What is Cervical Radiculopathy?
Cervical radiculopathy is a condition where the nerve traveling down the arm is compressed at the neck. Sometimes the pain will travel down the arm and in other cases the pain may be in one area of the arm, such as the outside of the elbow.
Where Does The Nerve Compression Happen?
The picture below shows the anatomy of the neck (cervical spine), including the vertebrae, intervertebral discs, and cervical spinal nerves. Your cervical vertebrae are named from top to bottom, with C1 just below the skull. The picture below shows the C7 spinal nerve being compressed by a bulging disc, but increased bone growth around the joints (facet joints) connecting each vertebra can also contribute to nerve compression. It's important to consider other sources of nerve compression, as many people have bulging discs and extra bone growth without symptomatic nerve compression. This is why your physical therapist will also assess your posture, facet joint mobility, and mechanics with activities such as walking, as dysfunction in any of these areas can decrease the space where the nerve exits the neck.
How Do We Treat Cervical Radiculopathy?
We always look at why the nerve compression is happening to best decide how to treat it. The facet joints surrounding the nerve may be stiff so that you can't go through normal motions that would decompress the spinal nerve. If the upper back is tilted to the right from reaching the left hand on top of your steering wheel this causes a compensatory tilting to the left at your neck to keep your eyes level, which compresses the nerves on the left. If you're working at your desk and always looking to the left this rotation can also compress the nerves on the left. Working alongside your therapist, you'll identify specific movements or positions that may be increasing spinal nerve compression and work on modifying how you do these movements.
What Movements Compress and Decompress the Spinal Nerve?
In this example, we'll use the left cervical spine nerves which would cause pain down the left arm. Watch this video that shows how side bending the neck to the left as well as rotating the neck to the left decreases the amount of space between the facet joints, where the nerve exits the neck. The opposite motions will create more space and decompress the nerve.
What About Double Crush?
When there is compression of the nerve in a second location downstream from the neck this is called a double crush. For example, the nerve may be compressed at the neck and the elbow. Your therapist may have you work on loosening up muscles or joints at the shoulder, elbow, or wrist to address this downstream compression. Any deviations in your posture can lead to increased tension on the nerve and increased stress on muscles that contribute to nerve compression.
How Can Arm Posture Perpetuate Symptoms?
If there are deviations in your posture this can place muscles in an abnormal length (either shortened or lengthened). In either case, if a muscle is not in an optimal position that muscle has to work harder to create the same amount of force which can lead to muscle overuse and tightness. If the poor posture is not corrected then these muscular restrictions can keep recurring.
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Connie Hutchins, PT, DPT, OCS, BFR-1, CCI is a physical therapist at Rehab United. She completed her doctorate degree in physical therapy at USC as well as USC's residency program to specialize in orthopedics. Before moving back to San Diego, Dr. Hutchins was on faculty at USC, teaching doctoral students hands-on and clinical reasoning skills. Dr. Hutchins has a multifaceted approach to improving patients' results in physical therapy. She is always looking to create deeper understanding for patients and physical therapy students regarding why symptoms are happening and how to effectively treat the underlying causes.