A "pinched nerve" in the neck is also referred to as cervical radiculopathy. It is a pain that originates in the neck and radiates ("radicular") to the shoulder, shoulder blade, arm and/or hand, even down your back. The patient with cervical radiculopathy will also complain of generalized weakness in the arm and hand. Though most patients affected by cervical radiculopathy happens most to people in their 50's, it also happens most often with athletes, heavy laborers and workers working with vibrating machinery, and people who sit for long stints of time. Folks who have arthritis in the neck are also prone to cervical radiculopathy. Physical Therapy is very effective in reducing symptoms and improving posture, strength, and function. In fact, most patients who are treated by conservative physical therapy recover from their condition without the need for surgical intervention.
The following are some very common pinched nerve injuries that we see at Stride Strong's Portland Physicial Therapy Clinics and a summary of what physical therapy can do to help rehabilitate these injuries.
How Does A Pinched Nerve Happen?
There are nerve roots that emerge from the spinal cord from the center of our spine. When the cervical (neck) nerve roots become compressed, this can cause neck pain and/or numbness and a tingling in the arm and shoulder. The compression of the nerve roots can happen for various reasons. In the younger population, this is usually a result of cervical disc herniations due to trauma. In other more chronic cases and older individuals cervical radiculopathy happens because of chronic arthritis and desiccation or collapse of a cervical disc.
The cervical spine is made up of 7 cervical vertebral bones. The vertebra is separated by a gel-like disc and stack on top of each other to form the spinal column. The purpose for the discs is to provide shock absorption to the spine as the body moves and pushes through other external forces. The spinal cord travels through the central canal of all the spinal vertebrae and spinal nerve roots branch out at different levels through holes called foramen. The foraminal opening is supported by disc height and bony structures. When the disc height is reduced, the bony structures can constrict this foraminal opening and the spinal root can be "pinched". Spinal nerve roots innervate multiple aspects of the arm and provide the informational connection where motor and sensation signals pass through.
Spinal nerves can be impinged by:
- Arthritis or a loss of disc height from aging and use
- Herniated or bulging discs
- Spinal stenosis and foraminal narrowing from bone spurs
- Tumor impinging the nerve root
When spinal nerves are impinged, messages cannot be properly passed on to muscles and therefore the motor control suffers of the relative muscle. Since cervical spinal nerve roots innervate the arm, this would result in weakness in the arm. Also, the region of the arm cannot properly send messages of sensation so this can be interpreted by the brain as pain, numbness or tingling.
Symptoms of Pinched Nerve/Cervical Radiculopathy
Symptoms can vary depending on the nerve root involved, but symptoms usually are felt on the same side of the affected nerve. The patient may feel:
- Neck pain, pain in the shoulder blade, shoulder joint, upper chest, or arm. The pain may radiate to the fingers following the nerve root pathway.
- Pain is usually described as "sharp" in the neck.
- General dull ache or numbness in the regions innervated by the pinched nerve.
- Shoulder, arm, or hand weakness
- Pain that is aggravated by neck movements.
- Pain is relieved by putting the arm rested over and behind the arm (this relieved tension on the pinched nerve).
The following regions are innervated by the spinal nerves and can cause the following symptoms:
- C5 nerve root: weakness in the deltoid muscle and upper arm; shoulder pain and numbness
- C6 nerve root: weakness in the bicep muscle and wrist muscles; numbness on the thumb side of the hand. This a common presentation in pinched cervical nerves.
- C7 nerve root: weakness in the triceps muscle; numbness and tingling in the back of the arm and the middle finger. This is also a very common presentation.
- C8 nerve root: hand grip weakness; numbness in the little finger.
How Do I Know If I Have a Pinched Nerve?
Your physical therapist at Stride Strong Physical Therapy will perform a thorough evaluation that encompasses a subjective history about your symptoms, and also a full objective exam with special tests to better ascertain where the affected area is and particularly which nerve and where the dysfunction lies. There are several hints that would help your PT hone this in better – so it would behoove you to prepare answers to these questions when you come in for your first visit:
- How your pain started: was the injury spontaneous from trauma to the neck?
- The location of the symptoms: have they been consistent, or has the region changed since the pain started?
- What are the aggravating and alleviating factors of your pain?
- What job functions or positions are in a lot for work? For hobby/recreation?
Your physical therapist then test the range of motion of your neck and your upper extremities. To be sure of nerve involvement, he/she will also check your tendon reflexes and strength along with special tests to rule in or rule out a pinched nerve diagnosis. If symptoms are severe, and your PT thinks that other interventions (cortisone injection, surgery) may be needed, they may refer you to an orthopedic physician or neurosurgeon for further diagnostics. These tests may include MRIs or EMGs that will show extents of soft tissue injury, disc bulges and nerve function.
How Can Physical Therapy Help With A Cervical Pinched Nerve?
As mentioned before, physical therapy is very effective in treating cervical pinched nerves and can oftentimes help alleviate all of the symptoms. Following are some treatment methods your physical therapist may employ in your treatment:
Pain Management. Initially, your physical therapist will want to give you some pain relief by way of ice packs or hot packs. Ice is effective in reducing inflammation so is very useful in acute situations where the injury is traumatic or sudden. Nerve pain can oftentimes be caused by excessive inflammation along its pathway, so ice would be a good therapy if the inflammation is ongoing. Conversely, heat therapy is effective in relaxing the muscles and soft tissues of the neck so any muscles that tighten around the offending nerve will be less tensioned. Your PT may also guide you through better sleep positions so you are aggravating your symptoms as you sleep.
Manual Therapy. Your physical therapist will manual therapy techniques to relieve pressure and compression in the cervical region. One such method is cervical traction, whereby the vertebrae are given a gentle pull from each other, thereby increasing blood flow to the joints, stretching neck muscles on a micro level, and also spacing out disc height for the foramen to open up and alleviate nerve pinching. Your PT may also use myofascial release to relieve tension in the muscles and introduce better circulation in the neck area.
Posture Education. Posture education is the biggest key in recovery. Workstation adjustments may be needed to promote a better-working posture for you, and your PT will help guide you through this. Your PT will also give you strong suggestions on how to sit, stand and perform daily functions with good body mechanics so you don't keep injuring your neck. Though this can be a lot of hard work on your part, it is the most valuable component of recovery and should not be taken lightly. It is a very likely chance that if you have chronic cervical radiculopathy, your posture has a lot to do with the cause and progression of the disease itself.
Range-of-Motion Exercises. A fundamental part of neck injury recovery is to restore pain-free range of motion. It is important that all of your range of motion is pain-free and should not be forced. If you neck feels stiff after a long day's work at the computer, your PT will show you some gentle stretches to regain some fluidity in your range of motion. This will help your overall mobility and also decrease pressure in the cervical spine.
Strengthening Exercises. In order to keep a good posture and perform activities with good body mechanics, you need to have strength to be able to hold those positions healthily for some time. Your Stride Strong PT will prescribe to you strengthening and stabilization exercises of the neck and shoulders to help your hold your head in a healthier manner. When your nerves start to calm down from being pinched and aggravated, you will also need to gradually strengthen the muscles innervated by these nerves so you regain function. Starting Day 1 of your PT program, you should be going home with a set of home exercises given to you by your physical therapist. Regular practice of these exercises will build your strength and stamina until you can be discharged with a healthier and effort-free posture.
Functional Training. As you symptoms improve, and your strength, range and posture improves, your PT will start coaching you back to doing functional activities that mimic daily life. So if you are in sports, your PT will go over movements that you typically perform to make sure you are still observing the same posture and good body mechanics as you do these activities. Same goes for job duties and computer work.
Can Cervical Radiculopathy Be Prevented?
Cervical radiculopathy and its resultant pinched nerve pains can absolutely be prevented. Maintaining proper posture, as mentioned before, is key to preventing cervical degenerative damage. This includes how you sit and position yourself while doing computer work, or while you are using the phone and other twisting/bending movements that you do all day. Setting up your workstation is key here since you spend most of your day there. Click here to read about how to achieve a better workstation environment. Other good tips to prevent cervical radiculopathy is also maintaining a healthy lifestyle through exercise and conditioning to maintain muscle flexibility and strength for the upper extremity, shoulders, upper back and core. Good exercise routines and keeping a healthy weight will also help minimize extra forces on your spine, since being overweight can also increase the compressive forces on your spine over time.