As if the pain in your neck wasn’t enough of a…well…pain in the neck, you’ve also got radiating symptoms going down your arm and into your hand. Whether it’s burning, numbness, tingling, weakness, or all of the above, Cervical Radiculopathy is the result of an irritated nerve in the neck. How does this happen? And, more importantly, how can you make it go away?
What Is Cervical Radiculopathy?
This type of neck problem frequently causes neck pain, pain down the arms, and sometimes a loss of feeling, or decreased strength in the arm.
Typical symptoms of Cervical Radiculopathy include:
- Neck pain
- Pain down one or both arms
- Pain in the Scapular (shoulder blade) region
- Neurological signs such as:
- Numbness and tingling
- Reduced tendon reflexes5
- Decreased cervical rotation range of motion to the involved side6
What are the Best Treatment Options for Cervical Radiculopathy?
Conservative treatment for Cervical Radiculopathy is geared toward lessening the irritation around the affected nerve in your neck.
Although there are many treatment options that can help, many studies suggest that no single treatment for Cervical Radiculopathy is better than another10.
With that in mind, let’s cover some of the common treatments for Cervical Radiculopathy and see what combination might work best for you…
- Thoracic mobilization: Improving joint mobility in the thoracic spine (middle and upper back) can directly influence the neck. There have been several studies that looked at how thoracic manipulation affects Cervical Radiculopathy. All of the studies showed significant improvements in pain and function in the vast majority of patients involved – many of which had a full and lasting resolution of pain11,12,13,14.
2. Centralization: The McKenzie method of treatment is intended to reduce pain by implementing centralization techniques to promote migration of symptoms from an area more distal (further away from center) to a location more proximal (closer to center)15.
An example of the McKenzie method would be to perform repeated movements in a certain direction to centralize your radiating symptoms.
- Chin Tucks:
- look straight ahead and retract the chin back (as if you’re giving yourself a double-chin)
- Hold 1 second
- Repeat 10-15 reps every waking hour
- Progress to…
- Chin Tucks with Extension:
- Perform chin tuck
- Maintain tuck as you gently extend your head back
- Hold 1 second
- Repeat 10-15 reps every waking hour16
Although this method is common and even beneficial, most research shows that Mckenzie methods of centralization aren’t more beneficial than other treatments for Cervical Radiculopathy17.
3. Neural mobilization: Neural mobilization is the process used to restore the dynamic balance between movement of nerves and surrounding tissues – thus minimizing pressure on the nerves and optimizing movement18.
A recent study found 93% of patients with Cervical Radiculopathy who had treatments of neural mobilization had a significant decrease in disability in the long term.19 When comparing treatments of neural mobilization and cervical mobilization, another study found the neural mobilization group had significantly lower pain levels after 8 weeks of treatment20.
4. Traction: There are 2 kinds of traction:
- Mechanical traction: performed in at Physical Therapy clinic with a traction machine
- Over-the-door traction: performed on your own with a weight-and-pulley system while seated
To further support the use of mechanical intermittent cervical traction, a recent systematic review shows evidence of its effectiveness in treating Cervical Radiculopathy22.
If you’re experiencing Cervical Radiculopathy symptoms, I recommend first seeing a Physical Therapist who can provide a thorough evaluation to accurately assess your impairments.
The best evidence points to a combination of treatments for Cervical Radiculopathy23. Although I’m not a proponent of the “shotgun” technique – trying every treatment at once in hopes that something will work – I am a fan of following the evidence.
Therefore, I’d recommend a combination of either traction and exercise or neural mobilization and exercise.
- When it comes to traction, see your Physical Therapist who can give you the proper guidelines.
- The same goes for neural mobilization. I’m reluctant to provide any neural mobilization self-exercises here without a prior evaluation. There are different nerves that can be mobilized and a thorough neurological evaluation should be done prior to mobilization.
- As for safe and effective home exercises for Cervical Radiculopathy:
- McKenzie centralization techniques such as :
- Repeated Chin Tucks
- Repeated Chin Tucks with Extension
- Strengthening and coordination of the Deep Neck Flexors
- Thoracic mobility exercises
- McKenzie centralization techniques such as :
Again, I don’t recommend trying everything at once. Choose one set of exercises or the other. Combine those exercises with either traction or neural mobilization.
If you see results, continue what you’re doing. If you don’t see an improvement or if your gains plateau, you can switch it up.
Question: What combination of Cervical Radiculopathy treatments work best for you? You can leave a comment by clicking here.
- Radhakrishnan K, et al. Epidemiology of cervical radiculopathy. A population-based study from Rochester, Minnesota, 1976 through 1990. Brain. 1994;117 pt 2:325-335. ↩︎
- Autio RA, et al. The effect of infliximab, a monoclonal antibody against TNF-alpha, on disc herniation resorption: a randomized controlled study. Spine. 2006;31:2641-2645. ↩︎
- Carette S, Fehlings MG. Clinical Practice. Cervical radiculopathy. N Engl J Med. 2005;353:392-399. ↩︎
- Cyteval C, et al. Predictive factors of efficacy of periradicular corticosteroid injections for lumbar radiculopathy. AJNF Am J Neuroradiol. 2006;27:978-982. ↩︎
- Bogduk N. The anatomy and physiology of neck pain. Phys Med Rehabil Clin N Am. 2003;14:455-472. ↩︎
- Wainner RS, et al. Reliability and diagnostic accuracy of the clinical examination and patient self report measures for cervical radiculopathy. Spine. 2003;28:52-52. ↩︎
- Childs JD, et al. Neck pain: clinical practice guidelines linked to the International Classification of Functioning, Disability, and health from the Orthopaedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2008;38:A1-A34. ↩︎
- Manchikanti L, et al. Comprehensive evidence-based guidelines for interventional techniques in the management of chronic spinal pain. Pain Physician. 2009;12:699-802. ↩︎
- Rubinstein SM, et al. A systematic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy. Eur Spine J. 2007;16:307-319. ↩︎
- Thoomes Ej. Et al. The effectiveness of conservative treatment for patients with cervical radiculopathy: as systematic review. Clin J Pain. 2013;29:1073-1086. ↩︎
- Browder DA, Erhard RE, Piva SR. Intermittent cervical traction and thoracic manipulation for management of mild cervical compressive myelopathy attributed to cervical herniated disc: a case series. J Orthop Sports Phys Ther. 2004;34:701-712. ↩︎
- Cleland JA, et al. Manual physical therapy, cervical traction, and strengthening exercises in patients with cervical radiculopathy: a case series. J Orthop Sports Phys Ther. 2005;35:802-811. ↩︎
- Moeti P, Marchetti G. Clinical outcome from mechanical intermittent cervical traction for the treatment of cervical radiculopathy: a case series. J Orthop Sports Phys Ther. 2001;31:207-213. ↩︎
- Waldrop MA. Diagnosis and treatment of cervical radiculopathy using a clinical prediction rule and a multimodal intervention approach: a case series. J Orthop Sports Phys Ther. 2006;36:152-159. ↩︎
- McKenzie RA. The cervical and Thoracic Spine: Mechanical Diagnosis and Therapy. Waikanae, New Zealand: Spinal Publications;2009. ↩︎
- Rathore S. Use of McKenzie cervical protocol in the treatment of radicular neck pain in a machine operator. J Can Chiropr Assoc. 2003;47(4):291-297. ↩︎
- Kjellman G, Oberg B. A randomized clinical trial comparing general exercise, McKenzie treatment and a control group in patients with neck pain. J Rehabil Med. 2002;34:183-190. ↩︎
- Ellis RF, Hing, WA. Neural Mobilization: A Systematic Review of Randomized Controlled Trials with and Analysis of Therapeutic Efficacy. J Man Manip Ther. 2008;16(1):8-22. ↩︎
- Murphy DR, et al. A nonsurgical approach to the management of patients with cervical radiculopathy: a prospective observational cohort study. J Manipulative Physiol Ther. 2006;29:279-287. ↩︎
- Allison GT, Nagy BM, Hall T. A randomized clinical trial of manual therapy for cervico-brachial pain syndrome – a pilot study. Man Ther. 2002;7:95-102. ↩︎
- Fritz, et al. Exercise only, exercise with mechanical traction, or exercise with over-the-door traction for patients with cervical radiculopathy, with or without consideration of status on a previously described subgrouping rule: a randomized clinical trial. J Orthop Sports Phys Ther. 2014;44(2):45-57. ↩︎
- Graham N, Gross AR, Goldsmith C. Mechanical traction for mechanical neck disorders: a systematic review. J Rehabil Med. 2006;38:145-152. ↩︎
- Sueki D, Brechtar J. Orthopedic Rehabilitation Clinical Advisor. Maryland heights, MO: Elsevier/Mosby;2010. ↩︎