Physiotherapy Can Help Cervical Nerve Root Neck Pain
Posted: Monday, November 10, 2008
by Jonathan Blood Smyth
Cervical radiculopathy is a pain syndrome involving one of the cervical nerve roots, with the C7 root (60%) and the C6 root (25%) being the most commonly involved. In younger persons this is due a direct injury which compromises the nerve exit or due to an acute disc prolapse. In older age groups this syndrome can also occur, but in this case is due to narrowing of the nerve exit by arthritic joints and ligament enlargement, disc bulging and bony outgrowths. Cervical nerve root pain referred to physiotherapists for the management of neck pain and arm pain.
Cervical radiculopathy can occur for a variety of reasons while sometimes there is no obvious precipitating factor that can be found. A sudden extension, side bending and rotation, e.g. in sport or trauma, could close down the exit gap quickly and squeeze the nerve, injuring it. Sudden flexion or extension with a side bend away from the affected side could pull the nerve strongly, again injuring it and causing symptoms. Disc prolapses can occur with a sudden load on the neck in any position, and in older people sustained or repetitive extension and rotation may cause the osteophytes to contact the nerve, with similar results to the previous events but with a slower onset.
To ensure the problem is radiculopathy the physio will take a history including the area and type of pain, muscle weakness or numbness, factors making the pain worse or better, how the injury happened, any current treatment and any lower limb or bowel or bladder problems. Commonly the pain has not come on quickly but insidiously and over time, initially presenting with a dull achy pain to a very severe burning pain in the neck and over the shoulder. This can worsen to the upper arm, then the forearm and the hand as the root irritation increases. Rarely there may be no real pain but loss of muscle power and sensibility.
Initially a clear history will be taken by the physiotherapist to clarify the diagnosis, including where the pain is presenting and what kind of pain it is, whether there is muscle weakness and sensory change, the worsening and improving factors, the way the injury occurred, leg or bladder/bowel symptoms and treatments already attempted. Pain onset is usually slow and steady with discomfort in the neck, arm and scapula, varying form a dull aching to a high level of pain. The pain progresses to the upper and lower arms and then into the hand as the syndrome develops. In some cases there is little or no pain, but loss of feeling or muscle strength.
A postural abnormality is often present with the neck held side flexed or rotated away from the painful side. Examination by the physiotherapist includes recording any muscle spasm, checking reflexes, sensibility and muscle power, any combined movements which might aggravate the pain and any easing factors such as manual traction. Acupuncture and cervical epidural injections of steroids may be useful if physiotherapy cannot reduce the pain sufficiently.
Patients hold their necks stiff and have reduced movement with postural deformity such as a head tilt or rotation away from the painful side. Physiotherapy testing includes checking muscle spasm, testing muscle strength, reflexes and sensory abilities. Manual traction may help symptoms and this and movement combinations which aggravate the pain are noted.
Initially the physiotherapist concentrates on reduction of the pain and potential inflammation, using ice, non-steroidal anti-inflammatory drugs and other analgesia, avoiding aggravating postures and activities, manual or mechanical traction. The aim of treatment is to reduce the forces going through the nerve root and to allow it to settle. A collar for support and to reduce movement, especially at night, can be useful. Manual traction is a physiotherapy skill which needs to be carefully applied if it is not to worsen the condition. Once the acute phase is over the physio turns to restoring range of movement and neck and overall muscle power, beginning with isometric exercises and progressing. Patients should keep up strengthening, stretching and cardiovascular fitness over the long term.
Jonathan Blood Smyth is a Senior Physiotherapist at an NHS hospital in the South-West of the UK. He specialises in orthopaedic conditions and looking after joint replacements as well as managing chronic pain. Visit the website he edits if you are looking for a Physiotherapists in Kensington.
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