When you start to experience neck pain with numbness and/or tingling down your arm, a pinched nerve in the neck could be the culprit. A pinched nerve in the neck (aka cervical radiculopathy) is a condition where the nerve root becomes compressed and irritated. This can stem from a variety of causes, including disc herniation, arthritis, or simply wear and tear of daily life leading to nerve compression. Determining the direct cause of cervical radiculopathy can lead you to a quicker recovery. This article will review conservative management of a pinched nerve in the neck with an emphasis on how physical therapy can help relieve your neck and radiating pain.
How can physical therapy treat a pinched nerve in the neck?
TAKE ME STRAIGHT TO THE EXERCISES!
**This is not medical advice. Please consult your medical provider for more information.
Anatomy of the Cervical Spine
Within the neck, there are seven cervical vertebrae that start at the base of the skull and extend down the neck. The first two vertebrae are a bit more specialized and differ in their anatomy compared to the others. C1 is known as the atlas and C2 is known as the axis. C3-C7 are more classic in their anatomy and shape. The nerves that travel from the spinal cord and down the arms travel through the facet joints. The nerve root is the first part of the spinal nerve that comes from the spinal cord.
With cervical radiculopathy, the nerve root exiting the cervical spine becomes compressed or irritated. There are many different things that can lead to nerve root compression. This includes inflammation, arthritis, disc herniation, and wear and tear.
Treatment Options for Cervical Radiculopathy
When dealing with cervical radiculopathy, experiencing radiating symptoms and pain can significantly impact your quality of life and spinal health. Getting this checked can start you on your journey towards pain relief.
Treatment options will vary depending on your unique needs. Conservative treatment may involve physical therapy, acupuncture, and pain management. All aim to reduce pain, improve function, and relieve pressure on the nerves. Surgical treatment may be an option after conservative treatment fails or in more severe cases. Your doctor can help determine what may be the best treatment option for you.
Surgical Options
Surgery may be an option for a multitude of reasons. Criteria for pursuing surgical treatment is failed conservative treatment, debilitating pain, significant nerve compression seen on an MRI, and/or neurological symptoms related to weakness and loss of function that interferes with daily activities. Surgery aims to alleviate the pressure on the nerve. The type of surgery will depend on the where the nerve compression is occurring.
Minimally invasive procedures involve small incisions and are designed for quicker recovery times. Post-op care will incorporate rehabilitation exercises to strengthen the deep neck flexors, improve posture, and restore range of motion to support your spinal health.
Non-Surgical Options
There are a variety of non-surgical options available to help manage the symptoms of cervical radiculopathy. One of the most common and recommended paths is physical therapy. Physical therapy works on restoring range of motion, reducing radiating symptoms, and strengthening weaker muscles that are important for posture. Posture is a key player in physical therapy to help with recovery, but also to help prevent future nerve compression and to reduce the risk of future injury. This article will focus mainly on physical therapy as a means to treat a pinched nerve in the neck.
Acupuncture is another option to treat neck pain. Acupuncture aims to restore the flow of energy (aka qi) in the body. This form of treatment comes from traditional Chinese medicine. It can be helpful with reducing inflammation and pain. It can be helpful when paired with physical therapy on occasion. If pain levels are too high to fully participate in physical therapy, trialing acupuncture for pain reduction can help with participation in physical therapy afterwards.
Regardless of the route you choose, consistency is key. Working closely with a healthcare professional to diagnose the underlying cause and provide guidance in the next steps can help you get closer to a more effective treatment plan for your specific situation.
How Physical Therapy Treats a Pinched Nerve in the Neck
In order to determine where your nerve compression is coming from, your physical therapist will perform an initial evaluation. This entails taking a detailed look at your posture, spine, range of motion, strength, nerve mobility, and how you move. All of this gathered information will help establish your plan of care to determine what needs to be worked on and improve in order to get you back to optimal function and reduce your pain.
Based on what is found in the objective measurements, your physical therapist will be able to create a plan that incorporates exercises specifically targeting what you need to work on. These exercises will be aimed at alleviating nerve compression and reinforcing strength of your postural muscles.
Emphasizing postural awareness is critical. You can perform exercises for your posture all you want, but if you don’t work on becoming aware of your posture, then things won’t change. Postural awareness becomes a big emphasis on what you can work on at home. Ergonomic tips can assist you with your postural awareness. It takes a comprehensive approach to recover from cervical radiculopathy. Typically, nerve compression happens over a length of time; it is usually not a sudden thing that occurs, even though your symptoms may have suggested so. It will take time, patience, and consistency, but seeking relief from pain is in reach.
Deep Neck Flexor Strength and Motor Control
Poor postural habits can lead to nerve compression on your facet joints or can be linked to a cervical disc. Regardless, poor posture leads to repetitive strain on the cervical spine and surrounding structures, including your muscles and ligaments. Working on deep neck flexor strength and motor control can help alleviate radiculopathy symptoms.
The deep neck flexors are a group of small muscles located in the anterior portion of the neck. These muscles include:
- Rectus capitis anterior
- Rectus capitis lateralis
- Longus capitis
- Longus colli
Deep neck flexors are crucial for maintaining a healthy alignment of your cervical spine, acting as a natural counterpart to the strain your neck might endure from poor posture. By incorporating specific neck exercises focused on these muscles, you can help build your endurance to maintain better posture for longer periods of time. This, in turn, reduces the risk of further injuries and can help relieve your neck pain. These exercises often involve gentle yet targeted movements designed to engage and strengthen the deep neck flexors without exacerbating your current condition.
Remembering the importance of form, alignment, and technique is very important when targeting these muscles. It is very easy to lose the correct form and, instead, use other muscles we might not be trying to target. We will review more of this later.
Postural Awareness
When working to address a pinched nerve in your neck, postural awareness and correction is one of the most important aspects of your care. Much like how the alignment of your car’s wheels affects its performance and longevity, the alignment of your body plays a pivotal role in both prevention and alleviation of neck pain, including nerve compression.
Upper cross syndrome is a common postural dysfunction. It is characterized by tightness (and often overuse) of the pectoralis major (chest muscle), upper trap, and levator scapulae muscles and lengthening and weakness of the deep neck flexors (see above), lower trap, and rhomboids. It is seen in people who have rounded shoulders and a forward head posture.
Correcting this upper cross posture is paramount to set the foundation for neck pain relief, as well as other areas of pain. This can include shoulder, elbow, wrist/hand, and upper and lower back pain. This is because posture affects the entire body. Where your head sits affects your upper back. And the position of your upper back affects the alignment of your lower back, and so on and so forth. Setting the proper foundation for your trunk will set you up for success in the present and in the future.
For individuals who work desk jobs, setting up your workstation is a great place to start when working on your posture. Along with being consciously aware of your posture, your working environment will also play a significant role in prevention and alleviation of neck pain. If you are unsure where to start with a proper ergonomic workstation setup, check out my blog post here on workstation setup and mobility routines for desk workers.
Specific Exercises for a Pinched Nerve in the Neck
There are specific exercises you can do to help alleviate the pain from a pinched nerve in your neck. But remember, the quickest way to recovery is finding the specific cause of your pain. And if you have pain, numbness, or tingling going down your arm, there may be different nerves that are affected. But the one thing that is universal is working on correcting posture.
The exercises you do should focus on learning to activate and strengthen the deep neck flexors, rhomboids, and middle/lower trapezius muscles. They should also emphasize stretching the tight chest muscles to encourage chest expansion and working on movement retraining to avoid overuse of the upper trap and levator scapulae muscles. All of this will help to reverse the upper cross posture that is all too commonly seen.
On top of these exercises, focusing on making sure your cervical joints move well, your cervical range is within functional ranges, and your nerves are moving well (aka not getting compressed or “stuck” somewhere), should all be areas that you work on throughout your day to improve your spinal health.
Other Articles Related to Neck Pain and Posture
- What You Should Know About Tech Neck: Relieve the Pain
- A Complete Guide and Mobility Routine for Desk Workers
- TMJ Exercises: How to Unlock Jaw Pain Relief
- What to Know About Herniated Disc Treatment
- What is the Correct Sitting Posture?
- 5 Great Stretches and Exercises to Alleviate Tension Headaches
Exercises for Cervical Radiculopathy
Try out some of these exercises to help your nerves and cervical joints move better. Always speak to your healthcare practitioner first to see if physical therapy may be an option for you. And if you are looking for additional resources on fixing your posture and setting up your workstation to best fit your needs, check out this blog post here!
Scalenes Stretch
To stretch the small muscles within the right side of your neck, place your right hand behind your back or sit on your right hand.
Bring your left ear to your left shoulder (side bend your neck) and then slightly tilt your head backwards (cervical extension).
You should feel a stretch on the right side of the lower part of your neck. Hold this position for up to 30 seconds and repeat, then switch sides.
Cervical SNAGs (Extension)
Thinly roll up a pillowcase lengthwise. Let this drape around the back side of your neck. Hold both ends of the pillowcase with your hands.
Then, extend your neck backwards and try to look up towards the ceiling as far as you can comfortably go. Repeat this 20-30 times.
If this motion either reduces or gets rid of the pain you have when you try to look upwards, you can repeat this multiple times throughout the day for pain relief.
Cervical SNAGs (Rotation)
Thinly roll up a pillowcase lengthwise. Let this drape around the back side of your neck. Hold both ends of the pillowcase with your hands.
To work on right rotation (looking to the right), hold the end of the pillowcase over you right shoulder with your left hand. Your right hand will hold the left side of the pillowcase and will hold the end of it up against your jawline.
Your left hand will not move during this exercise. Only your right hand will move. Start looking to the right and use your right hand and the pillowcase against your left jawline to help pull your head to the right. Then return back to the start and repeat 20-30 times. Do not pull with your left hand. See the video to the right for demonstration purposes.
Repeat this to the left by switching your hands and the pillowcase on your right jawline.
If this motion either reduces or gets rid of the pain you have when you try to turn your head, you can repeat this multiple times throughout the day for pain relief.
Median Nerve Glide (Waiter Tips)
This exercise will help the median nerve move better. The median nerve innervates your thumb, pointer, and middle fingers and half of the ring finger, all on the side of the palm.
Nerves like to move well. When they don’t move well (get compressed somewhere), they are unhappy and cause symptoms like sharp pain, numbness, and/or tingling.
On the side that you have radiating symptoms, bend your elbow and extend your wrist so that your palm faces the ceiling. This position imitates holding a platter as if you were serving a plate of food.
Then, extend your arm out away from you. You elbow should extend until it is straight and you will flex your wrist so that your palm faces you. Then bring it all back to the starting position. Repeatedly do this 20-30 times. If you have radiating symptoms on both sides, you can repeat this on your other arm, too.
Ulnar Nerve Glide
This exercise will help the ulnar nerve move better. The ulnar nerve innervates your pinky and the medial half of your ring finger, all on both the back side and palmar side of the hand.
Nerves like to move well. When they don’t move well (get compressed somewhere), they are unhappy and cause symptoms like sharp pain, numbness, and/or tingling.
On the side that you have radiating symptoms, flex your elbow and extend your wrist so that your palm is near the side of your face. Then, extend your elbow and straighten your wrist so that your arm is extended out away from you and your palm is facing the floor. Repeatedly do this 20-30 times. If you have radiating symptoms on both sides, you can repeat this on your other arm, too.
Dealing With Nerve Pain in the Low Back? Take a Look Here:
- 5 Best Exercises for a Pinched Nerve in the Back
- Quadratus Lumborum: Stretches and Exercises to Relieve Back Pain
- Pain From Your Back Down Your Leg? Sciatica Treatment Explained!
TL;DR
A pinched nerve in the neck (aka cervical radiculopathy) is a condition where the nerve root becomes compressed and irritated. Determining the direct cause of cervical radiculopathy can lead you to a quicker recovery. This article reviews conservative management of a pinched nerve in the neck with an emphasis on how physical therapy can help relieve your neck and radiating pain, including exercises to help alleviate your neck pain from a pinched nerve!
