Cervical Radiculopathy

Cervical Radiculopathy

Article by John Miller

Cervical Radiculopathy

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.

cervical radiculopathy

File:Radicular-pain.png. (2012, February 24). Physiopedia, . Retrieved 06:12, July 22, 2020 from https://www.physio-pedia.com/index.php?title=File:Radicular-pain.png&oldid=49601.

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

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.

Massage

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

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.

Weight-Loss

Carrying excessive body weight can predispose you to injury or pain.

General Exercise

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.

Other Options

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.

Article by John Miller

When Should You Be Concerned About Neck Pain?

What's Urgent?

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. This means to either call an ambulance or head to a hospital emergency department.

Red Flags for Neck Pain

Otherwise, the rule of thumb is that you should start a more thorough medical investigation only when all three of these conditions are met. The three general red flags for neck pain are:

  1. it’s been bothering you for more than about six weeks
  2. it’s severe and/or not improving, or getting worse
  3. 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 but not all cases are sudden, on one side, and cause both 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.
  • A fierce headache, an inability to bend the head forward, fever, or altered mental state. These are all symptoms of meningitis (inflammation of the membranes covering the brain and spinal cord, caused by infection or drug side effects).
  • 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,
    • rashes,
    • 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

Article by John Miller

How Can You Relieve Your Neck Pain?

Neck Physiotherapy Treatment

The best treatment for your neck pain is determined entirely by the specific reasons for WHY you are suffering neck pain. Everyone is different, but there are some common similarities.

Your physiotherapist is highly skilled at the diagnosis and treatment of mechanical neck pain and headache. Posture correction is essential, but it depends on the availability of enough joint and muscle flexibility to attain a good posture, plus muscle strength and endurance to maintain your proper position. Address any deficit.

We understand that your neck pain may not be solely about stiff or wobbly joints or tight/weak neck muscles. A whole gamut of information that your physiotherapist will analyse during your diagnostic consultation and then commence correcting your problems. They'll also consider other systemic conditions that can cause neck pain, e.g. cancer, and direct you towards the appropriate healthcare practitioner if necessary.

Fortunately, the vast majority of neck pain does come from your neck joints and muscles. Pleasingly, researchers have shown that a combination of neck joint and muscle treatment performed by your physiotherapist and some specific strengthening exercises are an effective way to eliminate your neck pain, stiffness and headaches.

Please get in touch with your trusted healthcare practitioner for advice specific to the diagnosis and management of your neck pain.

Common Neck Pain Treatment Options

If you are in severe neck pain or have a stiff neck, it is best to assess promptly to exclude any red flag conditions such as cancer and then commence the best neck treatment straight away.

Chronic neck pain can be a lingering problem due to habit. Research tells us that symptoms lasting longer than three months become habitual and are much harder to solve.  The sooner you get on top of your neck symptoms, the better your outcome.

What's the Best Pillow for Neck Pain?

contour.pillow_sml

The correct pillow is also vital. If you are waking through the night or in the morning with a stiff or painful neck, it may be that it's your pillow and not your neck that is the cause.

Will A Posture Brace Help Your Neck Pain?

Posture support braces have improved over the years, with new designs beneficial in building awareness of the correct posture. Bracing or posture taping is excellent for teenagers, the elderly or those using computers.

There are various posture braces available. You can find more information about posture braces via our online shop.

Should You Wear A Neck Collar?

A neck collar is not recommended for most non-traumatic injuries as the collar encourages muscle weakness. However, in severe neck spasm conditions such as wry neck or whiplash, a collar is sometimes used in a few days to assist with muscle relaxation. Rarely is a neck collar required beyond four days.

Please ask your physiotherapist for specific advice.