Do you frequently wake up at night because your hands and lower arms have gone numb or “asleep”? You may find that it happens when you are sitting at a desk or even when driving long distances. This is commonly caused by compression of the nerves and blood vessels that enter the arm. The technical term is referred to as “thoracic outlet syndrome”. 

     The neck portion of your spine, the cervical spine, has seven vertebrae. Passing inside of vertebrae is the spinal cord. Originating from the spinal cord, there are eight nerves. These nerves exit the spine between each of the vertebrae and combine together into a large bundle of nerves. The bundle of nerves then pass under the chest muscles, through the shoulder and down the arm. The primary function for most of these nerves is to control pain or touch sensations and the contraction of the muscles of the arm. 

     When someone sleeps with their arm under their pillow or over their head, the bundle of nerves can become mildly stretched. When this happens, the nerves cannot perform their job as well. For example, if a water droplet hits your hand, a message from the hand is sent through the nerves to the spinal cord and then to the brain. Your brain then consciously tells you that your hand is being touched. So, if the nerves become stretched, they cannot communicate their message to the spine properly. This will eventually make your hand and arm feel numb and weak. This can also happen to those of you that prefer to sleep curled up into the fetal position. Your arms are likely curled up tight in front of your chest. This position causes compression of the nerves as they pass through the shoulder and into the arm area. The resulting numbness in the arm and hand will occur again for the same reason. Also, if you spend too much time at the computer or drive for long distances, the muscles in the chest and shoulder can become very tight. This can also compress the nerves as they pass through the shoulder and give the same result of numbness. If these muscles are only mildly tight but not enough to cause numbness, the overall space that the nerves have to pass through is still less. If you combine this scenario with your arm in the previously mentioned sleeping positions, you are even more vulnerable to experience the numbness.

     So how stop the numbness? First of all, avoid sleeping with your arms over your head or curled up in front of you. To alleviate the potentially tight muscles in the chest and shoulder, a simple stretch has been shown. Avoid a slouching posture, as the shoulders will roll forward and further decrease the available space for the nerves to pass through the shoulder and into the arm. If you are experiencing numbness into the arm or hand, you should also have your neck properly examined by a Chiropractor because all of these nerves pass through this area.  Problems in the neck can cause symptoms very similar to Thoracic Outlet Syndrome. 

     Next week I will discuss proper sleeping positions.  If you have any questions about neck pain or a topic for my next blog, email me at landrumdc@gmail.com or visit my website, http://www.landrumdc.com

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The next time you go to Wal-mart for your weekly outing, try to notice how other people’s heads are positioned. Sound weird? Probably. But if you know what to look for, you can see which people likely have headaches and neck problems. When someone is standing with their arms at their sides, look at them from the side. Their ear, shoulder, hip, knee, and ankle should be in vertical alignment. In other words if you drop a piece of string from their ear it should pass through all of those points. 

Did you know that for every inch a person’s head is positioned "forward", that gravity is pulling their head even further forward, equal to a pull of 10 pounds?! It’s true! As far as the muscles in your upper back and neck are concerned, they have to work even harder than normal in order to keep the head (chin) from dropping forwards onto your chest. This forces the muscles that raise the chin or pull the head back to remain in constant contraction, putting pressure and tension on the joints, muscles, and eventually the nerves of the neck and upper back. As an example, if a person’s head is tipped forward two inches, it would be similar to hanging a 20-pound watermelon from the front of his or her head? It is no wonder that people who do this consistently end up with tension headaches, upper back pain, and neck pain. 

When your head is held in a forward position, the mobility of the joints in the upper four vertebrae of the neck will be significantly restricted. All of our joints need to move and be positioned properly to remain healthy. If these joints have abnormal pressure on them due to improper positioning and are not allowed to glide freely, degeneration of the joints and discs in that area will eventually occur. 

To prevent forward head posture from happening in the first place, practice good posture and keep the muscles of your neck strong and flexible. If you have had forward head posture for some time, see your chiropractor so that the mobility in the joints and flexibility of the muscles within and around the neck can be restored. He or she can also show you some simple exercises to help strengthen and release the chronic spasm of the muscles involved. Once your treatment protocol is complete, your postural habits are improved, and you either commence or continue to exercise regularly, your persistent neck pain and headaches will be a thing of the past.
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Note Homer's excellent head posture
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“Piriformis syndrome” is caused by an entrapment (pinching) or irritation of the sciatic nerve as it exits the back of the pelvis, deep within the buttock region. The sciatic nerve usually exits the back of the pelvis immediately below a muscle, called the piriformis muscle.  The piriformis muscle is located on both sides of your body, deep within the buttock area. In rare situations (11% of population), the nerve actually passes right through the piriformis muscle. For various reasons, the piriformis muscle can go into spasm and entrap or even pinch the sciatic nerve.  This can result in pain along the back of the thigh and knee, with further pain and/or numbness extending as far down as the sole of the foot, called “sciatica”.

Piriformis syndrome can result in “sciatica”. These same sciatica symptoms feel very comparable to that of a herniated disk. A herniated disk usually pinches directly on one of the five nerves that eventually form the sciatic nerve. Because the resulting symptoms of both of these problems are very similar (pain, numbness and tingling below the knee and into the foot), it is not hard to misdiagnose what is actually going on if you don’t look for both potential causes.

Specific diagnostic tests performed by your chiropractor are what distinguish a herniated disk from piriformis syndrome. In simple terms, with piriformis syndrome your chiropractor will not find many positive test results that indicate that the lumbar spine is involved. More often, the acute pain or tenderness is localized to the buttock and hip, while the low back appears quite normal and often pain free.

Many weekend athletes and people who spend long hours sitting in cars or at work are prone to this syndrome. The athlete's cause is commonly due to improper stretching and warm-up exercises as well as overuse during activity. In this case it is most likely that the piriformis muscle is irritated and usually in spasm. For the patient who sits for extended periods of time, their primary cause is due to contracture or tightening of the piriformis muscle. In this case the piriformis muscle is shortened and does not allow for the smooth movement of the sciatic nerve during leg motion.

Any treatment plan must include stretching of the gluteal or buttock muscles as well as stretching of the piriformis muscles. Dr. Landrum can help you by instructing you on the proper stretches and the correct way to perform them. A series of spinal and hip joint adjustments may also be required to relieve your symptoms. 

 If you are currently diagnosed with a disk herniation but are wondering if the symptoms you are experiencing may at least be partially from piriformis syndrome, call my office for an appointment to have it checked thoroughly. It is always a good idea to rule out other possible causes of your sciatica before simply having surgery.
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