What is a Cervical Radiculopathy?
Despite the somewhat strange name, radiculopathy can be quite painful. The condition is commonly referred to as a pinched nerve, with pain, weakness or numbness spreading down the arm. Radiculopathy comes from radix = “root”, with the nerve root being the frequent site of nerve pinching.
What Causes Cervical Radiculopathy?
Radiculopathy generally occurs with irritation of the nerve root as it exits the spinal column. This irritation can be due to several reasons, including:
- physical compression of the nerve from a bulging disc or bony growth (osteophyte) at the edge of the vertebra
- chemical irritation from swelling around the nerve root
What are the Symptoms of a Cervical Radiculopathy?
Pain in your neck and radiating down your arm is the most common symptom. The worst pain is often felt further down the arm than in your neck. Compression of the nerve may also lead to impaired nerve function, meaning that you may have areas of reduced sensation in the arm or reduced power in muscles supplied by the compressed nerve. The graphic below shows common pain referral patterns for compression of nerves at different cervical spine levels.
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How is a Cervical Radiculopathy Diagnosed?
Your physiotherapist is skilled at determining which structures may be causing your neck and arm pain. There are specific questions that they may ask you to help narrow down the diagnosis, which helps guide a hands-on assessment. Your physio will palpate the muscles and joints around your neck, as well as perform testing of the nerves. If further investigation is required, an MRI is the best way to diagnose cervical radiculopathy. However, a CT scan or X-ray can still help with diagnosis.
Cervical Radiculopathy Treatment
PHASE I – Pain Relief. Minimise Swelling & Injury Protection
You are managing your pain. Pain is the main reason that you seek treatment for this condition and is our priority for you.
You are managing your inflammation. Inflammation is best eased via ice therapy and techniques or exercises that unload the inflammed structures.
Your physiotherapist will use an array of treatment tools to reduce your pain and inflammation. These include ice, electrotherapy, acupuncture, soft tissue massage, joint mobility techniques, taping techniques, or an arm sling to off-load the injured structures.
PHASE II – Restoring Normal ROM & Posture
As your pain and inflammation settle, your physiotherapist will turn their attention to restoring your normal joint range of motion (ROM), muscle length, neural tissue mobility and resting muscle tension.
Treatment may include joint mobilisation and alignment techniques, massage, muscle stretches and neurodynamic exercises, plus acupuncture, trigger point therapy or dry needling. Your physiotherapist’s experience in choosing the best methods to work for you will result in your prompt recovery.
PHASE III – Restore Normal Muscle Control & Strength
Researchers have discovered the importance of your muscle recruitment patterns with a standard order of deep, then intermediate and finally, superficial muscle firing patterns in healthy, pain-free people. Your physiotherapist will assess your muscle recruitment pattern and prescribe the best exercises for you, specific to your needs.
PhysioWorks has developed a rehabilitation programme to assist their patients in regaining standard muscle control of the neck and shoulders. Please ask your physio for their advice.
PHASE IV – Restoring Full Function
This stage of your rehabilitation is aimed at returning you to your desired activities. Everyone has different demands for their bodies that will determine what specific treatment goals you need to achieve. For some, it may only be to walk around the block. Others may wish to do boxing classes or return to labour-intensive work.
Your physiotherapist will tailor your rehabilitation to help you achieve your own functional goals.
PHASE V – Preventing a Recurrence
Injury and the pain associated does tend to return. The main reason is probably due to insufficient rehabilitation.
Your physiotherapist experience to identify underlying joint restrictions and poor muscle patterning can help you to work on these to prevent a recurrence.
What Results Can You Expect?
Disc and nerve injuries can take a while to recover as the blood flow to these structures can be reduced, meaning healing takes longer. Generally, acute radiculopathy will feel much better in one to two weeks, with a resolution by three months. Some cases will take longer, with slower improvements for up to six to twelve months.
Surgery is not a typical path but can be an option, particularly for patients with extreme pain and frank nerve symptoms such as complete loss of muscle power or sensation. Your GP may refer you to see a specialist. MRI scans may be requested.
Other Treatment Options
Specific Interventions, e.g. Injection
A cortisone injection or nerve block may assist if other treatment fails. You will need a referral from your GP or specialist for this.
Many patients find that soft tissue massage therapy is beneficial in the early stages of their rehabilitation to assist your pain relief, muscle relaxation and swelling reduction. Please ask your physiotherapist if you would benefit from a massage.
Acupuncture can be helpful to relieve your pain. If you are interested in trying some acupuncture, many of our therapists are acupuncture-trained. Please ask for their advice.
Carrying excessive body weight can predispose you to injury or pain.
General exercises are essential for keeping your body fit. If you have a specific activity you enjoy, please ask your physiotherapist if that activity will benefit your long-term health.
For this particular injury, other patients have benefited from the following activities: hydrotherapy, pilates, yoga, walking, swimming or cycling.
Some linaments and creams, such as Fisiocrem or Flexall, can provide pain relief by rubbing the cream into the neck, shoulder or arm. For more information, please consult your physiotherapist or doctor.
Neck Pain Causes
Neck Joint Injuries
Nerve-related / Referred Pain
When Should You Be Concerned About Neck Pain?
There is one situation where there’s no need to wait several weeks before deciding if your neck pain is serious.
If you’ve had an accident with forces that may have been sufficient to fracture your spine or tear nerves, seek a medical assessment as soon as possible. In this instance, either call an ambulance or head to a hospital emergency department.
Red Flags for Neck Pain
Otherwise, the rule of thumb is to start a more thorough medical investigation only when you meet all three of these conditions.
The three general red flags for neck pain are:
- it’s been bothering you for more than about six weeks
- it’s severe and/or not improving, or getting worse
- there is at least one other “red flag” (see below)
Red flags are reasons to seek a professional opinion rather than to worry. Seek the advice of your physiotherapist or doctor if any of these red flags apply to you.
- Light tapping on the spine is painful.
- A torn artery may cause severe, throbbing or constrictive (novel pain), with a high risk of a stroke. Pain is the only symptom of some tears. Most cases are sudden, on one side, and cause neck and head pain (in the temple or back the skull), but the pain is usually strange. Any hint of other symptoms? Promptly attend a hospital emergency.
- There are many possible signs of spinal cord trouble in the neck, with or without neck pain, mainly affecting the limbs: e.g. poor hand coordination; weakness, “heavy” feelings, and atrophy; diffuse numbness; shooting pains in the limbs (especially when bending the head forward); gait awkwardness. Sometimes patients present with both neck pain and more remote symptoms and don't realise they are related.
- Unexplained episodes of dizziness or nausea, and vomiting may indicate a problem with the stability of the upper cervical spine.
- Weight loss without dieting (it's a potential sign of cancer).
- Mystery fevers or chills, especially in people with diabetes).
- A severe headache that comes on suddenly is a “thunderclap headache”! Most are harmless, but it is always wise to investigate thoroughly.
- Symptoms of meningitis (inflammation of the membranes covering the brain and spinal cord, caused by infection or drug side effects). The presence of a fierce headache or an inability to bend the head forward, fever, or an altered mental state.
- The main signs that neck pain might be caused by autoimmune disease specifically include:
- a family history of autoimmune disease,
- gradual but progressive increase in symptoms before the age of 40,
- marked morning stiffness,
- pain in other joints as well as the low back,
- difficult digestion,
- irritated eyes, and
- discharge from the urethra (bladder).
- Steroid use, other drug abuse, and HIV are all risk factors for a serious cause of neck pain.
- If you feel pretty unwell in any other way, that could indicate that neck pain isn’t the only thing going on.
More info: Neck Pain