Cervical radiculopathy is defined as cervical nerve root compression. Many times, what causes this so-called compression is things like herniated disc material or arthritic bone spurs. It’s essentially the “sciatica” of the upper extremity. Common symptoms include neck and radiating arm pain which can travel all the way down into the fingers. Often, this pain is accompanied by sensory disturbances (i.e. pins-and-needles or burning sensations) and even loss of muscle function in more severe cases (muscle weakness and abnormal reflexes). Headaches, neck pain, and scapular pain can also accompany cervical radiculopathy. While not as common as sciatic nerve irritation (only a 0.4% prevalence rate), it can be just as debilitating and a significant cause of neck pain and disability. In this article, we will show you assessment and cervical radiculopathy rehab exercises and approaches that you and your physical therapist can employ to get you out of pain!

 

What Does Cervical Radiculopathy Treatment Look Like?

While the definition of cervical radiculopathy is technically nerve root compression, there is increasing evidence that inflammation surrounding the nerve root is most responsible for the signs and symptoms that accompany cervical radiculopathy. Furthermore, there does not need to be signs of nerve root compression on imaging to make the diagnosis of cervical radiculopathy. This is important to understand because it implies that just because you have “nerve root compression” on an MRI, it does NOT necessarily mean it is the cause of your pain! (READ: You are NOT your MRI!). To further support this claim, Kuijper and colleagues found a 45% false positive rate of root compressions in MRIs. This finding means that an MRI determined that there was nerve root compression at some level despite the fact that patients presented with no signs and symptoms of nerve root compression. Furthermore, Teresi and colleagues found that 25% of patients aged 45-54 years and 57% of patients older than 64 years had cervical disc protrusions visible on MRI, but showed no clinical symptoms.  After successful cervical radiculopathy treatment, chances are you will still have the same arthritic osteophytes or herniated disc material in your cervical spine – yet your symptoms are gone because the inflammation is gone! Suffice to say that your MRI findings do not dictate how you will present!

 

Treat Your Cervical Radiculopathy With Our Program

Exercise and education are key when it comes to managing cervical radiculopathy. Click here to learn more about our program that will take you through progressive exercises along with education to answer the questions you likely have!

 

Self Assessment For Cervical Radiculopathy

Before determining how to treat your pain (not medical advice), you must first determine beyond a reasonable doubt that you do in fact have cervical radiculopathy! Luckily, there is a battery of tests you can do at home to help you recognize the signs and symptoms of cervical radiculopathy. A physical therapist will use what’s known as the “Wainner Cluster” to objectively determine the probability that you have cervical radiculopathy. Of course, we advise that you seek out a qualified physical therapist in your local area to screen and treat your symptoms, but if you can’t get in to see a PT, follow along in the video below and I’ll walk you through a modified version of the Wainner cluster you can perform at home!

***IMPORTANT*** PLEASE BE GENTLE WHEN ADMINISTERING THESE TESTS. Is your pain severe (>6/10)? Does it take a long time to go away if it’s bad? If so, please be extremely gentle with this screen! Once you begin to feel your symptoms, STOP! At the end of the day, you can’t go wrong leaving this to the professionals!

Wainner Cluster Self Assessment

• Spurling’s Test: This test aims to close down the intervertebral foramen in your cervical spine, adding further compression to the nerve root. Tilt your head back and sideways towards the side of your pain (i.e. if your pain is on the right, tilt back and to the right side). Does this neck position recreate your neck/arm symptoms? If yes, the test is positive, and move on to the next one. If no, SLOWLY apply pressure with your opposite (left) hand. If this test brings on your symptoms, it’s also considered a positive test.

 

• Distraction Test: This test aims to open up the intervertebral foramen in your cervical spine, decompressing the nerve root. This test can only be performed if you experience your symptoms at rest. What you will do is LIFT your head up and apply a traction force. If this maneuver alleviates or lessens your symptoms, it’s considered a positive test.

 

• Upper Limb Nerve Tension Test: This test aims to add a traction force to the nerve root, which nerves do not typically like. Keeping your shoulder down, stick your arm out forward at 90 degrees with your palm facing in. Next, extend your wrist back. Finally, slowly bring your arm out to the side. BE GENTLE AND MOVE SLOWLY!! If at any point in this movement your symptoms are worsened or recreated, it’s a positive test.

 

• Cervical Rotation Test: Rotate your head in the direction to the side of your symptoms. If you cannot rotate your head 60 degrees, which is approximately your earlobe to your shoulder, it is considered a positive test.

 

These self-administered tests are not the exact same ones used in the Wainner cluster, but they are decently good enough to help you determine if you may or may not have cervical radiculopathy. According to Wainner and colleagues, if 3 of the 4 tests are positive, there is a 65% of cervical radiculopathy. If 4 of the 4 tests are positive, it’s essentially a golden ticket and the probability jumps to 90%!

LISTEN: SECRETS TO IMPROVING POSTURAL PAIN

 

Decrease Your Pain Immediately!

Now that you’ve determined there’s a high probability you may have cervical radiculopathy, what do you do about it? Lucky for you, there are a host of cervical radiculopathy treatment options available. And by far the best cervical radiculopathy treatment is to avoid the things that aggravate your symptoms!

First, a little background anatomy on the cervical spine. The nerve roots responsible for cervical radiculopathy run through little spaces called intervertebral foramen (IVF) in the cervical spine. As we discussed earlier, when lesions like herniated disc material or arthritic osteophytes get into this space, they can lead to nerve root compression. This compression can cause inflammation to arise in the IVF and around the nerve root, causing your symptoms. Therefore, if we can alleviate the trigger (i.e. the compression) causing the inflammation, we can alleviate your pain!

We can do this by preventing those motions that close the IVF, specifically cervical extension and rotation(turn your head to the side while looking up to any degree) as well as cervical side bend (tilting your head to the side). All of these motions cause the IVF to get smaller, and subsequently compress the nerve root! So, if you have right-sided cervical radiculopathy, try to limit how much you look to your right!

• When standing, turn your body instead of your neck!

 

• If you’re at work, try to position your computer screen and other objects of interest on the opposite side so you don’t have to look to the right!

 

Pinched Nerve In Your Neck? Watch This Video!

 

Avoid Neck Positions that Hurt!

Furthermore, cervical extension (purely looking up) is usually an aggravating position. Try your best to look up with your eyes and your thoracic spine. One of the worst things you can do at the computer is to let your head come forward. When you do so, you are essentially extending at the cervical spine to keep your eyes forward on the screen!

 

The Prehab membership is the anti-barrier solution to keeping your body healthy. Access state-of-the-art physical therapy, fitness programs, and workouts online in the comforts of your own home or gym! Taking control of your health with exercise & education from the palm of your hand has never been easier. Get access to 50+ programs, 100+ unique workouts, and 3000+ exercises to build your own workout routines. Trial it for free, and learn how to get out of pain, avoid injury, and optimize your health with [P]rehab!

 

Manual Therapy

Manual therapy has been shown to be more effective than a wait-and-see approach (i.e. doing nothing) in countless studies. There are many different manual therapy treatments for cervical radiculopathy, including but not limited to cervical spine up glides, lateral glides, posterior-to-anterior mobilizations, manipulations, thoracic spine mobilizations and manipulation, and various soft tissue mobilizations. No one single intervention has been shown to be more effective than another; however, a multimodal approach incorporating many of the above manual therapy treatments in addition to therapeutic exercises and education has been shown to be the most effective cervical radiculopathy treatment approach of all.

 

Manual Therapy Cervical Radiculopathy Treatment

In the video above, I demonstrate some various manual therapy techniques that your physical therapist may employ to treat your symptoms. In order, they are cervical upglide, cervical manipulation, cervical lateral glide, cervical unilateral posterior-to-anterior mobilization, thoracic mobilization, and thoracic manipulation.

 

The McKenzie Method

Another mode of cervical radiculopathy treatment that has been supported throughout the literature is The McKenzie Method. This is a diagnositic and treatment modality for mechanical issues of the spine and extremities of the body. This method is useful in diagnosing an individual who has neck pain to decipher if it is mechanical (meaning symptoms come from a musculoskeletal source), or if the clinical presentation is non-mechanical neck pain (meaning symptoms are coming from an underlying source that is NOT musculoskeletal). In addition, if a clinician does find that an individual’s neck pain is indeed mechanical, often times the McKenzie Method of diagnosis can be a guide for optimal treatment strategy.

The evaluation and examination hold more weight and are more thorough if an individual is trained in this specific mode of physical therapy treatment. The evaluation consists of specific questions to gather a thorough history from the patient, followed by various examination techniques, such as assessing functional movements, posture, and a staple of this technique known as repeated movements.

In an article by Guzy et al 2011, 61 patients aged 30-60 years were allocated to one of two, three-week interventions: the McKenzie method (30 subjects), and a complex rehabilitation program called traditional therapy (31 patients). The results demonstrated the McKenzie method was more efficacious than the complex rehabilitation program in regards to centralization of symptoms, head, and upper extremity pain intensity, headaches, and the number of pain-free days; however, there were no differences between the interventions in regards to neck and shoulder pain intensity.

As previously stated, there has not been a consensus in regards to what is the MOST efficacious treatment strategy for individuals with cervical radiculopathy. What is important to take from reading this article is that there are various strategies that can be effective, and it is important for each case to be individualized appropriately to each person’s clinical presentation.

 

Specific Exercise

Last but not least, therapeutic exercises with the intent of downregulating the nervous system, decreasing inflammation, opening the intervertebral foramen, and postural re-education are effective in the management of cervical radiculopathy. From a mobility standpoint, start first with neural mobilization. The rationale behind neural mobilizations is to increase the circulation to the nerve and disperse intraneural edema or inflammation. When nerves are stretched, there is an accompanying increase in tension and intraneural pressure on the nerve, which nerves do not like! We know from animal experiments that when a nerve is inflamed and irritated, a minimal stretch (<3%) is enough to lead to the provocation of pain!

We can combat this inflammation with specific exercises called nerve glides or nerve tensioners. By increasing the mobility of the nerve/dura itself, or the structures that surround the nerve such as neighboring muscles and joints (called the nerve bed), we can facilitate an optimal environment to disperse inflammation and desensitize the nervous system. Nerve glides are best used when your pain is extremely acute or severe. Nerve glides produce a high level of nerve movement with minimal tension and can help facilitate dispersing inflammation around the nerve. A nerve gliding technique entails elongating the nerve bed at one joint, while simultaneously reducing the length of the nerve bed at an adjacent joint.

Nerve Slider Technique

On the other hand, nerve tensioners entail elongating the nerve bed at two joints at the same time. While this may seem harmful at first glance, your nerves are meant to be move and elongated! The goal of nerve tensioners is to downregulate the nervous system and get it accustomed to nerve tension. However, in the acute stage when your pain levels are high, it is best to avoid nerve tensioners and stick to nerve glides. As the pain dissipates, you can then progress to nerve tensioners. While you can move any joint along the nerve bed to perform nerve glides and tensioners, we recommend moving your wrist and neck – as the nerves run from your neck all the way down to your hand!

READ: IMPROVE POSTURAL PAIN

 

Neck Strength and Motor Control

Below this video outlines various exercises that you can begin to work on to assist in modulating symptoms related to cervical radiculopathy. In regards to what has been supported by the literature in regards to neck pain with radiating symptoms, interventions include deep neck flexor endurance and strengthening exercises (one of the hallmark exercises being chin tucks with progressions), mobilizations to the cervical spine that can be performed by a therapist and/or self mobility exercises by the patient, improving mobility of the thoracic spine, distraction/traction interventions, improving postural mechanics, and also improving strength of the scapular musculature.

Cervical Radiculopathy Treatment Exercises

 

Closing Thoughts

In conclusion, cervical radiculopathy treatment involves more than just decompression of the nerve root. Often, it is the inflammation itself that is responsible for the pain and symptoms you feel, and thus exercises and movement are crucial in the treatment paradigm. Furthermore, research has strongly indicated that psychosocial factors such as low self-efficacy and depression play a large role in determining how disabled one feels and plays a role in determining prognosis.

Speaking of prognosis, most patients with cervical radiculopathy have a favorable prognosis with non-surgical management. While re-occurrence is common, a large-scale epidemiology study found that at final follow-up, 90% of patients were asymptomatic or only mildly incapacitated by their symptoms.

So if you have cervical radiculopathy or “pathologic” findings on your cervical MRI – do not fear! Avoid those positions that cause your symptoms. Schedule an appointment with your local physical therapist to provide you with some manual therapy and sound educational advice. And give these exercises a shot!!

 

Learn How To Treat Your Own Neck Pain

Neck and mid-back aches and pain often times get neglected until it’s too late, turning a minor fixable ache into a potential chronic pain and debilitating issue. This program is designed to minimize pain and optimize your neck and mid-back health.

 

REFERENCES

1. Basson, Cato A., Aimee Stewart, and Witness Mudzi. “The Effect of Neural Mobilisation on Cervico-brachial Pain: Design of a Randomised Controlled Trial.” BMC Musculoskeletal Disorders 15.1 (2014)
2. Bove, G. M. “Inflammation Induces Ectopic Mechanical Sensitivity in Axons of Nociceptors Innervating Deep Tissues.” Journal of Neurophysiology 90.3 (2003): 1949-955.
3. Cheng, Chih-Hsiu, Liang-Ching Tsai, Hui-Chu Chung, Wei-Li Hsu, Shwu-Fen Wang, Jaw-Lin Wang, Dar-Ming Lai, and Andy Chien. “Exercise Training for Non-operative and Post-operative Patient with Cervical Radiculopathy: A Literature Review.” Journal of Physical Therapy Science 27.9 (2015): 3011-018.
4. Coppieters, Michel W., Alan D. Hough, and Andrew Dilley. “Different Nerve-Gliding Exercises Induce Different Magnitudes of Median Nerve Longitudinal Excursion: An In Vivo Study Using Dynamic Ultrasound Imaging.” Journal of Orthopaedic & Sports Physical Therapy 39.3 (2009): 164-71.
5. Coppieters, Michel W., Alan D. Hough, and Andrew Dilley. “Different Nerve-Gliding Exercises Induce Different Magnitudes of Median Nerve Longitudinal Excursion: An In Vivo Study Using Dynamic Ultrasound Imaging.” Journal of Orthopaedic & Sports Physical Therapy 39.3 (2009): 164-71.
6. Falla, D., R. Lindstrøm, L. Rechter, S. Boudreau, and F. Petzke. “Effectiveness of an 8-week Exercise Programme on Pain and Specificity of Neck Muscle Activity in Patients with Chronic Neck Pain: A Randomized Controlled Study.” European Journal of Pain (2013).
7. Kuijper, B., J. T. J. Tans, B. F. Van Der Kallen, F. Nollet, G. J. Lycklama A Nijeholt, and M. De Visser. “Root Compression on MRI Compared with Clinical Findings in Patients with Recent Onset Cervical Radiculopathy.” Journal of Neurology, Neurosurgery & Psychiatry 82.5 (2010): 561-63.

8. Guzy, G., Franczuk, B., & Krakowska, A. (2011). A clinical trial comparing the McKenzie method and a complex rehabilitation program in patients with cervical derangement syndrome. Journal of Orthopedic Trauma Surgery, 22.

9. Langevin, P., J.-S. Roy, F. Desmeules, M. Lamothe, and S. Robitaille. “Cervical Radiculopathy: A Randomized Clinical Trial Evaluating the Short-term Effect of Two Manual Therapy and Exercise Protocols.” Physiotherapy 101 (2015).
10. Radhakrishnan, Kurupath, William J. Litchy, W. Michael O’fallon, and Leonard T. Kurland. “Epidemiology of Cervical Radiculopathy.” Brain 117.2 (1994): 325-35..
11. Teresi, L. M., R. B. Lufkin, M. A. Reicher, B. J. Moffit, F. V. Vinuela, G. M. Wilson, J. R. Bentson, and W. N. Hanafee. “Asymptomatic Degenerative Disk Disease and Spondylosis of the Cervical Spine: MR Imaging.” Radiology 164.1 (1987): 83-88.
12. Thoomes, E. J. “Effectiveness of Manual Therapy for Cervical Radiculopathy, a Review.” Chiropractic & Manual Therapies 24.1 (2016).
13. Wibault, Johanna, Birgitta O–berg, Asa Dedering, Hakan Lofgren, Peter Zsigmond, Liselott Persson, and Anneli Peolsson. “Individual Factors Associated with Neck Disability in Patients with Cervical Radiculopathy Scheduled for Surgery: A Study on Physical Impairments, Psychosocial Factors, and Life Style Habits.” European Spine Journal 23.3 (2013): 599-605.
14. Zhu, Liguo, Xu Wei, and Shangquan Wang. “Does Cervical Spine Manipulation Reduce Pain in People with Degenerative Cervical Radiculopathy? A Systematic Review of the Evidence, and a Meta-analysis.” Clinical Rehabilitation 30.2 (2016): 145-55.

 

About The Author

Michael Lau, PT, DPT, CSCS

[P]rehab Co-Founder & Chief Product Officer

Michael was born and raised in Northern California but now currently resides in Sunny SoCal ever since attending the University of California, Los Angeles as an undergraduate majoring in physiology. After his undergraduate studies, he received his Doctorate in Physical Therapy from cross-town rival the University of Southern California. As a licensed physical therapist with a strong background in strength and conditioning, Michael likes to blend the realms of strength training and rehabilitation to provide prehab, or preventative rehabilitation, to his patients. A common human behavior is to address problems after they become an issue and far often too late, which is a reactionary approach. He believes the key to improved health care is education and awareness. This proactive approach-prehab-can reduce the risk of injuries and pain in the first place. He is a huge proponent of movement education and pain science. Clinically, he has a special interest in ACLR rehab and return to sport for the lower extremity athlete.

 

 

 

 

 

Disclaimer – The content here is designed for information & education purposes only and is not intended for medical advice.