My MRI Says Foraminal Stenosis. Is My Nerve Actually Being Pinched?

By Dr. Brad Gorski, DC, FSBT | Elite Family Chiropractic | Charleston, SC

You open your MRI report and see “moderate foraminal stenosis.” Maybe it says “severe.”

Is my nerve being pinched? Is this why my arm or leg hurts? Am I going to need surgery?

Foraminal stenosis means the opening where a nerve exits your spine has narrowed. It is commonly described on MRI, but the finding alone does not prove that the nerve is causing your symptoms or that you need surgery. The next step is to match the imaging with your symptoms and examination.

At Elite Family Chiropractic, that connection guides the conversation: which finding matters, how the nerve is functioning, and what level of care makes sense for you.

What is foraminal stenosis?

Think of your spine as a building with a main hallway and smaller exit doorways.

The central spinal canal is the main hallway. The foramina are the openings on either side where nerve roots leave the spine. “Stenosis” simply means narrowing.

Foraminal stenosis means one or more of those exit doorways has become smaller. Your report may also call it “neural foraminal narrowing” or “neuroforaminal stenosis.”

A narrowed doorway does not always mean the nerve is compressed. In some cases, there is less space around the nerve without visible deformation. In others, the surrounding structures crowd or flatten it. Some people have foraminal narrowing without symptoms.

Is this different from central canal stenosis?

Yes. When people hear “spinal stenosis,” they often think of central canal narrowing. Foraminal stenosis affects a different space.

You can have either finding or both. A report that says “no significant central canal stenosis” can still describe foraminal narrowing.

The main hallway may have enough room even when an exit doorway is crowded.

What makes the nerve opening smaller?

Several changes can reduce the available space:

• A disc bulge or herniation can extend toward the opening.

• Loss of disc height can reduce the height of the opening.

• Degenerative joint changes and bone spurs can take up space around the nerve.

More than one change may contribute. A disc can lose height while nearby joints enlarge, narrowing the same opening from different directions.

That is why “foraminal stenosis” tells us where space has been lost, but we still need to understand what is narrowing it. A disc-related problem and narrowing caused mainly by bone may lead to different conversations about treatment and recovery.

If your report mentions both terms, our explanation of disc bulges versus herniated discs on MRI can help you understand the distinction.

Why do symptoms often affect just one arm or leg?

Each nerve opening has a location and a side. When a nerve root is affected there, symptoms often develop on that same side, in areas supplied by the involved nerve.

In the neck, symptoms may travel into the shoulder, arm, or hand. In the lower back, they may travel into the leg or foot.

Symptoms can include pain, tingling, numbness, or weakness. One-sided symptoms are common, but narrowing can affect both sides or several levels. Symptoms also do not always follow a perfect textbook map.

The side and location give us clues. We still need an examination to determine whether the MRI finding fits.

Is a pinched nerve the same as radiculopathy?

You may hear one provider call your condition a pinched nerve and another call it radiculopathy. They can be describing the same underlying problem, but the terms are not always interchangeable.

“Pinched nerve” is an everyday term for a nerve being compressed or irritated. It can refer to a problem near the spine or elsewhere, such as the wrist or elbow.

Radiculopathy is more specific: it means a spinal nerve root is not functioning normally. This may produce changes in strength, sensation, or reflexes, sometimes alongside pain traveling into an arm or leg. Traveling nerve-root pain is often called radicular pain; it can occur without measurable loss of nerve function.

Foraminal stenosis describes the narrowed opening. Radiculopathy describes dysfunction of the nerve root. One can cause the other, but an MRI finding of narrowing does not automatically establish radiculopathy.

Can an EMG/NCV confirm radiculopathy?

When the diagnosis needs clarification, we may coordinate electromyography and nerve conduction studies, often referred to as EMG/NCV.

The needle EMG checks electrical activity in selected muscles for evidence of nerve-root injury. Nerve conduction studies help distinguish that problem from conditions such as a nerve being compressed at the wrist or elbow.

Testing can help confirm radiculopathy and identify the involved nerve root. However, it is not required in every case. A normal result does not completely exclude radiculopathy, particularly early in its course or when the problem primarily affects sensory fibers.

MRI shows the structures around the nerve. EMG/NCV adds information about nerve and muscle function. We interpret both alongside your symptoms and examination.

What do mild, moderate, and severe mean on an MRI?

These words describe the degree of narrowing seen on the images. Grading methods vary, but the general idea is:

Some lumbar grading systems specifically use changes in the nerve’s shape to define the most severe grade. These labels describe imaging findings; they are not pain scores or automatic surgery recommendations. Research on MRI grading

“Severe” deserves careful review. “Mild” should not end the evaluation when someone has persistent symptoms or weakness.

How do we know whether the finding explains your symptoms?

When I review an MRI with a patient, I look for a reasonable match between the image and what is happening clinically.

That includes:

• Side and level: Does the narrowed opening fit the affected arm or leg and suspected nerve root?

• Nerve function: Are strength, sensation, or reflexes changing?

• Symptom behavior: Which positions and movements reproduce or ease symptoms?

• Progress: Are you improving, staying the same, or losing function?

For example, if the main MRI finding is on the right but all your symptoms are on the left, I would look more closely before attributing your pain to that finding.

The examination also helps identify other explanations, including nerve problems outside the spine.

An incidental finding is a real change that may not explain the current complaint. Recognizing that possibility helps us avoid building a treatment plan around the wrong problem.

Let’s translate a sample MRI sentence

Here is an illustrative lumbar MRI sentence:

“L4-L5 moderate left neural foraminal stenosis with contact of the exiting left L4 nerve root.”

Here is what it means:

• L4-L5 identifies the level between the fourth and fifth lumbar bones.

• Left neural foraminal stenosis means the nerve’s exit opening is narrowed on the left.

• Moderate describes the degree of narrowing.

• Contact of the exiting left L4 nerve root means tissue is touching that nerve as it exits.

“Contact” does not automatically mean the nerve is flattened or permanently damaged. If the report describes compression, that is a more specific structural finding.

Either way, we still need to determine whether the examination and symptom pattern fit the left L4 nerve.

Can chiropractic and conservative care help?

For appropriately selected patients, chiropractic care can be part of a conservative plan to improve comfort, movement, and daily function. The approach depends on what is narrowing the opening, how the nerve is functioning, and whether symptoms are improving or progressing.

As a chiropractor, my first responsibility is to determine whether conservative care is appropriate and what that care should involve. At Elite Family Chiropractic, we review your examination and available imaging before recommending treatment.

When a disc problem contributes to the narrowing, we may consider whether spinal decompression therapy is appropriate as part of your individualized plan. It is not suitable for every patient and should not be presented as a way to remove bone spurs or permanently reverse foraminal stenosis.

Care may also include individualized hands-on treatment, activity guidance, and coordination with physical therapy or an exercise program.

We monitor more than pain. Can you sleep, walk, work, or use your arm more comfortably? Are strength and sensation stable or improving?

Those changes help us determine whether the plan is working and whether another provider needs to become involved.

When should pain management become involved?

Co-management can be especially useful when nerve pain interferes with sleep, daily activity, or participation in rehabilitation, or when progress has stalled.

A pain management physician can evaluate medication options and whether a targeted procedure is appropriate. For some patients with nerve-root pain, an epidural steroid injection may provide modest, mainly short-term relief. 

These injections aim to reduce inflammation. They do not remove the bone or disc material narrowing the opening.

Improving pain control may help someone participate more comfortably in rehabilitation while we continue monitoring nerve function and recovery.

I view that consultation as part of a coordinated treatment plan. The goal is to bring in the right provider when their expertise can help.

When might surgery be necessary?

A surgical opinion becomes more important when there is significant or worsening weakness, loss of function, or disabling symptoms that persist despite appropriate nonsurgical care.

The MRI should identify a problem that reasonably matches those findings.

Depending on the cause, surgery may remove tissue crowding the nerve or enlarge its exit opening. A procedure called a foraminotomy creates more room at that doorway. 

A consultation helps clarify your options. It does not commit you to an operation. Some patients need that opinion early rather than after a prolonged course of treatment.

Which changes should not wait?

New or worsening weakness, including difficulty lifting the front of your foot, warrants prompt medical assessment. Sudden major weakness needs emergency evaluation.

New inability to urinate, loss of bladder or bowel control, or numbness around the groin or saddle area requires emergency care. These symptoms can signal a broader nerve-compression emergency and should not be attributed to a routine foraminal-stenosis finding. 

What should I ask about my MRI?

Bring your report and, when possible, access to the actual images. Useful questions include:

• Which opening is narrowed, on what side, and which nerve could be affected?

• Does the finding match my symptoms and examination?

• Is there evidence of radiculopathy, or is the narrowing an imaging finding without clear nerve dysfunction?

• Would EMG/NCV testing help clarify the diagnosis?

• What improvement are we looking for, and what would trigger a referral?

Frequently asked questions

Does foraminal stenosis always cause a pinched nerve?

No. It describes narrowing around a nerve’s exit. That narrowing may irritate or compress the nerve, but some people have the finding without related symptoms.

Can I have foraminal stenosis without central canal stenosis?

Yes. The exit openings and central canal are different spaces. Narrowing can affect either one or both.

Does radiculopathy have to be confirmed with an EMG?

It should. Radiculopathy can be diagnosed clinically using the history and examination, with imaging helping identify a possible cause. EMG/NCV can provide additional confirmation or clarify an uncertain diagnosis, but a normal test does not rule out every case.

Can symptoms improve even if the narrowing remains?

Yes. Pain and function can improve without every structural change disappearing. Persistent or worsening weakness needs reassessment even if pain becomes less intense.

Does severe foraminal stenosis mean I need surgery?

Not automatically. The decision depends on symptoms, nerve function, examination findings, and response to appropriate care. Significant or progressive neurological changes may require an earlier surgical opinion.

Understanding your next step at Elite Family Chiropractic

If your MRI says foraminal stenosis, you deserve an explanation of what it means for you and a clear plan for what comes next.

At Elite Family Chiropractic in Charleston, I review the available imaging alongside your history, examination, and response to previous care. My fellowship training in spinal biomechanics and trauma informs how I evaluate the relationship between spinal structure, movement, and your symptoms.

Our goal is to help you understand what your spine needs and connect you with the care that can help.

Schedule an evaluation at Elite Family Chiropractic to discuss your MRI findings, your symptoms, and your next step.

Author

Brad Gorski DC, FSBT At Elite Family Chiropractic in Charleston, South Carolina, Dr. Brad Gorski is a top-ranked chiropractor offering effective treatment options for back pain, knee pain, neck and shoulder pain, sciatica, migraines, pinched nerves, herniated discs, and more. Dr. Gorski received his Doctor of Chiropractic degree from Palmer College of Chiropractic in Davenport, Iowa in 2008. He has completed extensive post-graduate training, becoming qualified in Hospital Based Spine Care, MRI Interpretation Review, and Trauma while also completing a Fellowship in Spinal Biomechanics and Trauma. He provides chiropractic care and helps his patients achieve their goal of optimum health and wellness.