, you'll be spinning your wheels and wasting a whole lot of time. Work smarter, not harder!
I hope this blog was helpful and allowed you to recognize a few of your own habits which you can improve upon.
Keep in mind there are many other causes for numbness and tingling in the arm, including, but not limited to, a condition called thoracic outlet syndrome, or a compression on the nerve further down in the arm, such as carpal tunnel syndrome.
If you're in the central NJ area and need help with your condition, send me a message or give me a call. I'd love to help!