To suffer from a pinched nerve in your neck is an agonizing experience. Sharp, shooting pain down your shoulder and arm, together with irritating tingling in your fingers. Suddenly, your hand feels useless, and you drop things. You’re aware of the pain constantly, and it doesn’t go away even when you stretch. Even when you try to sleep, it simply feels worse. These are common symptoms of nerve compression in the neck (also called cervical radiculopathy).
The good news is that 75 – 90% of patients can recover from these symptoms without the need for surgery. Even though nerve pain is severe and causes a lot of concern, don’t lose hope. If you would like to understand this condition better, this article is for you.
Understanding the anatomy of your neck will help you know where the pinch and the pain are coming from.
Bones
Your cervical spine is made up of seven small vertebrae in your neck, labeled C1 to C7. These bones stack on top of each other to form the structure of your neck. Your neck supports the weight of your head and allows a wide range of motion, like turning, tilting, and nodding.
Discs
Between each vertebra is a spinal disc, which acts like a cushion and shock absorber. These discs have a soft, gel-like center and a tougher outer layer. They help keep your spine flexible and decrease the pressure between the bones.
Nerves
Running through the middle of the vertebrae is your spinal cord. It is a vital communication highway that connects your brain to the rest of your body. From the spinal cord, nerve roots branch out through small openings between the bones, exiting the spine to form a network of nerves that supply your arms, hands, legs, and feet. Each nerve is covered with a sheath, also called a myelin sheath. It speeds up the conduction of the impulses through each nerve. Inside this sheath is a fine network of arteries that provide the nerve with enough blood and oxygen.
Muscles
Surrounding all of this is a complex network of muscles. They play a key role in supporting your head, maintaining your posture, and moving your neck. The neck muscles, including the scalenes, levator scapulae, sternocleidomastoid, and upper trapezius, help control head and neck motion. Further down, shoulder and upper back muscles like the trapezius, rhomboids, and rotator cuff muscles work together to support posture and shoulder movement.
What do nerves do?
Nerves are the body’s electrical wiring system. These power cables are responsible for two-way communication from the brain to the hands and feet.
Some of the things that nerves do for you:
- Voluntary movement: Nerves allow you to control your muscles for different actions like walking, talking, and reaching.
- Senses: Your senses (touch, sight, smell, hearing, and taste) rely on nerves to transmit information to the brain.
- Involuntary actions: Essential functions like breathing, digestion, and a steady heart rate are controlled by nerves.
- Stress Response: The body’s fight-or-flight response to stress is controlled by your nervous system.
When a nerve is pinched or compressed, it affects the ability of the nerve to transmit and receive messages.
I think I have a pinched nerve in my neck. How did it happen?
The slow burn
The pain and discomfort that you become aware of with a pinched nerve in your neck don’t happen instantly. It’s a process that unfolds as the nerve becomes increasingly compressed and irritated.
It all starts when something, such as a herniated disc, bone spur, or tight muscles, puts extra pressure on the nerves in your neck. Nerves are incredibly delicate structures that need two important things to function well. Firstly, they are extremely sensitive to the blood supply and oxygen supplied by the vast network of small blood vessels around them. Secondly, they need to be able to move and glide inside the myelin sheath and between the different layers of tissue in your body. Compression on a nerve causes an immediate change in circulation and nerve movement. Ultimately, this affects the nerve’s ability to send and receive signals.
Inflammation starts a fire
This initial pressure creates inflammation around the nerve. It leads to swelling in the nerve and surrounding joints, and muscles. In response to this, your neck muscles tighten and form incredibly painful spasms. The spasms are there for a reason. To keep you from moving your neck too much and worsening the pinch on the nerve.
It spreads…
With continued pressure and poor blood flow, the pinched nerve starts to send abnormal signals down the arm. Now, you feel shooting pain down your arm, sometimes making your arm more sore than your neck. Together with constant and intense pain, other symptoms arise. It starts with an electric tingling in your fingers or an irritating numbness that doesn’t want to go away, even if you try to ‘shake it off’.
It quickly feels out of control
If the cause of the nerve compression isn’t found and treated, it can ultimately block the flow of impulses through the nerve completely. This leads to muscle weakness, leaving you with a heavy, weak arm. The longer the nerve remains irritated, the more intense and widespread the pain can become. With time, the pinched nerve becomes more sensitive through a process called sensitization. Now, the smallest movement or pressure leads to a big reaction (overreaction).
Causes of a pinched nerve
Disc herniation or bulge
These gel-like discs between your cervical (neck) vertebrae can bulge outward, impinging on the space where the nerve exits from the spine. It typically happens due to swelling or increased compression on the disc.
Facet joint sprain (Locked neck)
That sudden pinching pain that makes your neck ‘lock up’ in place. The facet joints form part of each neck joint and help with movements like turning your head. A facet joint sprain or pinch can often happen with a sudden movement like looking over your shoulder in the car.
Degenerative changes in your neck
These ‘wear and tear’ type changes happen in joints as we age. It is also called cervical spondylosis. The spaces between the vertebrae narrow, leading to increased pressure between the joints and nerve openings. And, sometimes osteophytes (also called bone spurs) form and can easily irritate a nerve that runs from the spine.
Poor posture and repetitive strain
Sitting hunched over a desk or computer for many hours puts immense strain on your neck muscles and joints. They have to work hard to support the weight of your head, and a position like that is not optimal. The more hours you spend like that, the more it adds to strain, pain, and muscle spasms. In turn, it increases the pressure and traction on sensitive nerve tissue in your neck.
Traumatic accidents or falls
Accidents that cause a whiplash effect on your neck can easily overstretch nerve tissue and lead to injuries of your neck joints or discs. It leads to inflammation and irritation of nerves in your neck.
How severe is the compression on my nerve?
In medical terms, nerve injuries are often classified into three levels of severity:
Neuropraxia is the mildest form, where the nerve is compressed but not permanently damaged. The outer covering (myelin sheath) surrounding the nerve is damaged, and this affects the conduction of signals through the nerve. Signals are slower than usual, but the nerve can recover completely.
Axonotmesis is more serious. The inner part of the nerve (the axon) is damaged, although the outer covering remains intact. That means almost no signals can run through this nerve. This type of injury can heal, but it takes much longer.
Neurotmesis is the most severe form, where the nerve is completely cut or torn.
While this classification is useful, we use other key areas to determine the severity of your pinched nerve:
Sensation changes
Changes in feeling are one of the first signs of nerve compression. You might notice numbness and tingling (pins and needles) in specific patterns along your arm and hand. The more pronounced and widespread these abnormal sensations become, the more significant the nerve irritation.
Muscle strength
Mention reflexes.
Irritability
Limitation of movement
Diagnosis
Physiotherapy diagnosis
Describe a sentence to give the patient confidence that we’re the equipped/best at diagnosing this problem.
“We can handle it” vs “Our knowledgable expert physiotherapists are well versed, confident, and experienced in their approach to diagnosing your…”
We follow a structured plan to diagnose, classify the severity, and determine the hierarchy of priority that your knee needs. We stress, screen and scan all the possibilities that could be causing your pain. Identify any other injuries to surrounding structures. If there is an injury to the ligaments, meniscus, muscles or nerve, or cartilage we will find it.
We understand the physiological healing stages you’ll go through, and custom-fit your treatment program. By knowing the extent of the tissue damage we can guide you through a structured program to recover faster and safely return to the things you love doing. That’s why our physiotherapists are the best at diagnosing this type of problem.
Why is it crucial to get/understand a diagnosis? Does it mean anything? Or is it a death sentence? or will you treat it differently if you know what you’re dealing with?
X-rays
Soft tissue, like disc and nerves, can not be seen on X-rays. X-rays will show us the integrity and alignment of the cervical vertebrae. This will enable us to see if there are any pathology of the vertebrae or loss of disc space. This may be an indication that the pinched nerve is caused by either inflammation around the disc or a bulging disc.
Muscles cannot be seen on an x-ray, so it will not be effective to diagnose a muscle spasm. X-rays will however show the integrity and alignment of joints in your spine. 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.
What are you looking for on an X-ray? Cortical stress lines, Displacement measurements, What Classification is done via X-ray?
Your physiotherapist can refer you to get x-rays taken if necessary.
Diagnostic ultrasound
Diagnostic ultrasound can be used to show the presence of a muscle tear (muscle strains), inflammation, swelling or simply increased contraction of a muscle (muscle spasms).
If you need an ultrasound, your physio will refer you.
MRI
An MRI scan can image all of the structures in your lower back, including soft tissue, discs, nerves and bones. However, for a muscle spasm an image like this is unnecessary and very expensive. If your physiotherapist suspects anything more than just a muscle spasm, you will be referred to the right specialist.
Is an MRI necessary for this diagnosis – if not when could it become a necessity?
Why is the pain not going away?
Discuss why the pain does not improve –
- This section assumes that NO intervention/ treatment/ personal care/medical attention is applied….
- A patient that leaves his fracture untreated, undiagnosed, what will happen
- Without treatment “wait and see” approach. – what’s wrong with it and the problems they’ll face.
- There is a risk of more critical and possibly irreversible damage if you don’t take the warning signs seriously.
- What slows down your recovery period
- Discuss – Non-union, Malunion, Prolonged healing, Abnormal Calllus formation,ect.
- You become stuck in a cycle of pain, not knowing if it is safe to move or not
- Make sure you are getting the right treatment from the start
- Without intervention, or treatment why is the tissue state not improving?
Why will this condition NOT resolve or recover on it’s own
Problems we see when patients come to us with …
A lot of patients come in terrified of moving their own necks because of X ray reports. “You have the spine of a 70 year old” is something we hear often. Do not fear, we are here to help you. Please bring any previous investigations and your concerns with you, we will discuss and explain anything that may be worrying you. A lot of people tend to stop their treatment as soon as they feel better. It is important to complete your rehabilitation to the end. If you wait too long the pinching may get progressively worse. Rather stop it in it’s tracks, than waiting until you have chronic pain.
Complications (guaranteed, or high probability of developing with this problem/diagnosis/condition.
- One concept per paragraph. Explain What resistance or problems can you encounter during the treatment process. Stay to the core message.
- Speak to your patient as if each of these is happening to them.
- Explain the WHY it’s a problem, not only state “it’s a problem”, but why…
- Not bullets – they are only to guide your thoughts. Choose a few (not all), and explain why its more severe.
- E.g. Not staying in the sling for the recommended period, “Taking the sling off occasionally to drive” Explain why its a problem.
- Compensation expectations
- Reasons that delay recovery time
Pain medication (how long is normal/ acceptable)
Misconceptions about treatment
Physiotherapy treatment
Please inspire confidence in your ability to test, identify, diagnose and treat/ deal with this.
Example:
Our priority is to determine the extent of the damage to your piriformis muscle. Then, we test the structures surrounding your hip and lower back to clear the nerve pathway and resolve the sciatic nerve pain. Avoiding nerve compression is crucial to prevent relapse and restore the sciatic nerve’s regular sliding. We must protect the muscle from overworking by differing forces away from the piriformis muscle, strengthen the surrounding muscles, correct the compensation, and retrain the correct firing pattern. This allows time for the piriformis muscle to adapt and heal. Our practitioners bring on a change and monitor the results until it’s working, and then we magnify the effects to get even better outcomes.
Patient asks you:
“So why should I come see you for … ?”
Your answer is…
- We can provide the best treatment for, provide guidance and answers., Implement a very effective and structured plan of action like
- Use the antonyms of the words the patient complains of. Instibility – stability/stable, Fear – confidence, worried – calm/carefree, anxiety – serenity
- And we will also look at (muscle strength, joint range of motion, flexibility, ligament stability, and nerve control.)
- Gradual strengthening, control, and conditioning.
Phases of rehabilitation
Keep your focus on the primary problem structure.
As long as I can see progression & functional expectations changing, Example:
- crutches
- 20% Weight (limited ROM)
- 50% weight (FROM)
- 100% weight with concentric & eccentric contractions
- Speed & Power (Jump)
Please work the PEACE & LOVE protocol into the Plan of Action (Not all in the first phase)
- Balance on one leg
- Perform a lunge
- Squat to 90 degrees
- Balance reactions (stepping out sideways, forwards & backwards)
- Jump & Land from a step
- Do a Single leg jump
- Sit in a crouched position & get up
- Jump over a hurdle
1st Phase: What you want to achieve (Week 0 – 1)
Functional expectation, what we’ll do.
E.g. “Our first aim is to get the proper diagnosis and identify and prioritize any contributing factors to your unique problem. Now, we can guide you in avoiding any aggravating activities for the time being and managing your symptoms. This includes a list of things that are safe to do and some that are not. ”
To progress to the next stage you should be able to …
2nd Phase: What you want to achieve in Week 1 – 2
What needs to happen in the tissue/ pathology to fix it
This is the thing you should be able to do by now
3rd Phase: What you want to achieve in Week 2 -3
Treatment elaborated
This is what you need to be able to do with ease so we can progress to the next phase of treatment.
4th Phase: What you want to achieve in Week 3 – 4
Re-inforce, strengthen, guide,
What you should be able to do by this stage is ….
5th Phase: Test return to normal life Week 4 – 6
To makes sure you’re safe to turn to
- Driving you should be able to
- Jogging you should be able to
- Run you should be able to
- Work
6th Phase: Final medical clearance tests (Week
By now, you should be able to jump and throw, but there are some specific stress tests you should be able to do.
By now, you should be able to return to your routine. During the final week of your …….. treatment, we want you to be able to train at your full capacity. ………….. should be able to handle stretch stress, max load, and compressive forces.
So we can sign off on your recovery, knowing you’re safe.
Healing time
Physio protocol time frame for healing (weeks/months)
- A full recovery and return to sport will take longer and should not be confused with the healing period.
- It takes about 3 to 4 months to return to exercise and sports.
- You will need physiotherapy treatment twice a week for the first two weeks.
- After this, your treatment sessions can be …
- Remember: “Non-operative Treatment” or Non- Surgical Not
conservative
Other forms of treatment
This section is about other treatments that can help the process services that can help – but we don’t provide.
- Your doctor (GP) will probably
- Pain meds, injections,
- Getting your back or neck ‘aligned’ or ‘clicked’ in the hopes of improving the … will not improve the state of the muscle or change your pain. It could even worsen or trigger a muscle spasm. You need to look at the bigger picture.
- 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 back brace won’t be the solution to your problem.
- Stretching or foam-rolling might ease your pain temporarily, but
Is surgery an option?
Surgery for pinched nerves in the neck
Surgery will only be considered if the nerve is in danger. That is you have no sensation and a lot of weakness. If not most specialists prefer their patients trying physiotherapy first.
If you do need surgery a decompression fusion is usually done from the front of the neck. Rods and screws and inserted to relieve the compression. There may be side effects to the procedure, neck rotation is sometimes limited because of the hardware.
Surgery is necessary when …
- These are the surgical checkboxes that must be ticked before surgery is even considered.
- Surgery is only Halfway mark for a successful surgery, the rest is the reintegration, strengthening and adapting your body to the change.
- Types of surgeries that can be done.
- Why is rehab important after surgery?
What else could it be?
- Whiplash
- Thoracic outlet syndrome
- Only mention a few (up to 5) differential Diagnosis
- Describe one symptom or difference between the two that sets them apart
- This section is for very similar Conditions but one or 2 differentiating factors.
Also known as
- Synonyms
- List key phrases (careful – start each bullet with different word)