Cervical radiculopathy describes the pathology where the nerve roots of your neck are compromised. This can happen due to inflammation or compression from other structures of your neck. In essence, it only describes the group of symptoms you experience and not the root cause of your problem. Which is of course an issue with the nerve root! A trapped nerve in your neck causes pain, weakness, numbness or pins and needles down your arm or shoulder blade. This is because the nerves of your neck supply the skin and muscles of your arm and hand. Cervical neuropathy affects people between 40 and 50 years of age and men more than women. This article explains where physiotherapy aids cervical radiculopathy treatment. Knowledge is power and understanding what is going on in your neck helps your cervical radiculopathy therapy.
The Anatomy of your Cervical Nerve Roots
Your nerve roots exit above each vertebra of your spinal cord to form nerve roots C1 – C8. These nerves roots branch out, like a growing plant, to form an intricate network of routes, almost like a map of a big city, like London. Your nervous system is very complex. These routes run along your neck to your arm, to form your brachial plexus and then divide to form the three main peripheral nerves (median, ulnar and radial) that supply your arm and hand.
Surrounding your nerves are bone, ligaments, discs and muscles. The joint complex refers to the entire team who work together to allow movement. This team includes two cervical vertebrae, the disc in between, the ligaments that aid in stability and the muscles that attach or pass over the joint to generate movement. All these components directly affect the neck joint’s movement and can contribute to pressure on the nerve if injured.
What do my cervical nerves do?
Your nervous system is an intricate network that allows information to travel through your body. Nerves function like power cables. They run from the main power supply (your brain) to the tips of your fingers. Like power cables, our nerves are also enclosed within a sheath, the myelin sheath. The myelin sheath protects the nerve, like the plastic around a power cable. It also enhances the speed at which a message is carried. Think broadband versus fibre. Our nerves can also glide within the myelin sheath that surrounds it.
These power cables are responsible for two way communication from the brain to the fingertips. Any precision task, like writing or playing an instrument, is planned in the brain. The nerves can send information to the brain about the position of your fingers on the keyboard, how hard you are hitting the keys and any other sensations like temperature and pain.
A pinched nerve in your neck is agonizing. Damage or injury to the nerves can lead to an interruption of this communication system, with painful and debilitating consequences.
How did I get a trapped nerve in my neck?
The intervertebral foramen, where the nerve root exits the spine, is tiny. That makes the nerve root especially susceptible to compression from anything that occupies space. Inflammation, disc material or bone can cause direct pressure on your nerve roots.
Inflammation
Injury to any structure will cause an inflammatory response. These inflammatory changes can cause direct pressure on the nerve root. Pressure on the nerve root then causes your symptoms of acute, sharp pain, pins and needles, numbness or weakness.
Disc herniation
A neck disc herniation happens when there is a tear in the outer layer of the disc, causing the inner core to bulge out. This causes swelling and inflammation in the area which takes up space and irritates the nerves in your neck. In some cases this bulge of the disc causes direct pressure on the nerves exiting the spinal cord.
Spondylosis
Cervical spondylosis is normal degeneration of the structures in your neck. This includes intervertebral discs, facet joints and ligaments connecting these structures to one other. This is a natural process that happens over time, like getting wrinkles and grey hair.
Disc material loses fluid and becomes thinner over time, like a flat tyre. This brings the vertebrae closer together and causes facet joints to enlarge because of bearing more weight. Arthropathy (largening of joints) and osteophytes (bony protrusions) take up some of the limited space and directly cause nerve root impingement.
Causes of trapped nerve in neck
Your risk of developing neck joint degeneration is higher after injury or trauma – like a car accident, fall, rugby injury, disc prolapse/bulge – or excessive strain due to posture, sport or work – like dentists, computer work and cycling. The following positions, hobbies, injuries or habits increase the likelihood of sustaining a cervical disc herniation or spondylosis that causes cervical radiculopathy:
- age
- whiplash injury
- motor vehicle accident
- fall from height
- desk work with poor ergonomics
- poor posture
- weak shoulder girdle
- work that requires head down position (chef, surgeon, dentist, nail technician)
- musicians (violinists, guitarists)
- sport (rugby, cycling, gymnastics)
Cervical radiculopathy results from continuously neglecting seemingly minor injuries or symptoms.
How severe is my Cervical Neuropathy?
Nerve pathology by definition feels more painful than a muscle injury. Depending on the cause of your nerve root symptoms, intensity and frequency of your pain can vary.
Irritation of the nerve root causes a heightened response of the nerves. Pins and needles, tingling and weakness are the nerve’s way of prompting you to get help. Any information, although painful, is better than no information.
Nerve root compression causes the nerve to slowly lose function. Numbness, loss of sensation and power need immediate medical attention.
Cervical myelopathy, where the spinal cord is compressed, causes loss of sensation and strength. You can experience symptoms on both sides, clumsiness and bowel and bladder dysfunction. This requires emergency medical attention.
Deterioration of nerve function requires immediate medical attention.
Diagnosis of Cervical Radiculopathy
Physiotherapy diagnosis of trapped nerve in neck
Our physiotherapists are experts in anatomy, we have experience in movement disorders and understand how the biomechanics of your ribcage can contribute to your cervical radiculopathy. Do you want to get to the root cause of your problem? We have a structured plan to diagnose, classify the severity, and determine the hierarchy of priority that your trapped nerve needs. We will guide you on the road to recovery.
As physiotherapists, we understand the physiological healing stages you’ll go through, and custom-fit your treatment program accordingly. By knowing the extent of the tissue damage we can guide you through a structured program to safely return to your work, hobbies and sport.
X-rays
X-rays show the integrity and alignment of the vertebra and joints of your neck. This will enable us to see if something is wrong with the structure of the bones in your spine or if there is a loss of disc space. Degeneration, facet joint arthropathy, stenosis and osteophytes will be visible on X-rays, but we cannot visualise any soft tissue structures.
Your physiotherapist can refer you to get x-rays taken if necessary.
EMG
Electrophysiologic studies and nerve conduction determine the nerve’s ability to relay messages and the speed and accuracy of these messages. These tests can only be ordered by a specialist. However, we can do a clinical neurological assessment in the rooms, comparing soft touch, pain, temperature, reflex and power output of your nerve roots. This is adequate to diagnose cervical radiculopathy and track your recovery. If your symptoms deteriorate we will refer you to the right specialist to get the studies you need.
MRI
An MRI scan shows all of the structures in your neck, including soft tissue, discs, nerves and bones. If we suspect a disc herniation to be the cause of your trapped nerve and you experience deterioration of nerve function, we will refer you to the right specialist to get the imaging you need. Clinical evaluation is sufficient to diagnose cervical disc herniations and start treatment.
Why is my cervical neuropathy pain not going away?
If you ignore your trapped nerve it will force you to listen at some stage. The longer you wait to seek help, the more compensatory movement patterns you need to break in the future. You risk more, and possibly irreversible damage, if you don’t take the warning signs seriously.
Nerves are critically important to communicate from your brain to your limbs. Just like your heart needs to supply itself with blood, your nerves have their own protective information system when compromised. If your nerves suffer from inadequate blood and oxygen supply or direct compression, pain is the message you will receive. This is your body’s way to force you to take action.
If you wait and see the messages will get loader and the pain more frequent or more intense. Sensitized nerves respond to any message, not only potential or actual threats. Like sunburn makes the touch of your clothes feel painful, sensitized nerves will send big messages for small impulses.
Pins and needles, numbness and weakness can become permanent if not treated.
Problems we see when patients come to us with trapped nerve in neck
Waiting too long
The longer you wait, the bigger your chances of causing unnecessary complications. Before you run off to the ER, our practitioners can detect, prioritize and establish the severity. It’s best to let it be seen to within the first 48 hours of symptom onset. The longer you wait, the more compensation kicks in. This brings up challenges in the treatment process that can be avoided.
Starting strenuous activities too fast
It soon feels better with treatment and some rest, but hold on before you aim to tick off everything that was neglected on your to-do list. A common trend amongst patients is to continue as before, as soon as they’re feeling a bit better. Just like a scab heals, the physiological healing process takes a while before it is strong enough to take some strain. We’ll give you milestones that must be achieved to enable your neck to adapt, overcome, and come back stronger. Our goal is to keep you as active as possible but safe.
Medication
Overusing pain medication to get you through the things you must do – is a short-term solution. You run the risk of more severe tissue damage, compensation, and abnormal tissue healing that can cause long-lasting effects. In some cases, it is irreversible. Medication is a pain management tool for the first month of your recovery.
Incorrect diagnoses and treatment
This article and all the information we provide are to give you a better idea of what the spectrum of the problem can be. However, making the wrong assumptions and doing more advanced exercises or stretches in the wrong healing phase can delay your recovery. There’s a lot of advice online on what to do, but they have no idea the extent of your tissue damage and severity, not to mention the subtle secondary complication you may have. Instead, know exactly what you’re dealing with before jumping into home remedies.
Misconceptions about treatment
“I’m feeling better, so I must have healed”
“I don’t have time for my rehab exercises”
“I don’t need all these sessions”
Everything worthwhile takes time. You will regret not seeing your treatment through till the end in the future when you have early onset degeneration, facet joint arthropathy and stenosis. The arrogance of youth is believing you are invincible, or won’t suffer any consequence of your injury. Do the work, see it through and prevent feelings of regret in the future.
Physiotherapy Cervical Radiculopathy Treatment
Our physiotherapists are experts in rehabilitation and understand biomechanics. We have studied how joint movement can influence the local tissue, but also contribute to areas further away. Changing your pillow or posture can greatly decrease your pain. Improving your neck strength will aid in stability and the body will be less inclined to seek stability from osteophytes and muscle spasms. Muscle spasm is one of the main reasons why people eventually decide to come see us.
We understand how stabilisers are different from mobilisers and what each one needs. Flexibility, control, endurance and strength are the commodities we deal with daily. There are no shortcuts to healing. It’s important to find a balance between enough movement to keep the muscles strong and the joints moving, and too much movement that will cause a spike in pain. We will guide you to find this balance and do the right exercise at the right time as your cervical radiculopathy treatment progresses. We will guide you every step of the way.
Phases of Cervical Neuropathy Rehabilitation
1st Phase of Cervical Radiculopathy treatment: Pain management (weeks 0 – 2)
Once we have established the cause of your cervical radiculopathy, we can guide you to avoid certain “closing movements” that contribute to your symptoms. Your sleep and work posture may need to change. Treatment will focus on pain management with plenty of manual techniques, including massage, joint mobilisation, traction, laser therapy, dry needling and strapping as needed. Your exercises will include regular movement breaks, small neutral setting holds and some stretches to gain flexibility and improve general posture.
Once you know what positions contribute to your symptoms and how to gain some relief at home, we can move on to the next phase of your cervical radiculopathy treatment.
2nd Phase of Cervical Radiculopathy treatment: Range of Motion (weeks 3 – 4)
Neural mobility is even more important than joint movement now and you can expect some nerve gliders, sliders or flossing. If your nerve feels happy and safe to move, your muscles and joints will automatically be more inclined to allow movement.
You can expect some isometric setting exercises of your neck now and resisted training of shoulder and upper back stabilisers to ensure better alignment and decrease the likelihood of recurrence.
3rd Phase of Cervical Radiculopathy treatment: Kinetic chain (weeks 5 – 6)
Now the real fun starts as we delve into endurance of stability. You can expect to see us less often, but get more homework to do. The aim is to ensure that all those contributing factors we identified during your evaluation, like forward head posture, thoracic kyphosis, rotator cuff weakness and decreased pectoral length is addressed and lasting change is made.
4th Phase of Cervical Radiculopathy treatment: Reintegration (weeks 8 – 10)
During this phase of your cervical radiculopathy treatment, we make sure you can maintain the good habits that we have established. We can reintegrate your normal exercise/training routine with your rehabilitation exercises.
Healing time for trapped nerve in neck
Every condition is unique and healing time will be different for all. The cause of your symptoms, paired with the method of injury will greatly determine how fast you can return to your hobbies or training.
In general cervical radiculopathy takes 6 – 8 weeks to heal. You will not experience the same intensity of pain throughout this period but will need to avoid aggravating factors and positions as we slowly reintegrate regular movements into your rehabilitation program.
You will need treatment twice a week for the first two weeks of your recovery for pain relief. Thereafter you only need treatment once a week as you gain movement. The duration of your rehabilitation will greatly depend on your commitment to your home exercise program. Diligent participation in strengthening exercises improves endurance and stability in a shorter time.
If your sport is contact-based we aim to get you back on the field in better condition than before your injury. Whiplash or concussion may lengthen your rehabilitation journey. Gymnasts and yogis practising headstands and shoulder stands may face the longest recovery to get them back on their heads as safely as possible.
Other medical cervical radiculopathy treatment
- Your doctor (GP) will probably prescribe anti-inflammatories, analgesics, muscle relaxants or anti-epileptic medications to decrease inflammation, pain and nerve irritability.
- These medications can be taken orally, as an injection or repository to limit gastrointestinal side effects.
- Getting your neck ‘aligned’, ‘adjusted’, ‘manipulated’ or ‘clicked’ without knowing the cause of your cervical radiculopathy could worsen your symptoms.
- Injection therapy, like epidural corticosteroid injection, can be considered but is not without risk.
- A biokineticist will be able to help you in the final stages of your rehabilitation and get you back to training for your sport.
- Wearing a neck brace won’t solve your problem, but it may limit movement and ease symptoms for the first few days after your injury. It is important to not get accustomed to wearing a brace full-time, as this will lengthen your recovery process unnecessarily.
- Be wary of “quick fixes” and magic treatments, if it sounds too good to be true, it probably is.
Is surgery an option for the trapped nerve in my neck?
Surgical intervention is considered where non-surgical physiotherapy treatment of a minimum of 6 weeks was unsuccessful or where nerve function is deteriorating. Your unique situation will guide your surgeon’s approach.
Anterior Cervical Decompression and Fusion (ACDF) is the most common procedure chosen, where two vertebrae are fused together using rods and screws to establish better height between adjoining vertebrae and decrease compression of your nerve roots. The cost is loss of movement after surgery.
Disc replacement can be considered for single level pathology in younger patients.
The research shows that patients receiving surgical intervention are not necessarily better off than their non-surgical counterparts one year later. On the contrary, they experience more restrictions in movement because of the intervention. The mistake people make is thinking that “fixing” the loss of height is all that needs to be done. But your body needs to learn to move again with these changes and that takes time and effort. Your post-surgical rehabilitation is even more important than your surgery.
What else could it be?
Isolated disc pathology causes localised, central symptoms only. You will experience the same limited movement, but the pain remains in your neck area only.
Whiplash described the method of injury, more than the injured structures and can cause similar neck pain that radiates down your arm.
Similar symptoms of pins & needles can be accompanied or caused by vascular constriction within the thoracic outlet.
Isolated nerve symptoms, pins & needles, weakness or loss of sensation following a compression or traction-like injury, like a fall.
Peripheral nerve entrapments, like carpal tunnel, cause symptoms distally only.
Cervical radiculopathy is also known as:
- cervical neuropathy
- trapped nerve in neck
- pinched nerve
