Best Therapy For Pain Radiating From My Neck To My Arm? Cervical Radiculopathy
Is your chiropractor or physiotherapist having trouble improving your neck pain that is travelling down your arm ( cervical radiculopathy )?
Do you have trouble checking your blind spot, while driving from pain radiating down your arm ( cervical radiculopathy ).
What’s the best therapy for cervical radiculopathy?
Radiating pain from your neck that goes down your upper arm to your forearm and even your hand is called cervical radiculopathy.
Cervical relates to the neck vertebrae called the cervical vertebrae and radiculopathy refers to numbness, tingling or pain that radiates down the arm when your nerve is irritated.
With cervical radiulopathy your nerve is irritated right where the nerve comes out from the spinal cord between two of the neck vertebrae or cervical vertebrae. This part of the nerve closest to the vertebrae is called the root of the nerve. Like the root of a tree.
In the picture above the nerve root sticks out of from the vertebrae like some tree roots stick out of the ground. Like the nerve roots the roots of the Mangrove Tree stick out from the ground.
Radiculopathy is thus caused by some form of irritation of the cervical nerve root. I will go over the causes of cervical nerve root irritation that is causing your cervical radiculopathy later in this article.
Cervical Radiculopathy Really Isn’t A Diagnosis
So if your doctor tells you that you have cervical radiculopathy this is really not a diagnosis. Cervical radiculopathy only tells you that there is a nerve pinched or irritated, it doesn’t tell you a cause of the problem. Cervical radiculopathy is a description, much like sciatica isn’t a diagnosis for lower back pain.
For example your doctor might tell you that you have C6 cervical radiculopathy. Let’s look at what this means.
There are seven vertebrae in the neck. They are called cervical vertebrae. To identify which specific vertebrae someone is talking about they are numbered.
So the first vertebra in the neck is called C1 while the second vertebrae in the neck is called C2, the third vertebra is called C3, and it goes all the way to C7. You get the idea.
The nerves are also numbered C1, C2 etc…All you have do is remember that there is a nerve that corresponds the vertebrae.
So in the example of C6 cervical radiculopathy your C6 nerve is pinched. So the question is what’s the diagnosis or the cause of the radiculopathy?
The diagnosis is critical as the treatment will differ depending on the cause. If your actual diagnosis is due to inflammation then you need to decrease the cause of the inflammation however if the nerve is pinched due to infection than the treatment is quite different.
Rest assured most people don’t have infections causing cervical radiculopathy. There are really only a few common causes of cervical radiculopathy.
Why Do I Have Cervical Radiculopathy
Here are the three main causes of cervical radiculopathy.
- Osteoarthritis of the bones and ligaments causing pinching of the nerve root called Cervical Lateral Stenosis.
- Osteoarthritis of the bones and ligaments causing pinching of the spinal cord called Cervical Spinal Stenosis.
- Osteoarthritis of the disc (degenerative disc disease) leading to disc herniations which causes pinching of the nerve root.
1. Cervical Lateral Stenosis=Pinching of the Nerve Root
Osteoarthritis can form bone spurs and enlargement of the ligaments that surround the nerve root. Cervical lateral stenosis is the pinching of the nerve at the nerve root.
Looking at the picture above you can see the label “impinged nerve” that is pinched between the “facet with spurs” and the “disc”.
Cervical lateral stenosis will cause pain down the arm usually when you bend side ways or rotate your neck to the bad side and often if you bend your head backwards as far as it will go. Sometimes all directions will be restricted.
2. Cervical Spinal Stenosis=Pinching Of Your Spinal Cord
Osteoarthritis can also form bone spurs and enlargement of the ligaments in the spinal canal. Looking at the picture above you can see the label “spinal canal” Inside the spinal canal is the spinal cord which is being pinched from the bony spurs and the disc as well.
The space for your spinal cord gets smaller and smaller. When the space for your spinal is small enough you will typically feel better when you bend your neck a little forward and worse in most other directions. Symptoms you can get include numbness, tingling and pain down the arm but you can also get pain going down the into the leg. Yes the leg as the spinal cord extends down to the lower back.
3. Disc Herniation
Cervical Disc Herniation: Osteoarthritis of the disc otherwise known as degenerative disc disease causes your disc to weaken, while sometimes trauma can damage your disc.
When enough layers of the protective annulus seen above are broken down then the inner stuff like a jelly doughnut called the nucleus can start to push outward. If the nucleus puts enough pressure from the inside the bulge can grow large enough to pinch the nerve.
Common Mistakes And MisDiagnosis
- Pinching of a bundle of nerves at the base of the neck. Your doctor might call this brachial radiculopathy or more accurately thoracic outlet syndrome.
- Pinching of the same bundle of nerves this time at the chest. Also called brachial radiculopathy or more accurately thoracic outlet syndrome.
- Cervical Radiculopathy with no symptoms in the neck but starts in the shoulder.
Number 1 and number 2 is not technically cervical radiculopathy but many doctors and chiropractors will often mistake this for cervical radiculopathy so I include it here. The importance of this is if your doctor doesn’t diagnose it properly and sends you to a chiropractor or physiotherapist that blindly follows your medical doctors diagnosis than the treatment will not work.
What happens most often is that you will be given exercises for your neck and upper back. Your neck will be treated often but the most crucial area in this case is the front of the neck at the base and the chest muscle pectoralis major. If your chiropractor doesn’t treat this area than they cannot fix your problem.
Number 3 is a common misdiagnosis where chiropractors, medical doctors and physiotherapists alike. They don’t check the neck. Why, the pain starts in the neck and is aggravated by shoulder problems. Should be a shoulder problem right. Sometimes true but many times the answer is that a neck problem will mimick a shoulder problem.
I have seen people treated for months with little to no results. The health care practitioner keeps treating the shoulder as that’s where the pain is. Often there is a extra tight muscles in the shoulder and below so if you treat the shoulder and the muscles down the arm the pain will decrease.
So you feel better after your chiropractor or physiotherapist treats your shoulder. This only encourages and to the novice health care practitioner reinforces their misdiagnosis. This perpetuates the process.
There are other diagnosis but they make up a small percentage of the patients that I see.
A small number of my patients have a trapped nerve further down the nerve far from the nerve root.
The great news is that treatment for cervical radiculopathy by manual methods like chiropractic was found to more effective than surgery.
What are the treatments that were used in research studies that were found to be effective.
- Mobilizations: Movements that is done by a health practitioner to move your vertebrae
- Retractions which are like a chin tuck movements
- Cervical Lateral Glides: Fancy way saying side movements of the neck done by a health practitioner like a chiropractor or physiotherapist
- Nerve Flossing: Stretching of the nerve to free the nerve that is trapped by muscles, tendon, discs, bones or other tissue.
Treatment that may or may not help
- Spinal Manipulation studies is not yet proven either way to help cervical disc manipulation [2-3].
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- Boyles R, Toy P, Mellon J et al., Effectiveness of manual physical therapy in the treatment of cervical radiculopathy: A systematic review, Journal of Manual and Manipulative Therapy 2011; 19 (3): 135-142.
- Peterson CK, Schmid C, Leemann S et al., Outcomes from Magnetic Resonance Imaging-Confirmed Symptomatic Cervical Disk Herniation Patients Treated with High-Velocity, Low-Amplitude Spinal Manipulative Therapy: A Prospective Cohort Study With 3-Month Follow-Up, Journal of Manipulative & Physiological Therapeutics 2013; 36: 461-467.
- Rodine R & Vernon H, Cervical radiculopathy: a systematic review on treatment by spinal manipulation and measurement with the Neck Disability Index, Journal of the Canadian Chiropractic Association 2012; 56(1): 18–28.
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