Physical Therapy for Neck Pain and Radiculopathy
Ever experience lower neck pain with certain head movements? What about pain and achiness going down your arm? Or even some nonspecific pain in your shoulder or arm that you didn’t know where it was coming from?
Please check out one of our recent articles, Cervical Radiculopathy in Fitness Athletes, for a brief synopsis about how neck pain with radicular symptoms can arise during common strength training exercises and fitness activities. In this previous article, we shortly touched on how Physical Therapy can help with neck pain and radiculopathy, so the purpose of THIS article is to expand upon that!
This condition arises as a result of mechanical compression of a nerve root that exits the spine, leading to pain in the neck with possible weakness and pain down the arm. The severity, location, and provoking factors greatly vary among individuals; some may have neck pain specifically, some may have this accompanied by pain that radiates down the arm. In fact, some may have pain ONLY in their arm, in various locations, WITHOUT neck pain, masking the presence of an underlying condition at the neck! Therefore, a thorough assessment is always necessary, and Physical Therapy treatment for neck pain and radiculopathy will always be specific to each individual.
The overall common goals of Physical Therapy are these: 1) reduce the compression, 2) restore full motion, and 3) gradually return to activities based on symptom tolerance with movement and load. While this article is to be referenced as an overview of this process, a formal evaluation by a Physical Therapist is ALWAYS necessary in order to determine the most appropriate treatment route.
What’s Happening in the Neck: Usually the nerve root compression occurs somewhere in the lower cervical spine (for the sake of simplicity in this article, we will mostly refer to the lower cervical spine at this time). Your spine has little spaces on each side of them, through which the nerves exit. This space can be encroached as a result of multiple things. Muscle tissue tension, joint stiffness in the facets of the vertebrae, and yes, discs can be involved too. Even if the disc is involved, this is NOT pathological. Often, the involvement of a disc is thought to be detrimental and necessitates urgent care; but realistically, it can respond VERY favorably to Physical Therapy intervention for treatment of neck pain and radiculopathy, and invasive interventions are not required!
What Do We Do: Physical Therapists will do a formal assessment on which movements and positions elicit the associated symptoms. For example: bending your neck, looking up, side bending, rotating, jutting your head forward, pulling your head backward, and combined movements of these listed. We want to improve segmental joint movement in the direction of the greatest restriction. To be (very) brief, often the movement of retracting your head and neck (aka, making a double chin motion or pulling your head backward), in combination with looking up into extension, are the most limited. This is because the vertebral segments move in this backward direction toward where the compressive structure is located, and intermittently contribute to this compression. There are several manual therapy techniques, and patient-directed techniques, that are performed to improve this. In fact, continuous movement in the limited direction is indicated in order to clear the restriction. In the presence of a disc, these direction-based movements help bring the disc tissue back into the spinal column and away from the nerve root. Progressions of this approach is known as the McKenzie Technique, which we can use to improve your pain.
Other Things To Address: Usually, treatment of mobility of the THORACIC spine is involved when treating the neck. This is because the segments of the neck move better when the upper back moves better! Additionally, treating any relevant muscle tension, such as in your upper trap muscles, can assist with alleviating pain and restoring motion. In this pursuit, studies actually show positive changes in muscle sensitivity and trigger point presence following joint mobilization/ manipulation, indicating this has multiple indications for Physical Therapy treatment of neck pain and radiculopathy2.
How do We Move Forward: Our favorite part… we get to address movement patterns, loading principles, and get you STRONGER to prevent this from re-occurring. By building strength through the spine and helping you return to activities of your daily life pain-free, we can overcome the neck pain barrier together. As outlined in the previous article, many contributing factors from training, including impairments to movement and loading qualities, will contribute to nerve root compression at the neck. Once we reduce the issue of the source of pain, we can improve the way you move, build strength and resilience against further injury. Often this comes with addressing issues in mobility at the thoracic spine and shoulder, proximal stabilization at the scapula, and more, during strength training.
Overall, Physical Therapy can greatly improve pain, and help you return to the activities you love, during treatment of neck pain and radiculopathy! If you’re experiencing neck or referring pain that is keeping you from living your life, come to our clinic in Minneapolis, or reach out at 612-200-2962 to see how we can help!
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) 200-2962 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!
The McKenzie Institute
Fernández-de-Las-Peñas C. Interaction between trigger points and joint hypomobility: A Clinical perspective. J Man Manip Ther. 2009;17(2):74-7
