Your neck is composed of seven cervical spinal segments that are named C1 through to C7. The segments are attached to its neighbour by two joints, one on each side (left and right) of the vertebrae. At each level of the spine, a nerve comes out through the space created by the facet joints and travels a specific path to innervate muscles, tendons, organs, cells in the skin, and everything else in our bodies. When these nerves get pinched, they tend to produce symptoms such as pain, decreased sensation in limbs, weakness in the shoulder, elbow or fingers, and tingling pins and needles sensations radiating into the arm. Different nerve root levels produce different symptoms and patterns. The pattern or path of pain is also different if the nerve is pinched away from the nerve root (where the nerve exits the spinal cord). This why orthopaedic testing can often determine which nerve is affected without diagnostic imaging.
As the nerve exits the spinal cord and passes through joints and tendons and muscles and other structures, it can become impinged. Herniated intervertebral discs, hypertonic (high tone) muscles, unstable joints, and bone spurs or arthritic joints in the spine are all possible causes for nerve impingement. When a portion of a nerve is pinched, it causes the nerve to be hypersensitive and is more likely to become impinged elsewhere as well.
Physiotherapy treatment for cervical impingement involves removing the source of impingement through manual therapy techniques. Soft tissue release, joint mobilizations, and postural education and corrections help alleviate pressure from the nerve, depending on the type of impingement. Stretches and range of motion exercises help to promote proper movement control and patterning of muscles without muscle spasms and guarding. Nerve flossing, an exercise to mobilize nerves to reduce any fascial restrictions, is also recommended to reduce pain and promote neural recovery. Manual technique for nerve releases can be done in clinic to help reduce restrictions in the dural and neural sheath. If muscle atrophy is present due to the chronicity or severity of the condition, a consistent home strengthening program is incorporated to return affected muscles to full strength.
The recovery timeline for these type of conditions is based on the severity and chronicity of the impingement. It can be anywhere from 8 weeks to 1 year. Surgery is often considered if there are structural changes in the spine (seen on MRI) causing severe nerve root impingement with severe pain, and conservative rehabilitation treatments yield no relief.
Written By: Danette Lam, MScPT