A Physical Therapy Guide to Cervical Radiculopathy (Pinched Nerve)
If you are experiencing pain, tingling, numbness, or weakness in your neck, arm, or hand, you may have cervical radiculopathy, more commonly known as a pinched nerve. In this guide, we will discuss the symptoms, causes, and treatment options for cervical radiculopathy.
Physical therapy is a top choice for conservative care of a pinched nerve, and is more effective than surgery in most cases.1
- Understanding Cervical Radiculopathy
- Symptoms of Cervical Radiculopathy
- What are the Most Common Causes of a Pinched Nerve?
- Diagnosing a Pinched Nerve
- What to Expect from Physical Therapy
- Preventing Nerve Inflammation and Compression
- Is It Time to Seek Treatment?
Cervical radiculopathy is a condition that occurs when a nerve in the neck is compressed, stretched (known as traction) or inflamed.
Cervical radiculopathy can occur at any of the 8 cervical nerve roots that branch from the spinal cord to exit the neck to innervate the arms. One nerve root branch can be found between each of the 7 cervical vertebrae and the first thoracic vertebrae — referred to as C1 to C8 (+ T1).2 They can become susceptible to compression and other forms of irritation under certain conditions.
Any affected nerve tissue is not able to effectively transmit or receive messages from the brain and spinal cord, which leads to a variety of symptoms.
What does a pinched nerve feel like? Symptoms are typically experienced on the same side of the body as the pinched nerve. Ultimately, what symptoms manifest will depend on the amount of pressure and what specific area of the neck is affected.
Symptoms can be constant or off and on, mild to severe, and include one or more of the following:
- Numbness or tingling in the arm or hand
- Weakness in the muscles of the neck, arm, or hand
- A feeling of "pins and needles"
- A sharp pain or electrical sensation that radiates into the arm or hands
- Difficulty using the affected arm or hand
- Trouble sleeping at night due to neck or arm discomfort
- Pain or dull aching in the neck, shoulder, chest, upper back, or arm
- Aggravation of symptoms with certain neck movements
There are a variety of things that can lead to the compression of a nerve in the neck. Let's review:
- Degenerative changes to the cervical spine (normal age-related changes)
- Herniated disc
- Bone spurs
- Spinal stenosis
- Trauma or injury to the neck
- Changes in the cervical spine and upper body due to postural demands and muscle imbalances
- Rheumatoid arthritis
Ready for some answers? It's time to schedule a consultation with a CityPT physical therapist.
Your CityPT therapist will first ask you questions about your symptoms and medical history. Questions might include:
- When did your symptoms start?
- Do you experience more symptoms at certain times of the day?
- What movements or positions make your symptoms better or worse?
- Do you have any other health conditions?
- What other major events have occurred in your life lately?
- What strategies do you have in place for stress?
Your physical therapist will also perform an remote or in-person physical examination. This will likely involve tests and measures to assess:
- Neck and arm range of motion
- Posture and work/sport ergonomic assessment
- Muscle strength
- Sensation in the neck, arm, and hands
- Functional assessment
- Special tests to rule out other potential causes of neck pain
In some cases, your physical therapist may recommend having imaging tests ordered by an orthopedic doctor, such as an X-ray, CT scan, or MRI. Additionally, an EMG may be useful to look more specifically at nerve function.
Most cases of cervical radiculopathy can be well managed with personalized guidance from a CityPT physical therapist. In particular, an exercise prescription with a focus on returning to activity participation is most effective.1
The key to long-term recovery and optimal treatment is understanding what the true underlying cause of your dysfunction is. Once this is determined, your physical therapist will provide extensive education to help you make sustainable progress.
Other high-quality conservative treatments you might encounter include:
- Manual therapy: Including cervical joint mobilization, traction, soft tissue work of the shoulders and neck, dry needling, nerve mobilization, and taping.
- Therapeutic exercise: To improve neck range of motion, upper body flexibility, nerve extensibility, and strength, with a focus on functional training that promotes engagement in life activities.
- Short-term pain management: Use of modalities such as heat, ice, ultrasound, and electrical stimulation. You may also need to use a neck collar, take pain medications, or undergo injections in conjunction with PT treatment.
- Postural and biomechanical training: To reduce strain on local tissue with activities of daily living. Common daily activities to modify include overhead reaching, sitting at a desk, on the couch, or in a car, and pushing or pulling.
What If Conservative Treatment Doesn't Work?
Typically, your physical therapist will know within a few visits whether conservative treatment is working. If you haven't noticed any improvement by 6 weeks, your orthopedic doctor may want to discuss other options with you, such as an epidural injection or surgery.
Luckily, regardless of the exact outcomes, there are always benefits to physical therapy at each stage of recovery.
- Ideally, you can recover and avoid surgery with long-term management strategies (which is possible with most cases of cervical radiculopathy).
- If surgery is needed, the time you spend in physical therapy can help boost your post-surgical outcomes. This is particularly true when a PT care provider can help reduce any anxiety regarding surgery.3
- After your surgery (if needed), you will be referred to a physical therapist to ensure an optimal recovery and reduce the risk of re-injury.
Although you can't always prevent cervical radiculopathy, there are some things you can do to reduce your risk. Some general tips include:
- Maintaining a balanced posture: Posture is a three dimensional effort. Whether you're sitting or standing, think of your head as a golf ball that needs to sit correctly on its "tee" (your neck and shoulders). Other important considerations include keeping the holes in your ears balance over your shoulders (not in front), your vision on the horizon, and chest gently lifted.
- Activity modification: Avoid high-impact activities, contact sports, and repetitive movements that strain the neck. Additionally, temporary modifications to your daily activities and ergonomics may be necessary to reduce nerve irritation.
- Exercise: Its so important to stay physically active and exercise regularly to maintain muscle strength and flexibility- especially in the neck and shoulders. Plus, it helps with optimal weight management to reduce the overall strain on the spine.
- Ergonomics: Set up your workspace, car, and other spaces you frequently sit for optimal spinal alignment.
- Sleep: Getting enough high quality sleep is important for maintaining healthy tissues and promoting healing. Not only is it important to sleep in good posture, but also try to keep a consistent schedule, sleep in a dark room, and avoid screen an hour before bedtime.
Cervical radiculopathy can make it hard to carry on with your normal daily tasks. From gripping your steering wheel and chopping up a salad for dinner, to being able to sit comfortably at a desk and focus on a task, symptoms can make everything feel more complicated. The good news is that most cases of cervical radiculopathy will resolve without invasive interventions.
With exercise and education being two of the most powerful treatment options available, it may be time to seek out physical therapy. Ultimately, a CityPT physical therapist will help you understand exactly what's going on with your body and how to move forward with clarity for long-term results.
Get in touch with a CityPT care provider today to see how you could benefit.
This guide is intended for informational purposes only. We are not providing legal or medical advice and this guide does not create a provider-patient relationship. Do not rely upon this guide (or any guide) for medical information. Always seek the help of a qualified medical professional who has assessed you and understands your condition.
Cheng CH, Tsai LC, Chung HC, Hsu WL, Wang SF, Wang JL, Lai DM, Chien A. Exercise training for non-operative and post-operative patient with cervical radiculopathy: a literature review. J Phys Ther Sci. 2015 Sep;27(9):3011-8. doi: 10.1589/jpts.27.3011. Epub 2015 Sep 30. PMID: 26504347; PMCID: PMC4616148. ↩ ↩2
Tanaka N. et al, The anatomic relation among the nerve roots, intervertebral foramina, and intervertebral discs of the cervical spine. Spine. 2000 February; 25(3): 286-291 ↩
Engquist M et al., Surgery Versus Nonsurgical Treatment of Cervical Radiculopathy: A Prospective, Randomized Study Comparing Surgery Plus Physiotherapy With Physiotherapy Alone With a 2-Year Follow-up. 15 September 2013. Spine, 38(20): 1715–1722 ↩