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.

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.

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:

1. Voluntary movement: Nerves allow you to control your muscles for different actions like walking, talking, and reaching. 
2. Senses: Your senses (touch, sight, smell, hearing, and taste) rely on nerves to transmit information to the brain. 
3. Involuntary actions: Essential functions like breathing, digestion, and a steady heart rate are controlled by nerves. 
4. 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.

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).

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.

Symptoms are the words your patient will use – in a subjective assessment.

Try to resonate the exact words used by your patients to describe it to you. Then Read your symptoms again and imagine a patient reading it to you… (Does it fit into the Title Diagnosis) can you describe it even better (signs they haven’t even noticed yet)

Remember – Symptoms are Subjective Feelings of the patient. Use the words you expect a fractured fibula patient will say… Clicking, Stinging pain, Wabble, – Not “Abnormal movement of your lower leg” Rather describe what you expect to hear them say.

In this section more vague includes more scenarios, than specifics.

Use emotions to describe what they might feel:

• Hesitant to even open a door
• Scared to lay on that side, climb over a step
• Difficult to work on your computer
• Uncertain if you can train

Self-test your … at home with these modified tests and see if you might have a ….

Use your key phrases abundantly here, if you need a few more.

1. Load progression in your tests.
2. Do not use “try to..” – keep to clear instructions. It’s an ‘must do’ instruction. These are tests, must be clear and simple, and avoid words like: “attempt” “try”
   “attempt to cross your painful leg”, “attempt to bend”, “try and twist”.

Describe at least:

• Weight-bearing
• Loaded
• Unloaded
• Stretch/ End of Range

Choose 4/6 of the below signs and DISCUSS that you (as a professional) use to identify and classify as more severe than another person with the same diagnosis.

Meaning: Imagine there’s a group of 20 patients, all with this same diagnosis and you must rank them from ‘less severe’ to ‘more severe’ ~ What markers/ signs will you look for to make your hierarchy and group them?

• Frequency – Intermittent/Constant/ re-occuring
• Movement or static positions (rest) flare pain.
• Duration – Days, Weeks, Sudden, Short burst, change position of your … eases the pain.
• Size – Radiate – Shoulder, Upper back, Head…
• Intensity (pain) – bearable, pain doesn’t stop you, hesitant to
• Colour: Bruising, Blue, Red,
• Loading: Contraction, Low load required to bring on pain, High load (jump)
• ROM: Limitation? Less than 10 degrees limitation (not a  problem) vs completely locked up.
• Stiffness
• Swelling
• Intensity: Discomfort – Painful – Sharp sting

WHY is it a serious type of injury?

On a scale from 0-10 describe a picture of Regression.

• Ligament tear Gr 1 – 3
• Muscle strain, micro tear – complete separation split in fibers
• Tendon phase of degeneration
• Cartilage erosion, plugging, tears

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?

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 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.

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?

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

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

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.

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

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

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?

• 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.

• Synonyms
• List key phrases (careful – start each bullet with different word)