Pinched nerve vs. muscle spasm

A man wakes up early, goes to the gym, and notices a pain in the back of his shoulder. Shrugging it off, he continues the session.

Through the day, the pain gets worse. By lunchtime, he struggles to turn his head to one side or lift his arm without severe pain. The area feels tight and “locked up.”

What’s going on? Does he have a nerve pinch or a muscle spasm?

The answer could be one or the other, or both. Fortunately, there are some easy ways to tell.

How to tell if it’s a pinched nerve or muscle spasm

Symptoms of a pinched nerve include severe pain that is worse when you move and stretch, sometimes with numbness or tingling in the problem area.

A muscle spasm is different – the pain will happen even if you are not moving. A spasm feels like an on-and-off tightening of the muscle.

How do nerves get pinched?

Nerves can become pinched from daily activities that involve repetitive motions or sustained positions. Over time, this build-up of pressure can result in pinching.

In some cases, a trivial event or trauma may cause it. Something as simple as washing your hair, or reaching backward in the car!

Poor posture is also a common reason people end up with symptoms of a pinched nerve. When we slouch or sit in an awkward position, our spinal joints, discs, and ligaments become vulnerable to degeneration, increasing the chances of nerve compression.

Both parts of your nervous system can suffer physical pressure. I will mainly discuss nerve pinch and muscle spasms in the back, neck, and shoulder blades.

But briefly, here are some other conditions you might recognize, that arise from nerve pinching:

• carpal tunnel syndrome
• thoracic outlet syndrome
• sciatica

What causes muscle spasms?

A muscle spasm is a sudden, involuntary contraction of muscle fibers. It can happen in any muscle in the body but is most common in the legs and back. Muscle spasms can be caused by muscle weakness, muscle strain, or a muscle cramp.

A muscle cramp is a sustained muscle contraction that usually occurs as a result of overuse or dehydration. Central nervous system disorders, such as multiple sclerosis or ALS, can also lead to muscle spasms.

Nerve compression, such as from a herniated disc, can also cause muscle spasms. In some cases, muscle spasms seem to occur for no apparent reason.

They are more likely to occur after prolonged periods of inactivity, such as sitting or standing for long periods. Treatment for muscle spasms typically includes stretching and massaging the affected muscle, and nutritional guidance, like in the case of an electrolyte problem.

In severe cases, heat or ice therapy, medications, or sedatives may also be used to relieve pain and relax the muscle.

The tricky part is working out if your muscle spasm is caused by a pinched nerve in the first place! Let’s back up a moment and return to our pinched nerve scenario.

How to fix a pinched upper back or shoulder nerve quickly

Since the pressure of a pinched nerve can be caused by a herniated disc, bone spurs, or other tissues that are involved, there are several ways to relieve the pressure and reduce the symptoms for fast relief. Often with minor pinches, however, they will clear up on their own.

The obvious and most effective solution is to take pressure off the nerve root! Chiropractors, osteopaths, and sometimes physiotherapists, use spinal adjustments and manipulations to correct the fixated vertebrae involved.

Many times, a patient has believed they have a nerve pinch, when it’s a rib joint subluxation, or sprain.

This can feel like a nerve or muscle problem but is actually a joint problem, and these tend to settle quickly with the appropriate postural adjustments.

Why does my neck nerve keep pinching?

The origin of this is likely in your cervical spine. The cervical spine is the 7 vertebrae that support your head and allows you to move your head in different directions.

However, repetitive movements at home or work in the cervical spine can put pressure on the nerves that run through it, causing neck pain and related nerve symptoms like burning and tingling.

Another potential reason is because of reduced space at the intervertebral foramen (IVF). This is the space between the vertebrae in your spine where the nerves exit.

If this space becomes narrowed, it can cause compression of the nerves, leading to a feeling of pins and needles or numbness.

Lastly, if you have osteoarthritis, this can also cause your neck nerve to keep pinching where it exits the spinal bones to travel to your upper body tissues.

Is my leg pain from a pinched low back nerve?

Leg pain caused by a pinched nerve in the low back is common. It’s known as lumbar radiculopathy. If you have leg pain and low back pain at the same time, your issue is likely a low back pinched nerve.

This can happen if there is pressure on the nerve roots exiting your spine in the low back, causing symptoms to radiate down into your legs.

One example you may be familiar with is sciatica. This is when pressure on the sciatic nerve, which starts in the lower back and runs down the back of each leg, causes pain, numbness, or tingling in the legs.

A new and promising option for the pain of sciatica and pinched nerves is dry needling and acupuncture.

What happens with a long-term nerve pinch?

If a true nerve pinch is left untreated, it can potentially lead to permanent damage to the nerve. This is because prolonged pressure causes oxidative stress on the nerve sheath, causing it to break down.

Basically, the information along that nerve becomes compromised. This can result in decreased sensation and muscle weakness in the affected area.

Peripheral neuropathy is the name for nerve damage in the arms, hands, legs, or feet. Diabetics may get this, because of uncontrolled blood sugar. When peripheral neuropathy is from a nerve pinch, similar symptoms can occur.

Closer in, at the spine, a common reason for nerve pinch is from an intervertebral disc injury, such as a bulge. Many people ask about the long-term risks of a spinal disc herniation, so we wrote a comprehensive post on it.

That’s why getting a proper assessment with neurological tests is important if you think you have a pinched nerve – so you can tell it from a muscle spasm, which is usually less concerning.

The tests at your physical therapist, chiropractor, or doctor’s office can be quite simple, including:

• reflex tests
• muscle strength tests
• pinprick and light touch tests
• joint position (proprioception) tests

What are the dangerous causes of muscle spasms?

In some instances muscle spasms can be a worrying sign, so be on the lookout for persistent pain, or progressive or worsening spasms.

Dangerous causes of muscle spasms include:

• dehydration
• electrolyte imbalances
• multiple sclerosis – plaques develop in nerve tissue, affecting their function
• spinal cord injury
• spinal stenosis – direct pressure on the central nervous system in your spine
• amyotrophic lateral sclerosis (ALS or ‘motor neuron disease’)

What a muscle spasm from a pinched nerve feels like

Because every muscle is controlled by nerves, a pinched nerve can cause spasms because the signal is ‘confusing’ that muscle.

This may feel like an intense cramping or tightening sensation. It may even cause severe pain and referred sensations along the path of the affected nerve, for example from the neck and shoulder to the arm and hand.

The range of motion of the nearby joints will be reduced because the spasm causes tightness. So, patients with a muscle spasm from a nerve pinch feel very stiff.

This is the body’s protective mechanism to stop any further pinch or pressure happening around a nerve.

The best doctor to tell a pinched nerve from a muscle spasm

Ultimately, the best healthcare provider for this type of injury is one who has expertise in musculoskeletal conditions and experience diagnosing nerve pinches and muscle spasms. It’s important with muscle spasms to get an early diagnosis.

Seek out a physical therapist, or chiropractor. They will be able to provide an accurate diagnosis and appropriate treatment plan for your individual needs.

Your primary healthcare provider or general practitioner can also give a basic assessment of your symptoms, and determine whether they suspect a muscle spasm or pinched nerve. If they believe it to be the latter, they may refer you to see a neurologist for further testing.

Or, they may refer you to physical therapy or chiropractic care for spinal manipulative therapy, to relieve the pinch of the nerve, or treat the muscle spasm.