Physical Therapy Guide to Cervical Radiculopathy
Cervical radiculopathy is often referred to as a pinched nerve in the neck. It is defined by pain that may radiate (extend) from the neck to the shoulder, shoulder blade, arm, or hand. Weakness and lack of coordination in the arm and hand also can occur. The condition affects about 85 out of 100,000 people, and most often occurs in people in their 50s. It often develops from repeated irritation rather than a single injury. Athletes, heavy laborers, and workers who use vibrating machinery are commonly affected. People who sit for long periods, or those with arthritis in the neck region, also may be affected.
Conservative care, including physical therapy, can help reduce symptoms. A physical therapist can help relieve the acute neck and arm symptoms that result from the condition. They also can help people improve general strength and function. Most cases resolve with physical therapy and do not require surgery.
Physical therapists are movement experts. They improve quality of life through hands-on care, patient education, and prescribed movement. You can contact a physical therapist directly for an evaluation. To find a physical therapist in your area, visit Find a PT.
What Is Cervical Radiculopathy?
Cervical radiculopathy occurs when a nerve root near the spinal cord in the neck becomes compressed. This can be caused by:
- Arthritis and/or wear and tear of discs with age.
- Herniated or bulging discs from trauma or degeneration (decline over time).
- Narrowing of the spaces in which the nerves travel (spinal stenosis).
- Tumors (cancerous or benign) that impinge (touch or put pressure on) the nerve root.
The cervical spine consists of seven vertebrae (the bones that form the neck region). Each vertebra is separated by a gel-like disc that provides shock absorption for the spine. The spinal cord connects to the brain and travels down through a canal in the vertebrae. Cervical spinal nerve roots branch off the spinal cord and go to specific locations in the arm. Cervical spinal nerves send signals from the brain to the arms to move. They also enable feeling in the limb. The spinal cord is like a tree trunk, and the spinal nerves are like the tree branches. If there is abnormal pressure on a branch near the trunk, everything along that branch will be affected.
When the spinal nerves are impinged (or have pressure put on them), they cannot properly transmit messages from the brain to the muscles. Impinged nerves also will cause altered or absent sensation (feeling) in the arm along the route the nerve travels. This is why a pinched nerve in the neck can cause pain, weakness, and loss of feeling in the arm.
How Does It Feel?
Symptoms of cervical radiculopathy vary depending on the nerve root involved. Typically, symptoms occur on the same side of the body as the affected nerve and may include:
- Pain that is described as "sharp," "pins and needles" or a “popping sensation” in the neck region.
- Pain in the neck, shoulder blade, shoulder, upper chest, or arm. Pain also can radiate (branch out) into the fingers following the path of the involved nerve root.
- A dull ache, numbness/tingling, or an electrical sensation anywhere along the pathway of the nerve.
- Weakness in the shoulder, arm, or hand.
- Pain that worsens with certain neck movements. Often looking toward the ceiling and over the shoulder causes or increases pain.
- Symptoms that improve when the arm is lifted over and behind the head. This movement relieves tension on the spinal nerve.
Symptoms may be specific to the nerve root involved. Examples of the nerve root location and related symptoms include:
- C5 nerve root (between cervical vertebrae C4-C5):
- Weakness in the deltoid muscle (front and side of the shoulder) and upper arm.
- Shoulder pain and numbness along the outside of the upper arm.
- C6 nerve root (between cervical vertebrae C5-C6):
- Weakness in the bicep muscle (front of the upper arm) and muscles that extend the wrist.
- Numbness on the thumb side of the forearm and hand.
- C7 nerve root (between cervical vertebrae C6-C7):
- Weakness in the triceps muscle (the back of the upper arm) and muscles that curl the wrist.
- Numbness and tingling in the back of the arm and the middle finger of the affected hand.
- C8 nerve root (between vertebrae C7-T1):
- Weakness with hand grip.
- Numbness in the little finger and inside of the forearm.
The most common nerve root levels for this condition are C6 and C7.
How Is It Diagnosed?
Your physical therapist will conduct a thorough evaluation. This will help them determine all the factors that may contribute to your condition. Cervical radiculopathy often develops from repeated irritation rather than a single injury. Your physical therapist will begin by asking questions to gather information about your:
- Health history.
They may be helped by forms you fill out before your first session. The interview will become more specific to the symptoms of cervical radiculopathy. Your physical therapist may ask you questions such as:
- How did your injury occur?
- How have you taken care of the condition, such as seeing other health care providers?
- Have you had imaging (X-ray, MRI) or other tests and received their results?
- What are your current symptoms, and how have they changed your typical day and activities?
- Do you have pain, and if so, what is the location and intensity of your pain?
- Does the pain vary during the day?
- Do you have trouble doing any activities?
- What activities are you unable to do?
- What movements cause you pain?
- Are there any ways you reduce the level of your symptoms?
This information helps your physical therapist better understand what you are experiencing. It also determines the course of your physical exam.
The physical exam will vary depending on your interview. Most often it will begin with observing the region of your symptoms and any movements or positions that cause pain. Your physical therapist also may examine other nearby areas. The physical exam may include:
- Gently testing the movement of your neck and arms.
- Checking your tendon reflexes and strength.
- Conducting special tests on your neck and upper extremity. These tests will help detect which spinal nerve root(s) may be involved and rule out other conditions.
To confirm the diagnosis, your physical therapist may team with an orthopedic doctor or other health care provider. Your doctor may order further tests, such as:
- Magnetic resonance imaging. An MRI can show soft tissues, including the spinal cord and nerve roots. It also can identify what is causing the nerve compression (such as ruptured or bulging discs).
- An EMG measures the nerve and muscle function. This test can tell how well your spinal nerves communicate to your muscles.
If surgery is needed, a physical therapist can work with you to help you recover and improve function after surgery.
How Can a Physical Therapist Help?
Physical therapy is an effective treatment for cervical radiculopathy. In many cases, physical therapy completely resolves symptoms. Your physical therapist will develop a treatment plan specific to your condition. It will be based on the findings of your initial evaluation. Your treatment plan may include:
Posture education. Posture education is an important part of helping you get better. Your physical therapist may suggest adjustments to your workstation and work habits. The goal of any change is to promote good posture and protect your neck. In the early stages of recovery this may mean sitting only 15 to 20 minutes at a time. They also will instruct you on how to safely bend, reach, and lift throughout the day. Proper posture will ensure that you place the least amount of pressure on your spinal discs.
Pain management. The first goal is to reduce the pain and inflammation in the area. Ice applied to the neck and shoulder blade area during the first 24 to 48 hours after pain begins can help reduce inflammation. Moist heat can be used after 48 hours to help the surrounding muscles relax. Your physical therapist may advise you to wear a soft cervical collar for short periods throughout the day. This will allow your neck muscles to relax. They also may recommend you use a contoured pillow to support your neck for more comfortable sleeping.
Manual therapy. Your physical therapist may use hands-on therapy, such as manual cervical traction. This will relieve pressure in the neck area. Traction can help provide immediate relief from pain and arm numbness. Your physical therapist also may gently massage the muscles of your cervical spine and shoulder blade area. This helps your muscles relax and improves circulation to promote healing and pain relief.
Range-of-motion exercises. Your physical therapist will teach you gentle neck mobility exercises. These will help to relieve your symptoms and allow you to return to normal movement. As you begin recovery, it is important that none of these exercises increase your arm pain. If they cause pain, describe your symptoms accurately to your physical therapist. If you spend many hours sitting at a desk during your workday, your neck may become stiff. Your physical therapist also will teach you gentle neck stretches. These stretches will reduce pressure on your neck from too much sitting, to help improve movement.
Strengthening exercises. Your physical therapist will help you determine which muscle groups need to be strengthened. Exercises will be based on which spinal nerves are involved in your case. When pain no longer extends down your arm, you may begin more aggressive strengthening exercises. Neck stability (strengthening) exercises also will be performed. You also will receive a home-exercise program. This will help you continue to strengthen your neck, shoulder, arm, and upper back long after formal physical therapy has ended.
Functional training. As your symptoms improve, your physical therapist will work on functional exercises. These exercises will help you return to your job, sport, or other daily activities. If your job requires certain tasks, your physical therapist will teach you ways to do them to reduce undue stress on your neck. This may include instructions for:
- Overhead reaching.
- Managing long periods of sitting.
Can This Injury or Condition Be Prevented?
Your physical therapist will educate you on how best to prevent cervical radiculopathy from recurring. Your instructions may include guidance on:
- Maintaining proper posture. Sitting in a proper position while at your desk or in the car helps you keep ideal spinal alignment. It also reduces abnormal forces on the cervical spine. Your physical therapist may recommend changes to your chair to help with alignment.
- Workstation setup. It is important to set up your desk or workstation to minimize undue forces on the spine. Your physical therapist may advise you to make some changes to your work environment, such as:
- Using a hands-free phone.
- Adjusting your computer monitor to avoid excessive twisting or extending of your neck.
- Setting up your desk and chair properly for your height.
- Exercise. Your physical therapist may provide you a home-exercise program to help you maintain:
- Flexible spinal muscles.
- Range of motion.
- Strength in your neck, upper body, middle back, and core.
- Activity modification. Your physical therapist will provide information on sport, leisure, and/or repetitive activities. They may recommend changes or suggest activities that are least likely to make your neck condition worse.
- Maintaining a healthy weight. Keeping a healthy weight helps to reduce excess forces on the spine that can lead to neck strain.
What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and experience to treat cervical radiculopathy. You may want to consider:
- A physical therapist with an orthopedic or musculoskeletal focus. This physical therapist usually has more experience treating people with cervical radiculopathy.
- A physical therapist who is a board-certified clinical specialist or completed a residency or fellowship in orthopedics, spinal, or manual physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to your condition.
You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association. This tool can help you search for physical therapists with specific clinical expertise in your geographic area.
General tips when you are looking for a physical therapist (or any other health care provider):
- Get recommendations from family, friends, or other health care providers.
- When contacting a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people who have an underlying spinal diagnosis, including cervical radiculopathy.
- Be prepared to describe your symptoms in as much detail as possible and say what makes your symptoms worse.
The American Physical Therapy Association believes that consumers should have access to information to help them make informed health care decisions and prepare them for their visit with a health care provider.
The following resources offer some of the best scientific evidence related to physical therapy treatment for cervical radiculopathy. They report recent research and give an overview of the standards of practice both in the United States and internationally. They link to a PubMed* abstract, which may also offer free access to the full text, or to other resources. You can read them or print out a copy to bring with you to your health care provider.
Romeo A, Vanti C, Boldrini V, et al. Cervical radiculopathy: effectiveness of adding traction to physical therapy-a systematic review and meta-analysis of randomized controlled trials. Phys Ther. 2018;98(4):231–242. Article Summary in PubMed.
Bier JD, Scholten-Peeters WG, Staal JB, et al. Clinical practice guideline for physical therapy assessment and treatment in patients with nonspecific neck pain. Phys Ther. 2018;1;98(3):162–171. Article Summary in PubMed.
Thoomes EJ, van Geest S, van der Windt DA, et al. Value of physical tests in diagnosing cervical radiculopathy: a systematic review. Spine J. 2018;18(1):179–189. Article Summary in PubMed.
Childress MA, Becker BA. Nonoperative management of cervical radiculopathy. Am Fam Physician. 2016;93(9):746–754. Article Summary in PubMed.
Medscape. Cervical radiculopathy. Medscape website. http://emedicine.medscape.com/article/94118-overview. Updated October 8, 2018. Accessed February 10, 2021.
Medscape. Cervical radiculopathy clinical presentation. Medscape website. https://emedicine.medscape.com/article/94118-clinical. Updated October 8, 2018. Accessed February 10, 2021.
*PubMed is a free online resource developed by the National Center for Biotechnology Information. PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.
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