Can my Back be the Cause of My Neuropathy?

In our last blog post, we discussed the fact that neuropathy is a generic term that refers to a dysfunction, pathology, irritation, disease or damage to a nerve.  It is commonly used inaccurately to describe a specific nerve condition, when in reality there are dozens and dozens of different type of neuropathies.

We also discussed the concept that nerves are divided into “central” or “peripheral” nerves, based upon their location relative to the spine.  Those nerves found within the spinal cord and brain are considered part of the central nervous system; whereas, those found outside the spinal cord are considered peripheral nerves.

Peripheral nerves include the part of the long spinal nerve “roots” that exit from the spine all the way down to the final termination of that nerve—even when it is at the tip of the big toe!  Each nerve root contains hundreds of individual nerve fibers that control everything from pain sensation, muscle function, position sense, vibratory sense, hot/cold sensation, light tough, deep touch, discriminatory touch, etc.

In our office we utilize several cutting-edge treatment technologies, to include MLS deep tissue laser therapy, and spinal decompression to treat various types of peripheral neuropathies.  But before we can determine how our therapy can be properly applied, we must understand the causative factors for each neuropathy.  And in many cases, there are more than one factor causing the peripheral neuropathy.

As the nerve roots exit the spinal cord they become more prone to injury than when they were inside the cord.  This is due to several factors.  The first is the fact that the spinal cord is well protected by the bony vertebral column and the protective cerebral spinal fluid that acts as a cushion to the cord and nerves.  But as the nerve root leaves the spine it gives up the protective fluid and passes laterally through an opening in the bones known as the vertebral foramen.  A foramen is basically an opening within the body, and in this case, an opening between the vertebral bones.

Between each vertebrae is a disc.  This disc is made out of a cartilage so that it has flexibility.  Each side of the disc is connected to both the vertebrae above and below it.  Without the flexible disc, we would not be able to bend (as bones don’t bend).  This allows a tremendous amount of motion between the protective vertebrae.  There are also several other ligaments that assist the disc in both keeping the bones together, but still allows movement in all 3 planes.

Now as the spinal nerve root exits the spinal cord deep within the spinal column, it changes direction from a vertical orientation to a horizontal one, in order to exit the foramen.  Spinal nerves are always in pairs, and there is a right and a left one at each level of the spine.   As they pass horizontally through the openings, they pass very close to the disc at that level that separates the vertebral bones.

We already mentioned that each disc is made up of cartilage.  Inside the center of the disc is a very thick, gelatinous material known as the nucleus.  The outside disc cartilage keeps the fluid in the center contained.  A good analogy is a car tire.  The outside rubber of the tire and steel belting underneath, keep the air of the tire contained.  When you puncture through those protective layers, air can leak out.

It is the same with the disc.  The outer layers are called the annulus fibrosus, and they keep the fluid contained inside the disc.  When those annulus fibers get damaged, the pressure of the fluid inside can start to “bulge” the outer part of the disc (annulus) outward.  We refer to this as bulging disc.  When the annulus tears, it is called a herniation.  This typically leads to the inside fluid (nucleus) squirting out in what we call a protrusion.  These bulges and protrusions usually cause problems for the nerve roots that are passing by as they attempt to exit the vertebral foramen.   This frequently causes  not only back pain, but more frequently  leg pain, numbness, tingling down to the feet and toes.

Now, back to what we discussed last week.  When there is damage, irritation, disease, compression, or any problem with this part of the nerve root, we refer to it as a proximal peripheral neuropathy.  These disc bulges/protrusions create one of the most common peripheral neuropathies in the body.  We call it a radiculopathy.  Many cases of leg pain, numbness, tingling, loss of muscle function in the foot or leg, or balance issues are caused by this proximal peripheral neuropathy.  All of these symptoms may originate from the irritation or pinching of the nerve root at the back (or neck for symptoms in the hands, arms and fingers).

But why do some only have numbness? Or tingling?  Why do I have pain only in my big toe and not the rest of my foot?  And the number one question….why can someone have severe leg pain, numbness or tingling in the feet, but no back pain at all?  Next week we’ll discuss this further.

9 Comments

  1. Tom Dart on April 11, 2019 at 11:29 am

    Really enjoyed the post on peripheral neuropathy

  2. Dan Austin on April 13, 2019 at 5:42 am

    Hi my name is Dan I’m 44 years old I’m in decent shape im not diabetic and I have been diagnosed with neuropathy in both feet the left foot hurts much worse than the right but they both hurt. I’ve never been injured that I know of that could cause this the doctors say all they can call it is “Idiopathic” in other words their way of saying they don’t know why this is happening! I’m normally a very outgoing and on the go kind of guy and a slight workaholic but with this problem im worried im gonna have to give up the things I love doing most…
    So far I hardly dip anything with my family unless I can sit I really would like to get out and just play with my kids but the pain has just gotten to much to bare, as for work I get up every morning and go to work and yes I limp all day and by the time I get off work all I can do is get off my feet this is not healthy for me I should be getting my second wind and doing what and good husband or father should do help with house chores taking the dogs for a walk playing with the kids ect. But I can’t the pain is unbearable at this point!!!
    I really need to find a way to make this better or by some miracle make it go away. I used to work 3 part time jobs now I work 1 full time and 1 part time job it kills me to think that if this gets any worse will I have to quit being a man and supporting my family and not pulling my own weight I just can not handle that… I’m sorry for going on or sounding like a cry baby but I really am trying to find help for this serious problem that is taking the quality of life away that my family should be able to experience with me until I’m old not crippled for no reason
    Thank You
    Sincerely
    Dan

  3. Amysusankeller on June 4, 2019 at 3:12 pm

    I am interested in receiving your emails. I have numbness, weakness, and pain in my legs, feet, and hands. I’ve had spinal problems for years- degenerative disc disease, bone spurs, bulging disc, arthritis. I just had an emg. Neurologist said my problems are on discs 4&5. He is sending me to a pain clinic. Not sure what is next to get to help with pain and numbness. I’ve had shots and ablations.

    • Cameron Hatam on September 10, 2019 at 9:44 am

      Good morning Ms. Keller, I apologize for the delay. Thank you for your interest in receiving our emails. We will do that for sure. We are all so sorry to hear of your chronic spinal conditions. We would do a thorough review of your history and all imaging including MRI’s and emg’s on your consultation. We would then come up with a catered plan to help decompress these discs and relax the underlying nerves. In addition laser therapy does two things. Two simultaneous lasers will enter the damaged tissue. The first one will act as analgesic and help with the pain. The second laser goes into the mitochondria aka the powerhouse of the cell and stimulate tissue repair. From your comments it seems a good combination of laser and cervical/lumbar decompression will give you the best chance to avoid surgery. However, this all will start from the examination. If you are interested in making an appointment please call us at 703-370-5300. Have a wonderful day!

  4. Donald Walker on August 17, 2019 at 8:58 am

    I had back surgery on lower back l4 and l5 herniated disk. Two weeks after surgery still have back pain and numbness in both big toes and tingling. I also had a annual tear and I had very little reflexes in my right leg before surgery. I’ve had these problems almost two years before surgery can you explain to me if I have nerve damage thanks.

    • Cameron Hatam on August 17, 2019 at 10:36 am

      Hi Mr. Walker, yes what you are explaining called radiculopathy. Each nerve of the lumbar spine goes down what is called a dermatome. A dermatome is a distribution area where you feel sensation innervated by the nerve. When there is nerve damage between L4 and L5 you will particularly feel the dermatome down the inner leg and the big toes. In addition patellar reflexes will be diminished and the muscle weakness will be felt lifting the great toes.

  5. Scott Wyatt on September 15, 2019 at 12:07 pm

    Please add me to emailing list for blog posts

  6. Clare baddeley on November 16, 2019 at 3:43 am

    Four weeks ago i over did it with some heavy lifting and bending i had to do. That.night i was admitted to hospital with a suspected slipped disc and sever pain in my back and hip. I had pain management and came home two days later pain free. During this time i had numbness tingling in my foot i told the doctor but it was dismissed. Since then it has got worse with skin sensitivity and sharp stabbing pains all ovef my foot so bad im unable to sleep. Im being treated with anti inflammatries and nerve tablets. The pain in my back has compleyely gone although at times i feel a pinch at the base of my spine. Is this footpain a result of my back injusy and will physio help? Please email me some information. Thanks

    • Cameron Hatam on November 18, 2019 at 5:11 pm

      Hi Ms. Baddeley we have emailed you.

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