Cervical Radiculopathy in fitness athletes
Want to know a secret about that shoulder and arm pain you have…?
… it may not be coming from the arm.
In many cases, the pain problem athletes experience in the shoulder and/or arm ARE in fact related to an impairment relevant to this joint and surrounding structures. But sometimes, these impairments contribute to a structural or movement-related impairment even higher up… the neck!
When treating shoulder/arm pain, it is best practice to screen the neck for associated findings, or at least take the closely-related structures of the spine and shoulder into consideration when formulating a clinical diagnosis. Whether you have neck pain present in conjunction with the shoulder/arm pain, it’s important to consider spine and nerve root conditions that lead to localized pain problems with movements and loads. This is called radiculopathy — when defined, it is the mechanical compression of a nerve root that exits the spine and leads to pain and weakness down the extremity.
Radiculopathy does NOT mean that there is something wrong with your spine or nerves. All it means is that there is a mechanical problem, usually associated with movement patterns relevant to mobility, weakness, or motor control, that subsequently puts more stress on the nerve roots of your spine… Most of the time, it is a result of the whole movement system. For this reason, Physical Therapy is the BEST way to address this condition!
Many cases appear with differences in symptom location, symptom severity/ activity limitations, and history of injury/pain arousal. But, there are many commonalities with symptom description, clinical examination of the cervical spine, and movement pattern impairments, that turn our attention toward the neck in cases of non-specific shoulder/arm pain.
Common signs/symptoms that necessitate consideration of the neck:
the pain in the shoulder/arm may be delayed. You may notice you do a lengthy workout with overhead movements, and instead of having pain limit you right away, it’s at it’s worst later in the day. This indicates there could be a scapular/shoulder joint movement impairment, with faulty loading patterns that irritate the structures of the neck.
Impaired motion at the neck. I usually check for cervical rotation, cervical flexion with rotation, cervical extension, and cervical retraction — these may be limited, and/or painful with movement at end range. I use these as key indicators that there is nerve root stress at the neck, and whether or not it is actually relevant, use this to guide the rest of my clinical conclusions. We also do other forms of special testing, that are supported in research, to further confirm if the neck is involved!
The pain is not isolated to one part. It may be generalized, as if you cannot point to ONE specific location. Maybe the “general” location is small in diameter, but not specific to one structure.
The pain is described as achey, throbbing, and/or weak. Shooting pain and numbness/tingling are up there on the list too, but these are more obvious indicators of a nerve impairment. Many cases of radiculopathy in fitness athletes are not as clear to detect.
Weakness is present in nerve-referring patterns. This weakness may or may not be relevant to the neck at all, and may actually be an underlying cause for the pain to begin with — but if the there is a nerve root impairment from the neck, this can manifest into myotomal weakness in the areas the nerve innervates, which can help determine if this nerve is in fact involved.
These are some, but not all, the reasons why we’d consider screening the cervical spine when we are addressing your non-specific shoulder/arm pain.
So how does my movement affect my neck?? Well, we have to think of certain loading patterns as a whole movement system of the shoulder, scapula, thoracic spine, AND the neck. The below is a list of a few, but not all, movement patterns that involve this whole movement system, and should be reviewed and re-trained with your Physical Therapist:
Overhead: press, handstand, snatch, etc
Thoracic spine load: front squat, clean, etc
Pulling: Kipping, pull-up, toes to bar, muscle up, etc
Shoulder extension and rotation demands: Ring dip, push-up, dumbbell row, cable row, high pull, etc
So then…. What do we do about it? While this may seem complex, the treatment process is relatively straightforward. No, you don’t have a bad neck! And no, this does NOT mean stop loading up/ working out!
Symptom management. I usually start by addressing the cervical spine. This depends on symptom severity. We have many ways of doing this, including mobilization, manipulation, and with repeated movements through the McKenzie Technique.
Coach first — improving proprioceptive awareness of movement mechanics can be greatly effective to reduce unwanted stress at the spine before other forms of treatment/loading
Get used to moving again, with gentle loading initially, depending on symptom severity
Interventions will include mobility work as necessary, movement re-education, and strengthening positions.
YES — Physical Therapy can help! While uncovering the involvement of the neck in shoulder and arm pain can be tricky, our knowledge of kinesiology, periodized loading strategies, and pain modification fits well to address the neck as a contributing factor to your pain problem.
We would be happy to discuss further how Loon State Physical Therapy can be a teammate in getting you back to moving and feeling your best! Our convenient Minneapolis physical therapy, Edina physical therapy, and Stillwater physical therapy locations will happily welcome you to get you back to moving at your best. Call us at (612) 405-8503 or book with us online at www.loonstatephysicaltherapy.com for an in-person or virtual appointment.
We look forward to being your teammate through this journey!
