A pinched nerve (commonly called cervical radiculopathy) can be a real pain in the neck. This occurs when nerves that exits your neck are compressed or irritated near your neck bones. A pinched nerve in your neck can have a number of symptoms:
- Neck pain. pain is typically felt toward the back or side of the neck. It can range from a mild pain to a sharp or burning pain.
- Radiating pain. The pain can radiate down to the shoulder, arm and hands. This radiating pain can often range from a mild ache to a sharp shooting type of pain.
- Numbness/Weakness. If the disc is irritating the nerve it may result in weakness in your shoulder, arm or hands for example reduced strength whilst making a fist.
- Worsening pain with certain head movements. For example looking over your shoulder when you check your blind spot driving may make the pain worse.
- Neck stiffness.
To understand a pinched nerve in your neck let’s run through some anatomy. Your spine is made up of 24 vertebral bones. The seven vertebral bones at the top of your spine form your cervical (neck) region of your spine. Your nerves run from your brain down into your spinal cord parts of the nerves then branch off at each vertebral level coming out through small exit spaces called neural foramen (as you can see in the picture below). The yellow bits are the nerve roots.
What causes cervical radiculopathy?
As you can see from the picture anything that causes the neural foramen to narrow or any inflammation around this area can affect the nerves. A “pinched nerve” in the neck will most commonly occur at the sixth or seventh cervical vertebra level.
The two main factors that can narrow and cause inflammation around the foramen are
- Degenerative changes that occur within the cervical spine with age. As we age our disc height becomes smaller which puts more pressure on the facet joints this can lead to foramen narrowing. Other factors can also include cervical osteoarthritis (link)
- Herniated disc less common then in the lower back, approximately 25% of cervical radiculopathy will be caused by a herniated disc this can lead to compression and lack of oxygen to the nerve around the neural foramen
How do Physiotherapists help with this condition?
Physiotherapy is the best profession to allow accurate diagnosis and treatment for this condition. During our Initial assessment we will take a detailed history to establish when the pain started and any relevant contributing factors. Once we have a clear history and understand exactly where your neck, shoulder and/or arm pain or sensation changes are this will allow us to arrive at an accurate diagnosis. We know that having some of these symptoms can sound alarming and dangerous but it is important to keep in mind that the vast majority of patients will make a full recovery with appropriate physiotherapy treatment. Additionally, 90% of patients with this condition will not need further scans. Our physiotherapists see this condition nearly every day and are experts at diagnosing and formulating the correct treatment to help you.
Once we the diagnosis of cervical radiculopathy has been made we can begin treatment straight away in our very first session. Every particular case is different depending on the assessment however treatment can be thought about in three distinct stages.
Stage one involves offloading the pinched nerve and helping with pain relief. Our expert knowledge of anatomy allows us to utilise specific movements and positions that will help relieve pressure on the nerve. For instance this may involve passively moving your neck or gently tractioning your neck to offload the nerve whilst closely monitoring your response. In this stage depending on your severity we may also trial pain killers (in conjunction with your G.P.). We may also utilise massage, mobilisation of stiff cervical joints, heat or cold therapy, taping and gentle neck range of motion exercises to help with the pain as well as discussing sleeping tips and everyday neck postural strategies.
The next stage of treatment involves specific strengthening and postural exercises for your neck. This will be based around any of your individual symptoms or strength deficits we found in your assessment. We will give you a home exercise program and ask you to do these exercises multiple times per day.
Stage three involves transitioning towards any sport specific movements such as running jumping, changing direction with a focus on neck control and positioning during such movements. We will also focus on introducing the specific neck exercises into your ongoing everyday life even after the pain has subsided eg maybe you implement 1-2 of the exercises into your warm up routine before you go for a run or play sport.