The answer to this question is yes, there are cervical radiculopathy exercises that will help your pain. Cervical radiculopathy is a condition in the neck that causes pain down the arm. It is something that I have treated many, many times as an orthopedic physical therapist. The good news is that it usually responds very well to therapy. Read on to learn more about cervical radiculopathy and the exercises and techniques used to treat it. Let’s begin with anatomy!
The spine
In order to understand cervical radiculopathy, you need to be familiar with the structure of the spine. The spine is made up of 33 vertebrae. The vertebrae are the bones of the spine. Each is stacked on top of one another to make a column. The spinal cord travels through the column with nerves exiting at each vertebral level. The first 7 vertebrae make up the cervical or neck region. The middle 12 vertebrae are the thoracic or mid back region. The next 5 vertebrae are the lumbar, which is also known as the low back. The next five make up the sacrum which is the triangular bone at the base of the spine. The sacral vertebrae are fused meaning they have grown together. The last 4 vertebrae are also fused. This is the coccyx or tailbone. The discs are in between the cervical, thoracic, and lumbar vertebrae. The sacrum and coccyx have grown together and have no space between the vertebrae for a disc.
The cervical spine
The cervical spine is made up of 7 unique vertebrae (spinal bones). It’s job is to support and soften loads to the head and neck while allowing movement. It also functions to protect the spinal cord. The cervical vertebrae are named C1 through C7. C1 is the first vertebra below the skull and C7 is the last vertebrae of the cervical spine.
The cervical spine has 8 cervical nerve roots. These nerve roots come off of the spinal cord and travel between the vertebrae at each level. The cervical nerves provide sensation and movement to our neck, shoulders, arms, and hands. Each nerve root innervates a different area of the body.
What is cervical radiculopathy?
Cervical radiculopathy is a compression, irritation, or stretching of one the nerves that come off of the spinal cord at the cervical level. This typically occurs on one side of the body. It can cause pain, weakness, numbness, and/or pins and needles sensation. The area of the shoulder, arm, and/or hand that is affected will depend on which cervical nerve root is compressed.
What are the symptoms of cervical radiculopathy?
There are many symptoms of cervical radiculopathy. Some of the more general ones include:
- Pain in the neck or shoulder that radiates down the arm and, possibly, into the fingers
- Dull ache in the shoulder, arm, or hand
- Can also have electrical sensations in these areas
- Numbness and tingling in the shoulder, arm, or hand
- Weakness in the shoulder, arm, or hand
- Symptoms will increase with certain neck movements
- Typically increases with looking up and over the shoulder of the affected side
- Symptoms typically decrease when the arm is lifted and behind the head or when the head is tilted toward the unaffected side
More specific symptoms depend on which nerve root is irritated. Some examples of symptoms of specific nerve roots include:
- C5 (between C4-C5 vertebrae)
- Weakness in the shoulder
- Pain and numbness along the outside of the upper arm
- C6 (between C6-C7 vertebrae)
- Weakness in the elbow and wrist
- Numbness and tingling in the thumb side of the forearm and hand
- C7 (between C7-C8 vertebrae)
- Weakness in the elbow and wrist
- Numbness and tingling on back of forearm and hand to middle finger
- C8 (between C7-T1 vertebrae)
- Decrease in grip strength
- Numbness and tingling in the pinky finger side of the the forearm and hand
The most common level of compression is C7, followed by C6.
How do you get cervical radiculopathy?
There are several different ways in which one can develop cervical radiculopathy. These include:
- Disc herniation – The disc can bulge or herniate at the area of the nerve root and cause irritation.
- Degenerative disc disease – As we age the disc begins to dry out and lose height, and the boney vertebrae become closer together. This can cause compression of the nerve roots.
- Spinal stenosis – This causes a narrowing of the opening of the vertebrae where the nerves go through.
- Osteoarthritis – This can cause bone spurs that can irritate or compress the nerve root.
- Tumors – Tumors in the area can irritate or compress the nerve.
Who gets cervical radiculopathy?
Anyone can get cervical radiculopathy. The majority of people who suffer from it are in their 40s and 50s. However I have seen patients with it that are in their 30s and also some in their 60s.
Who do I see?
- Physical therapy – Your physical therapist can examine you and help determine what could be causing the radiculopathy and which nerve root is irritated. Treatment could include joint mobilization or manipulation, soft tissue mobilization, dry needling, stretching, and strengthening. Your PT should be able to help decrease the pain in your neck, shoulder, and arm while helping to improve your mobility, posture, and strength.
- Primary care physician – Your primary care physician can examine you and provide medications such as anti-inflammatories or muscle relaxers if appropriate. Imaging might also be ordered to provide more detailed information. A referral to a specialist might also occur depending on your symptoms and the results of the imaging.
What can I do?
- Aerobic – Performing low impact aerobic exercise is very beneficial for the spine.It increases the flow of nutrients and blood and decreases pressure on the discs. Examples of low impact aerobic exercise include walking, swimming, and biking. If you don’t currently have an exercise program, then carefully work into one. You might begin by walking for 5 to 10 minutes a day and slowly work up to 30-60 minutes over several weeks or months. Be sure that whatever you choose does not exacerbate your symptoms.
- Ice – Ice can help decrease irritation of the nerve root. Ice the neck and shoulder area area for 15 to 20 minutes at a time. I would recommend using an ice pack several times per day if the pain is constant or is preventing you from participating in an activity. Ice immediately after activity.
- Posture – Having forward rounded shoulders causes the chin to poke forward and the neck to forward flex. This takes the cervical spine out of it’s natural alignment. If the pectorals and biceps are tight, they will cause the shoulders to round. Below is a video showing how to stretch the pecs and biceps and also how to use a wall to check your posture.
- Strengthen and stretch the muscles around the cervical spine – Strengthening the deep neck flexors are vital in strengthening the neck and being able to maintain proper posture.The deep neck flexors are attached to the vertebrae and are the key stabilizers of the cervical spine. The upper trapezius and levator scapula are muscles that attach to the neck and shoulder. These muscles are commonly tight and can cause neck pain and headaches. Below is a video on how to strengthen the deep neck flexors and stretch the upper trapezius and levator scapula. Side bending the cervical spine toward the affected side might increase your symptoms. If it does, avoid performing the stretches to that side. Be sure to keep doing the stretches that help alleviate pain. This might mean that you perform an upper trapezius stretch on one side but not the other.
- Strengthen the scapular stabilizers –The scapular stabilizers are the muscles around the shoulder blade which help stabilize the shoulder joint while your arm is performing different activities. They are also very important in maintaining good posture. Activating these muscles will help properly align the thoracic spine which will help with proper posture of the cervical spine. The videos below review some strengthening exercises for the scapular stabilizers. Using loop resistance bands and resistance bands can increase strength and difficulty.
In review
- The cervical spine is made up of 7 unique vertebrae (spinal bones).
- It’s job is to support and soften loads to the head and neck while allowing movement.
- The cervical spine has 8 cervical nerve roots.
- The cervical nerves provide sensation and movement to our neck, shoulders, arms, and hands.
- Each nerve root innervates a different area of the body.
- Cervical radiculopathy is a compression, irritation, or stretching of one the nerves that come off of the spinal cord at the cervical level.
- Symptoms include pain in the neck or shoulder that radiates down the arm and, possibly, into the fingers.
- There are several different ways in which one can develop cervical radiculopathy.
- Disc hernitation
- Degenerative disc disease
- Spinal stenosis
- Osteoarthritis
- Tumor
- Physical therapy is the preferred treatment for those suffering from cervical radiculopathy.
- Your primary care physician might be needed if your condition is not responding to PT.
- There are things that you can do.
- Aerobic exercise
- Ice
- Posture
- Strengthen and stretch the muscles around the cervical spine
- Strengthen the scapular stabilizers
As always, If you have questions about the content of this post or any other musculoskeletal questions, please e-mail me.
Additional resources
https://www.physio-pedia.com/Cervical_Radiculopathy
https://www.choosept.com/guide/physical-therapy-guide-cervical-radiculopathy