"It's Just Muscular" — What Acute Care Actually Meant and What Usually Helps Next
- Dr. Lucas Marchand
- 2 days ago
- 5 min read
By Dr. Lucas Marchand, DC — MyChiro Mobile Chiropractic, Sioux Falls, SD
The text came in on a Sunday afternoon:
"Pinched nerve. Went to acute care. They JUST sent me home and said it's 'muscular.' Gave me steroids and a muscle relaxant."
The frustration behind those two sentences is palpable and completely understandable. You drove to an acute care clinic because something was wrong. You waited. You were seen. And you left with a prescription and a diagnosis that felt like a non-answer — because "it's muscular" doesn't tell you what happened, why it happened, or what's going to make it better.
This is one of the most common clinical situations I encounter as a mobile chiropractor in Sioux Falls. Not because acute care did something wrong — in most cases they did exactly what they should have done — but because the gap between what an acute care visit can offer and what a patient actually needs for this kind of complaint is real and worth understanding.
What Acute Care Is Actually Good At
Acute care clinics are designed for a specific clinical problem: ruling out emergencies quickly and managing symptoms in the short term. For back pain and neck pain presentations, that means screening for the red flags that would indicate something genuinely dangerous — fracture, infection, spinal cord compression, cauda equina syndrome. If none of those are present, the acute care visit has done its primary job.
The medications that follow — steroids to reduce inflammation, muscle relaxants to address the protective muscle guarding — are appropriate short-term interventions for managing the symptom load while the acute phase resolves. They're not a cure. They're a bridge.
What acute care is not designed to do is identify and address the underlying mechanical problem that produced the pain in the first place. That's not a criticism of the providers — it's a structural reality of the setting. An acute care physician seeing twenty patients in a shift doesn't have the time, the tools, or the training focus to assess which specific spinal segment is restricted, which muscles are guarding and why, or what combination of postural, ergonomic, and mechanical factors created the conditions for the episode. That assessment is what a musculoskeletal specialist visit is for.
What "It's Muscular" Actually Means
When an acute care provider says "it's muscular," they're communicating something specific and something vague simultaneously.
The specific thing: the imaging they ordered — if they ordered any — didn't show a fracture, a significant disc herniation compressing the cord, or structural damage requiring immediate intervention. The presentation is consistent with a soft tissue complaint rather than a bony or surgical one. That's genuinely useful information, even if it doesn't feel like it in the moment.
The vague thing: "muscular" doesn't distinguish between a muscle strain, a muscle in protective guarding around a restricted joint, a trigger point referring pain into a predictable pattern, or the chronic neuromuscular tension that builds around a chronically loaded spinal segment. These are meaningfully different presentations with different treatment approaches, and "it's muscular" covers all of them without differentiating.
The steroid and muscle relaxant combination addresses the acute inflammatory component and the surface-level muscle tension — which is appropriate for managing the immediate pain. It doesn't address whether there's an underlying joint restriction that the muscle is guarding, which is the piece most likely to produce recurrence if left unaddressed.
What a "Pinched Nerve" Actually Is
The term "pinched nerve" is patient language for a specific clinical experience — pain, numbness, tingling, or weakness that follows a distinct pattern suggesting nerve involvement. Clinically, this usually means one of three things.
True nerve root compression — where a disc herniation or bone spur is physically compressing a spinal nerve root as it exits the vertebral column. This produces dermatomal symptoms — pain and sensory changes that follow a specific pattern down the arm or leg corresponding to the affected nerve level. This is the presentation that sometimes requires imaging and occasionally surgical consultation when neurological deficits are significant and progressive.
Nerve root irritation without compression — where inflammation in the surrounding tissue is irritating the nerve root without physically compressing it. This produces similar symptoms but is typically more responsive to conservative care and resolves more completely with appropriate treatment. Most "pinched nerve" presentations fall into this category.
Referred pain from joint and soft tissue structures — where the nerve isn't actually involved but the pain pattern mimics nerve involvement. The facet joints, the sacroiliac joint, and trigger points in the surrounding musculature all refer pain in predictable patterns that patients and occasionally providers interpret as nerve pain. Treatment directed at the nerve or the disc in these cases is addressing the wrong structure.
Distinguishing between these three requires a clinical assessment — orthopedic testing, neurological screening, palpation, and movement analysis — that an acute care visit rarely has time to complete thoroughly.
What Usually Helps After the Acute Care Visit
The medications will do their job over the next few days. The steroids will reduce the inflammatory component. The muscle relaxants will take the edge off the protective guarding. During that window, a few things help the process along.
Gentle movement rather than rest. The instinct toward bed rest is understandable but counterproductive for most muscular and joint presentations. The tissue needs circulation to heal, and sustained rest reduces circulation while allowing the protective guarding to become more entrenched. Walking — gentle, flat, nothing that provokes sharp pain — is more useful than lying still.
Ice in the first 48-72 hours for acute inflammatory presentations. The heat vs ice question deserves its own full answer — the short version is that heat applied to an actively inflamed area in the first few days after an acute episode can amplify the pain rather than reduce it, despite feeling soothing in the moment.
Positioning that reduces the nerve load. For lumbar nerve root irritation, gentle lumbar flexion — knees to chest, fetal position — often reduces the compression. For cervical nerve root irritation, the arm position matters — some presentations are relieved by placing the hand of the affected side on top of the head, which reduces tension on the nerve root by taking slack out of the brachial plexus.
When to See a Chiropractor After Acute Care
The medications manage the acute pain. What they don't address is the underlying mechanical picture — which restricted segments are contributing to the nerve irritation, what the surrounding tissue looks like, and what combination of treatment will reduce the episode most efficiently and reduce the likelihood of recurrence.
The treatment sequence at MyChiro for nerve root presentations starts with percussion therapy to reduce the protective guarding that's been compressing the affected area, PIR stretching to restore the range of motion that's been restricted, and specific adjustment to the segments that are mechanically contributing to the nerve irritation. The sequence is conservative and appropriate alongside the medications from the acute care visit — chiropractic care and the medications aren't competing approaches, they address different parts of the same problem.
Most acute nerve root presentations that receive appropriate chiropractic care within the first one to two weeks of onset respond significantly better than presentations that wait for the medications to work and then return to baseline only to recur in a few months when the same mechanical conditions are recreated.
The Text I Sent Back
To the patient who sent that message — I told him tp move gently, use ice rather than heat for the next day or two, and call me when he was ready to address what the acute care visit didn't have time to. He booked two day.
If you've been sent home from acute care with a similar diagnosis and similar medications and you're wondering what comes next — that's exactly the situation MyChiro is built for. The clinic comes to you. Same-day appointments are usually available.
Book your visit here. Or call or text (605) 201-4862.
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