Neck pain is one of the leading causes of disability. In fact, it’s estimated that 10% of the population will be affected by neck pain each year. In some instances neck pain can also be accompanied with pain in the shoulder or even down to a person’s hand. In these cases not only is the pain experienced disabling it can also be frightening to a person that they may have developed a serious medical condition. Fortunately, this is the not the case for the vast majority of individuals. Usually the culprit behind neck pain that radiates down the arm is from a cervical radiculopathy.
There are multiple causes for a cervical radiculopathy to develop. For a younger individual usually trauma can play a major role. This is typically seen in a motor vehicle accident which may rapidly thrust a person’s neck at the end range of motion typically extending or flexing the neck to an extreme. This causes a rapid increase in pressure on the discs between the spine. The role of these discs is to act as shock absorbers, but if too much pressure is placed on the discs they can bulge out or herniate. A herniated or bulge disc can pinch one of the nerves that exit the spinal column. Because the nerves that exit the neck lead to the shoulder and arm this may result with pain throughout or through parts of the shoulder and arm. Additionally, if a person sustains trauma to the head or neck the ligaments the surround and support the cervical spine may become damaged or lax. This may result in spinal instability, which can lead to extra movement of the cervical spine which can potentially pinch a nerve that is exiting the spinal column.
There are several risk factors for developing a cervical radiculopathy. The peak incidence of cervical radiculopathies occurs between the 4th and 5th decade of life. Individuals with occupations that require more manual labor, specifically lifting are at greater risk of developing a cervical radiculopathy. There is also a higher correlation in developing a cervical radiculopathy in people who drive for prolonged periods of time on a daily basis.
For older individuals bulges and herniations can occur, although this is not the common cause of a cervical radiculopathy for this population. In older individuals disc degeneration is a much more common cause of why someone would develop a cervical radiculopathy. This is when the spinal discs lose water which causes the space in between the vertebra to shrink. This increases the likelihood that a nerve will become pinched. In addition, as the distance between the vertebra lessens bone spurs may begin to form. The bone spurs begin to form because the body sees the shrinking disc as a possibly area of weakness and to counteract this, the body begins to form bone spurs. Unfortunately, these bone spurs also increase the chances that a nerve will become impinged. Furthermore, having poor posture can also place additional pressure on these discs which can place a person at greater risk of developing a cervical radiculopathy or worsen a person’s symptoms.
There are several symptoms a person with a cervical radiculopathy may experience. A person may experience sharp pain only in the neck or pain that radiates to the shoulder or even to the fingers. A person may also experience pins and needles that go down the arm. Certain aspects of the arm may become completely or partially numb. Muscle weakness can also be experienced as well. A person may complain of diminished grip strength and begin dropping things on a regular basis. A person with a cervical radiculopathy may also experience increased symptoms when extending or rotating the neck. This may make looking up or backing out of a driveway painful and difficult.
During an initial examination the physical therapist will first rule out any serious pathologies. After the therapist rules out all serious conditions the therapist will employ several interventions to reduce the patient’s symptoms. First the therapist will focus on strengthening the deep neck flexors. By strengthening this muscle group less pressure is place on the cervical spine and as a result less pressure is placed on the nerve root. This can also aid in reducing the amount of spinal instability. The therapist may also incorporate stretches that cause the opening of the nerve root to widen which can help relieve the patient’s symptoms. The therapist will also focus on exercises that strengthen the muscles around the shoulder blades which will aid in correcting the patient’s posture. Often a patient will present with rounded shoulders and a forward head posture which increases the strain on the cervical spine and the nerve root.
The therapist will also utilize manual techniques such as traction. Traction helps distract the vertebra in the cervical spine which reduces the pressure on the nerve root and decrease’s the patient symptoms. Patients with cervical radiculopathies will usually present with muscle guarding throughout the neck and shoulder region as well. Muscle guarding can also cause the nerve to be entrapped which can increase the amount of pressure that is placed on the nerve and can contribute to the patient’s symptoms. To counteract this, the therapist will perform hands on techniques that will reduce this built up tension and help alleviate the patient’s symptoms.
For people suffering with this condition the overall prognosis is quite positive. Most people do not require surgery and the majority of people who attempt conservative management experience an improvement in symptoms and report a higher quality of life. For more information on physical therapy services visit www.totalperformancept.com.
Don’t let neck pain take control of your life; call Total Performance Physical Therapy for an evaluation today.