The “Funny Bone” Experience

By: Dr. Jeremy Bate, PT, DPT

Have you ever slammed your elbow into something and gotten that numbness/tingling that travels down your arm? Then inevitably, you hear someone say “Oh you hit your funny bone. Not so funny I guess!”. Meanwhile, you’re trying to give a polite, wan chuckle while you wait for the symptoms to go away. Or maybe you’ve sat on the toilet too long scrolling on your phone - it happens. Then when you try to get up, your leg feels numb, tingly, weak, or all three. 

In some people, that numbness and tingling can happen with no apparent cause or it can persist for long periods of time. This can technically occur anywhere in the body, but it occurs most commonly in arms or legs. Often, this is due to something called radiculopathy. 

What is Radiculopathy?

I’m glad you asked! Radiculopathy is a condition in which there is a compression or entrapment of one of the nerve roots that exits your spine. The spine is a complex structure built with nerves, muscles, blood vessels, cartilage, and ligaments. Sometimes, poor positioning of the spine (such as in scoliosis) or something like a disc herniation can cause increased compression of the nerves and create the same kind of sensation that happens when you hit your funny bone.

The spine has many segments called vertebrae to protect the nerves, support your torso, and allow for freedom of movement. There are spaces in between each set of vertebrae that allow for the nerves to exit and enter. These nerves have a big job: they control your movement and deliver sensory information back up to the brain.

Here is a visual example:

This is a small section of your spine. The yellow cords are the nerves that I’m referring to. Those blue-grey cushions in between the bones are the discs. These sit between each vertebrae to help absorb shock and facilitate movement. 

Sometimes, those discs can become “herniated”. This often occurs from overstressing them and causing a portion of them to protrude outward from their normal position. A common example of this happening is lifting something heavy with poor body mechanics or trauma such as a car accident. Here is what a herniation looks like compared to a normal disc:

See how the herniation protrudes and presses on the nerve? That is how the symptoms of radiculopathy start. When the nerves are irritated or compressed, they are not able to send/receive signals normally. The end result is the numbness, tingling, and weakness that persist or worsen with movement. 

These herniations most commonly occur in the cervical spine (neck) and lumbar spine (low back). Herniations of the cervical spine typically cause the “funny bone” symptoms in the arms and in the lumbar spine, they cause the symptoms in the legs. Typically symptoms are one-sided, but it is possible to have them in both legs/both arms. In cases of severe herniations or nerve compressions that cause severe symptoms such as incontinence, surgery is warranted to repair this. But in a majority of cases, physical therapy is highly effective in improving the condition.

How Does Physical Therapy Help?

The goal of physical therapy treatment with radiculopathy/disc issues is not to put the disc back into place. Unfortunately, we cannot put a herniation “back into place,” due to the structural changes that occur in the disc itself. It’s like taking the jelly out of a donut and then trying to put it back in. 

In physical therapy, we typically focus on reducing symptoms by improving mobility, strengthening the appropriate muscles, manual therapy/joint mobilizations, correcting strength imbalances, improving posture, and addressing biomechanics to prevent re-injury. These help to support the spine and prevent excess stress on the nerves and surrounding structures. 

For many people, they will see minor improvements in symptoms overall, but notice that they’ll tend to get stuck or plateau with no further improvement. The problem is that many physical therapy clinics tend to focus only on the symptoms and strengthening portions of treatment. While this may be helpful, the best type of care includes finding the root cause of the issue and focusing there. 

This may come in the form of poor lifting mechanics that are exacerbating symptoms. Maybe there is a postural imbalance causing increased pressure on the nerve. It could even be something such as sleeping position causing increased nerve tension and symptoms. Unfortunately, whatever the case may be, these are often overlooked details in physical therapy clinics. Many times, treatment ends up being a few minutes of manual therapy and then a strengthening program that is loosely supervised by the therapist. 

What Do We Do Differently?

In my experience, when people hit that plateau point, that’s a sign that I need to dig a little bit deeper and find the root cause causing someone to get stuck. However, it is difficult to perform an accurate assessment and investigation of this when you’re treating 3-4 patients at once, supervising rehab aides and assistants, and trying to write documentation all at the same time. 

For example, at one of my previous jobs, I had a person with cervical radiculopathy that reached a point where his symptoms were about 25% better, but he still had numbness and weakness in the hand that limited his ability to play golf. He ended up on my schedule one day after about 1 month of working with his regular therapist with minimal progression. I did a brief assessment and found that the issue was coming from his lower back, which nobody had assessed before. 

He had a postural imbalance due to a prior lifting injury that caused him to tilt his torso slightly to the right and then tilt his head slightly to the left to balance everything out. After working on his low back mobility, posture, and adding some core strengthening, he was sitting straighter and felt significant relief of his symptoms. He was able to get back to driving, and after about 1 more month, he played 9 holes of golf. I worked with him to assess his golf swing and prevent exacerbation of his symptoms while he played. 

At Pulse, this is the level of care we always strive for. We focus on 1-on-1 care for the whole session and we look for these root causes right from the start. Being 1-on-1 allows us to focus on the issues relevant to your specific case and finding those overlooked details to get the most out of every session. The focus isn’t on juggling multiple patients, supervising, and documentation. The focus is on collaborating to reach your rehab goals.