WHAT IS IT? CERVICAL RADICULOPATHY
Cervical Radiculopathy (Arthritis, Muscular and Disc related)
Pain around the neck region which can affect both head and neck and restrict movements.
This can have both a gradual onset or a sudden onset if related to trauma (falls/road traffic accident).
Consult your Doctor
If you experience any of the following symptoms then please contact your doctor or GP:
Persistent, unexplained dizziness, nausea, and vomiting
Feel feverish or generally unwell
Unexplained weight loss
Any violent trauma- e.g. fall from height/ road traffic accident
Have a history of Cancer
Problems with swallowing or speech
Signs & Symptoms
Symptoms of pain/weakness/burning discomfort which affect the arms and hands.
Sharp pain on movement of the neck.
Pins and needles (often at night) in the arms and hands.
Pain up the arm to the neck.
Weakness of grip.
Clumsiness when holding objects.
Easing of symptoms by shaking hands or tilting head away from painful side.
What Causes It?
Can be caused by pressure on the neck joints often due to poor posture, which then causes excess bony deposits (osteophytes) and some minor swelling to pinch on the nerves.
Can also be caused by a disc-prolapse (or “slipped disc”): the discs in-between the spinal levels (which are made out of jelly-like material) - pushing fluid like material out as they break due to pressure on them- your body has a very good ability to heal itself and the disc is constantly repairing and renewing itself. The fluid like material eventually dries up and is absorbed through your system.
Both the above causes can be are due to prolonged poor posture causing prolonged pressure on the spine.
If there is any acute trauma from a road traffic accident or fall, then muscles can also go into severe spasm pinching on nerves coming out of the neck.
Can be caused by abnormal neck positions- poor posture/ poor ergonomics (desk set-up) related- which can lead to strain on muscles around the neck.
How to Self Manage
Heat- hot water bottles/ heat packs around the neck to help relax muscles.
Ice (no direct ice to skin) can be used to treat severe pain ad swelling.
Gentle neck stretches and movements in all directions, but not to extremes.
Gentle chin tucks- keeping the head level and tucking the chin backwards- holding this for 5-10 seconds and repeating 5 times regularly throughout day.
Anti–inflammatory medication or painkillers are helpful to reduce pain and swelling.
Muscle relaxants with ease muscle spasm.
Use a pillow or 2 to bridge the gap between the head and shoulders if sleeping on your side- or a small pillow if sleeping on your back.
Refrain from using a neck collar.
Do not drive if you are severely restricted in moving your head or neck.
Most symptoms can be improved with conservative management (physiotherapy) if the injury has been present for less than 4-6 weeks- On most occasions symptoms improve very well with conservative management. The long-term prognosis of neck pain is generally also very good- people tend to recover very well.
If you have been experiencing pain/ pins and needles/ numbness/ weakness in hands and arms for more than 4-6 weeks- then please consult a doctor as you ma require an MRI scan.
Corticosteroid injections if conservative management is unsuccessful with help to reduce pain and inflammation.
Surgery may also be indicated following an unsuccessful cortisone injection if symptoms of continuous pain, numbness, weakness and pins and needles have been affecting arms and hands.
If there is some long-term symptoms in the nerves which have been affected- doctors/ consultants can prescribe neuropathic pain medication- such as: Gabapentin, Amitriptyline, and Pregablin.
How Physio Helps
Assessment to establish if symptoms are being caused by joints or discs, or muscles pinching on nerves.
Soft tissue massage to release tight muscles, and muscle spasms causing pain.
Electrotherapies including ultrasound/ Acupuncture therapy to improve circulation reduce swelling.
Prescription of strengthening exercises to address muscle tightness and improve neck stability.
Nerve mobilisation to reduced tension on the nerves.
Provision of stretches and home exercises for rehabilitation to strengthen the neck and
Mobilisation techniques to take the pressure off the joints and discs.
Review of workplace/sporting ergonomics.
APTA (2017) 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. American Physical Therapy Association. www.ncbi.nlm.nih.gov/pubmed/28666405
Cote, P. et al (2016) Management of neck pain and associated disorders: A clinical practice guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. European Spine Journal. Springer. www.ncbi.nlm.nih.gov/pubmed/26984876
Kjaer, P. et al (2017) National clinical guidelines for non-surgical treatment of patients with recent onset neck pain or cervical radiculopathy. European Spine Journal. Springer. www.ncbi.nlm.nih.gov/pubmed/28523381
Williams,N.H. and Hoving,J.L. (2004) Oxford textbook of primary medical care. In: Jones,R., Britten,N., Culpepper,L., Gass,D., Grol,R., Mant,D., Silagy,C. (Eds.) Neck pain.Oxford: Oxford University Press., 1111-1116.