Numbness and pins and needles. What are they telling you?

Numbness is one of the most common complaints within the musculoskeletal physiotherapy world. It gives a good clue that there is some nerve involvement to the symptoms. I will always ask whether there is any numbness or pins and needles involved with someone's pain, because it will often change my assessment approach, shifting my attention towards the nerves, rather than joint, muscular, tendon or ligament issues. It’s not always black and white, sometimes numbness can be caused by a compression on a nerve that is caused by swelling following a soft tissue injury, especially with traumatic injury as seen in sport.

Firstly, we want to identify how severe the neural implications are. When mentioning numbness, if concerning, a full neurological examination will be performed to ensure nothing more serious like nerve route or spinal cord compression is the cause. Although very rare, you should always have a full neurological examination before treatment commences if neurological symptoms are present. A detailed subjective should also be gathered to work out of there are any other issues, like fibromyalgia, diabetes, or multiple sclerosis (MS) which may be having an impact.

The assessment will gather information on the dermatomes (skin receptors), myotomes (muscular strength), reflexes and upper tracts (spinal cord). Any abnormality should be investigated further, but the presence of any of these issues does not equate to anything worrying in isolation. Your assessor should build a picture and decide whether the problem is caused by a simple irritation to the nerve, which can replicate some of these symptoms.

Once anything more serious is cleared from the diagnosis, it’s important to work out where the irritation is coming from. Often it can be coming from the spine itself, but a nerve can be irritated anywhere along its path by muscles or joints, and it can often be these areas that are causing the problems too. Once the source of the nerve irritation is identified, a treatment approach needs to be selected. Stretching, strengthening and a series of manual technique like traction, mobilisations and massage/soft tissue release should provide fast, natural and effective relief.

If you have numbness as a symptom, you should have it assessed by a professional who can identify the cause and can respond appropriately. Thorough neurological assessment is often essential to identify the cause, and identify the most effective treatment approach. Physiotherapy can help- before the numbness, pins and needles or pain becomes anything too serious, and identify quickly what the best treatment strategy is.