Spine 2023, Nov, 04 | 12:00 am

Alleviate Pain and Regain Mobility: Treatment Options for Cervical Radiculopathy

Get the complete guide about cervical radiculopathy (pinched nerve), its causes, symptoms, diagnosis, treatment, and prevention.

Cervical radiculopathy (also known as “pinched nerve”) is a condition that results in radiating pain, weakness and/or numbness caused by compression of any of the nerve roots in your neck. Most cases of cervical radiculopathy go away with nonsurgical treatment.

Table of Content
Cervical Radiculopathy Causes
Jump to Symptoms and Causes
Cervical Radiculopathy Symptoms
Jump to Symptoms and Causes
Cervical Radiculopathy Diagnosis
Jump to Diagnosis and Tests
Cervical Radiculopathy Treatment
Jump to Management and Treatment
Cervical Radiculopathy Exercises
Jump to Cervical Radiculopathy Exercises
Cervical Radiculopathy Stretches
Jump to Cervical Radiculopathy Stretches
Cervical Radiculopathy Prevention
Jump to Prevention
Cervical Radiculopathy Recovery
Jump to Outlook and Prognosis
Cervical Radiculopathy Prognosis
Jump to Outlook and Prognosis
Cervical Radiculopathy and Sleep
Jump to Living With
Cervical Radiculopathy and Driving
Jump to Living With
Cervical Radiculopathy and Work
Jump to Living With
Cervical Radiculopathy and Exercise
Jump to Living With
Cervical Radiculopathy and Pregnancy
Jump to Living With
Cervical Radiculopathy and Weight Loss
Jump to Living With
Cervical Radiculopathy and Stress
Jump to Living With
Cervical Radiculopathy and Anxiety
Jump to Living With
Cervical Radiculopathy and Depression
Jump to Living With
Cervical Radiculopathy and Pain Management
Jump to Management and Treatment
Cervical Radiculopathy and Alternative Medicine
Jump to Management and Treatment
Cervical Radiculopathy and Support Groups
Jump to Living With
Cervical Radiculopathy and Quality of Life
Jump to Outlook and Prognosis

Symptoms and Causes

The nerves that connect to your cervical spine (neck) extend out to your following body parts:

  • Shoulders.
  • Arms.
  • Chest.
  • Upper back.

Because of this, the neurological symptoms that result from cervical radiculopathy can radiate down from your neck to any one of or a combination of these body parts, depending on which nerve root is affected. Cervical radiculopathy typically only affects one side of your body — for example, your right arm, not both arms.

Neurological symptoms from cervical radiculopathy that can radiate down from your neck include:

  • Pain.
  • Numbness.
  • Tingling or a “pins and needles” feeling.
  • Muscle weakness.
  • Weakened reflexes.

Cervical radiculopathy affects people differently. You may have any combination of the above neurological symptoms or only one.

What does cervical radiculopathy pain feel like?

People with cervical radiculopathy typically describe the pain as sharp or burning. Moving your neck in certain ways, like extending or straining it, may increase the pain.

Some people with cervical radiculopathy notice that their pain decreases when they place their hands on top of their head. This may temporarily relieve pressure on the affected nerve root.

What causes cervical radiculopathy?

Cervical radiculopathy happens when a nerve root in your neck (cervical spine) becomes compressed (pinched) and inflamed.

This compression has two main causes:

  • Degenerative changes that happen in your spine as you age (cervical spondylosis).
  • A herniated (bulging) disk in your neck.

Cervical spondylosis and cervical radiculopathy

The majority of cases of cervical radiculopathy are due to cervical spondylosis.

Cervical spondylosis is a general term for age-related wear and tear (degenerative changes) in your cervical spine (neck) that can lead to neck pain, neck stiffness and other symptoms. Sometimes, this condition is called arthritis or osteoarthritis of the neck.

As you age, the disks in your spine between your vertebrae lose height and begin to bulge. They also become less jelly-like and become stiffer. This problem causes the collapse of the disk spaces and loss of disk space height.

As the disks lose height, your vertebrae move closer together. Your body responds to the collapsed disk by forming more bone — called bone spurs (osteophytes) — around the disk to strengthen it. These bone spurs can narrow the foramen — the small openings on each side of your spinal column where the nerve roots exit — and pinch the nerve root. This is called foraminal stenosis. The pinched nerve root causes cervical radiculopathy.

Herniated disks and cervical radiculopathy

Through aging or an injury, the outer layer of a vertebra disk can weaken and crack. A herniated disk happens when the inner “jelly” substance of the disk pushes through the crack.

A herniated disk causes cervical radiculopathy when the leaked material from a disk in your neck presses on nearby spinal nerves.

Several factors can contribute to a cervical herniated disk, including:

  • Aging.
  • Repetitive neck motions.
  • Lack of regular exercise.
  • Poor posture.
  • Incorrect lifting or twisting, causing additional stress on your neck.
  • Injury to your neck.

Cervical radiculopathy caused by a herniated disk is more common in people up to 50 years old.

Diagnosis and Tests

You’ll want to visit your healthcare provider about your pinched nerve if it’s not responding to conservative treatment at home.

Your healthcare provider will ask about your:

  • Medical history.
  • General health.
  • History of injuries or accidents.
  • Symptoms.

They’ll then examine your neck, shoulder, arms and hands. They’ll look for muscle weakness, check for changes in reflexes and ask about the different sensations you’re feeling. Since cervical radiculopathy almost always affects one side of your body (is unilateral), your healthcare provider will compare the sensations you feel on one side of your body to your other side.

Your healthcare provider may also ask you to perform certain neck and arm movements to try to recreate and/or relieve your symptoms.

Cervical radiculopathy can be difficult to diagnose, as many other neurological conditions, such as neuropathy, can cause pain and numbness. Because of this, you may need to undergo certain imaging tests so your healthcare provider can confirm a cervical radiculopathy diagnosis.

What tests will be done to diagnose cervical radiculopathy?

Aside from a physical exam, healthcare providers use the following tests to diagnose cervical radiculopathy or to rule out other possible causes of your symptoms:

  • Spine X-rays: X-rays of your cervical spine are the most common imaging tests for evaluating neck and upper extremity pain. Different views or angles can reveal different issues, such as disk space narrowing and foraminal narrowing (stenosis).
  • Magnetic resonance imaging (MRI): MRI uses a large magnet, radio waves and a computer to produce detailed images of the inside of your body. An MRI scan is the imaging method of choice for evaluating radiculopathy. MRI allows your healthcare provider to see soft tissue abnormalities, including herniated disks and compressed nerves.
  • Computed tomography (CT) scan: A CT scan shows structures inside of your body by using X-rays and computers to produce images. Healthcare providers typically use a CT scan for the diagnosis of traumatic injuries that result in cervical radiculopathy symptoms.
  • Electromyography (EMG): An electromyography (EMG) test measures muscle response or electrical activity in response to a nerve’s stimulation of the muscle. This test can help determine if a nerve is working normally.

Management and Treatment

Fortunately, over 85% of cervical radiculopathy cases resolve (get better) without any specific treatments within eight to 12 weeks.

If your symptoms persist, cervical radiculopathy has several treatment options. As the condition affects everyone differently, your treatment plan will be unique to your situation.

Treatment options include:

  • Immobilization.
  • Medication.
  • Physical therapy.
  • Cervical epidural steroid injection.
  • Surgery.

Healthcare providers almost always start with nonsurgical therapies to treat cervical radiculopathy. About 90% of people with cervical radiculopathy have good to excellent outcomes with nonsurgical therapy.

If nonsurgical treatment isn’t working, your healthcare provider may recommend surgery.

Immobilization for cervical radiculopathy

For short-term management and to alleviate symptoms, your healthcare provider may recommend wearing a soft cervical collar (neck brace) to minimize neck movement and reduce nerve root irritation. A soft cervical collar is a padded ring (collar) that wraps around your neck and is held in place with Velcro®.

Healthcare providers typically don’t recommend wearing a cervical collar for more than one to two weeks because it can lead to muscle atrophy (muscle loss) in your neck.

Medication for cervical radiculopathy

In some cases, certain medications can help alleviate (relieve) symptoms of cervical radiculopathy, including:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs, such as aspirin, ibuprofen and naproxen, can provide both pain relief and anti-inflammatory effects for cervical radiculopathy. They provide relief by targeting the inflammation at the affected nerve root(s). You can buy these medications without a prescription at a pharmacy.
  • Oral corticosteroids: A short course of oral (taken by mouth) corticosteroids may help relieve pain by reducing swelling and inflammation around the pinched nerve. You’ll need a prescription from your healthcare provider for these medications.

Physical therapy for cervical radiculopathy

Physical therapy and specific exercises focused on strength training and stretching your neck muscles can help treat cervical radiculopathy. Again, your physical therapy regimen will be unique to you and depend on several factors, such as which area of your neck is affected and your overall physical health and abilities.

In general, a physical therapy regimen for cervical radiculopathy will progress you through different stages as your pain improves, beginning with gentle range-of-motion exercises and adding strengthening and conditioning activities once the acute (severe and sudden) symptoms fade.

Your physical therapy may also include manual therapy, such as massage or mobilization techniques, to help relieve muscle tension and nerve irritation.

Cervical epidural steroid injection for cervical radiculopathy

A cervical epidural steroid injection is a minimally invasive procedure in which your healthcare provider injects a steroid medication directly into the space surrounding the affected nerve in your neck. The steroid medication helps to reduce inflammation and swelling, which can alleviate pain and other symptoms of cervical radiculopathy.

Your healthcare provider may recommend a cervical epidural steroid injection if other treatments have not provided relief.

Surgery for cervical radiculopathy

If your symptoms are severe or if other treatments have not been effective, your healthcare provider may recommend surgery to alleviate pressure on your affected nerve root. Surgery for cervical radiculopathy typically involves removing the portion of the herniated disk that is pressing on your nerve root. A cervical fusion may also be performed to stabilize your spine and prevent further damage.

While surgery is often successful in relieving cervical radiculopathy symptoms, it does come with risks and complications. Your healthcare provider will thoroughly discuss the potential benefits and risks of surgery with you before making any recommendations.

Cervical Radiculopathy Exercises

Physical therapy exercises can help alleviate pain and improve range of motion in your neck if you have cervical radiculopathy. Always consult with your healthcare provider and/or physical therapist before starting any new exercise regimen.

Neck range-of-motion exercises

Range-of-motion exercises for your neck can help alleviate muscle tension and improve mobility. Try these exercises:

  • Chin tucks: While sitting or standing with good posture, gently tuck your chin in toward your chest, as if you are giving yourself a “double chin.” Hold for 5 seconds, then release.
    Repeat 10 times.
  • Neck rotations: While sitting or standing with good posture, slowly turn your head to the right until you feel a stretch in your neck. Hold for 5 seconds, then return to center. Repeat on the left side.
    Repeat 10 times per side.
  • Side bending: While sitting or standing with good posture, slowly bend your head to the right until you feel a stretch in your neck. Hold for 5 seconds, then return to center. Repeat on the left side.
    Repeat 10 times per side.

Neck strengthening exercises

Strengthening exercises can help improve the stability of your neck and reduce the risk of further injury if you have cervical radiculopathy. Try these exercises:

  • Isometric neck exercises: While sitting or standing with good posture, press your palm against your forehead without moving your head. Hold for 5 seconds, then release. Next, press your palm against the back of your head without moving your head. Hold for 5 seconds, then release.
    Repeat 10 times per direction.
  • Resistance band exercises: Wrap a resistance band around a sturdy object and hold one end in each hand. Stand with good posture and pull the band toward your head, keeping your elbows straight. Hold for 5 seconds, then release.
    Repeat 10 times per set.
  • Shoulder blade squeeze: While sitting or standing with good posture, pull your shoulder blades down and back, as if you are trying to hold a coin between them. Hold for 5 seconds, then release.
    Repeat 10 times.

Cervical Radiculopathy Stretches

Stretching exercises can help relieve muscle tension in your neck if you have cervical radiculopathy. Always consult with your healthcare provider and/or physical therapist before starting any new stretching regimen.

Levator scapulae stretch

The levator scapulae is a muscle that connects your shoulder blade to your neck. Stretching this muscle can help alleviate pain and stiffness in your neck.

  1. While sitting or standing with good posture, tilt your head to one side, as if trying to touch your ear to your shoulder.
  2. Gently place your hand on the same side of your head and apply gentle pressure to deepen the stretch.
  3. Hold the stretch for 10-15 seconds, then release.
  4. Repeat on the other side.
  5. Repeat the stretch 3-5 times per side.

Upper trapezius stretch

The upper trapezius is a muscle that extends from the base of your skull to your shoulder blade. Stretching this muscle can help alleviate neck pain and headaches.

  1. While sitting or standing with good posture, tilt your head to one side, as if trying to touch your ear to your shoulder.
  2. Gently place your hand on the opposite side of your head and apply gentle pressure to deepen the stretch.
  3. Hold the stretch for 10-15 seconds, then release.
  4. Repeat on the other side.
  5. Repeat the stretch 3-5 times per side.

Scalene stretch

The scalene muscles are deep muscles in your neck that stabilize your spine. Stretching these muscles can help alleviate neck pain and improve range of motion.

  1. While sitting or standing with good posture, place one hand under your thigh.
  2. Tilt your head back slightly and gently turn your head toward the opposite shoulder, as if trying to touch your chin to your shoulder.
  3. Gently place your other hand on the side of your head and apply gentle pressure to deepen the stretch.
  4. Hold the stretch for 10-15 seconds, then release.
  5. Repeat on the other side.
  6. Repeat the stretch 3-5 times per side.

Prevention

You can’t always prevent cervical radiculopathy, but you can take steps to reduce your risk of developing this condition:

  • Maintain good posture.
  • Take frequent breaks if you work at a computer or do repetitive tasks with your arms.
  • Practice safe lifting techniques.
  • Incorporate regular exercise into your routine, focusing on strength training and flexibility exercises.
  • If you smoke, quit smoking.

If you have already experienced cervical radiculopathy, taking steps to prevent a recurrence is essential. Your healthcare provider may recommend continuing physical therapy exercises and performing regular stretching and strengthening exercises at home to prevent further damage to your neck.

Outlook and Prognosis

The outlook for cervical radiculopathy is generally positive. Most cases resolve (get better) within eight to 12 weeks with nonsurgical treatment. About 10% of people with cervical radiculopathy require surgery.

If you have cervical radiculopathy, following your healthcare provider’s recommended treatment plan and incorporating lifestyle changes, such as better posture and regular exercise, can help improve your prognosis (long-term outlook) and prevent further damage to your neck.

Living With

Depending on the severity of your cervical radiculopathy, you may need to make certain lifestyle modifications to manage your condition:

  • Avoid activities that aggravate your neck pain.
  • Practice good posture, especially when sitting for extended periods of time.
  • Avoid carrying heavy bags or backpacks that strain your neck.
  • Use a supportive pillow at night to keep your neck in alignment.
  • Use heat or ice therapy to alleviate pain and inflammation.

If your cervical radiculopathy is affecting your ability to work, drive or exercise, talk to your healthcare provider about modifying your routine or exploring alternative treatment options.

Joining a support group can also be helpful for managing the emotional and psychological impact of living with cervical radiculopathy. Support groups can provide a safe space to share your experiences and connect with others who are going through similar challenges.

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