What is a pinched nerve?

A pinched nerve, also medically called cervicalgia or a cervical radiculopathy, occurs when a nerve root coming off the spinal cord becomes compressed. The cervical spine consists of 7 cervical vertebrae (the bones that form the neck region). Each vertebra is separated by a gel-like disc. The discs provide shock absorption for the spine. The spinal cord is like a tree trunk, and the spinal nerves are like the tree branches. If an impingement or abnormal pressure is placed on a branch near the trunk, everything along that branch will be affected. The compression can occur for various reasons. In younger people, it may occur when a cervical disc herniates due to trauma. In older individuals, it commonly occurs spontaneously as a result of arthritis or decreased disc height in the neck region. Spinal nerves can be impinged by:

• Arthritis
• Disc wear-and-tear with age
• Herniated or bulging discs from trauma or degeneration
• Spinal stenosis (a narrowing of the spaces in which the nerves travel)
• Tumor (either benign or malignant)

When the spinal nerves are impinged, they cannot properly send messages to the muscles from the brain, nor receive proper sensation from the specific arm location the nerve travels. Everywhere the spinal nerve travels will be affected. That is why a pinched nerve in the neck can cause pain, weakness, and loss of sensation in the arm, even though the pinch is in the cervical region.

What are common causes of a pinched nerve in the neck?

There are many common causes of a pinched nerve, especially after major medical red flags are ruled out:

• Sleeping in an awkward neck position
• Being in an auto accident with whiplash
• Poor sitting posture at your computer or desk
• Improper heavy-lifting techniques
• Turning your neck to the side with poor posture
• Prolonged watching TV in a bad position
• Flying in an uncomfortable seat on an airplane
• Sport injury
• Sleeping with a bad pillow

Where does it hurt?

Your nervous system is a lot like a tree, with the ‘base’ of the tree near your neck and the ‘branches’ running through the rest of your body. Because of this, it’s possible to feel the effects of a pinched nerve in other parts of your body besides your neck. Understanding the root cause of your pain is fundamental approach to treating your pain in the long run & will decrease your dependence on painkillers or treatment that only address the symptoms.

How do I know if I have a pinched nerve in my neck?

Symptoms of a pinched nerve vary depending on the nerve root involved, and commonly occur on the same side of the body as the affected nerve. The symptoms may include:

• Pain in the neck, shoulder blade, shoulder, upper chest, or arm, with pain possibly radiating into the fingers following the path of the involved nerve root.
• Pain described as “sharp” or “pins-and-needles” or “popping sensation” in cervical region.
• General dull ache or numbness anywhere along the pathway of the nerve.
• Weakness in the shoulder, arm, or hand.
• Pain that worsens with certain neck movements.
• Pain that improves when the arm is lifted over and behind the head (relieving tension on the spinal nerve).

These symptoms may also be specific to the nerve root involved:

• C5 nerve root (between cervical vertebrae C4-C5): weakness in the deltoid muscle (front and side of the shoulder) and upper arm; shoulder pain and numbness
• C6 nerve root (between cervical vertebrae C5-C6): weakness in the bicep muscle (front of the upper arm) and wrist muscles; numbness on the thumb side of the hand
• C7 nerve root (between cervical vertebrae C6-C7): weakness in the triceps muscle (the back of the upper arm and wrist); numbness and tingling in the back of the arm and the middle finger of the affected hand
• C8 nerve root (between vertebrae C7-T1): weakness with hand grip; numbness in the little finger

The most common nerve root levels for this condition are C5, C6, and C7.

Can a pinched nerve in the neck be treated?

Yes, a pinched nerve can be treated and with great results. Even better, many times it can be treated conservatively without needing injections, pain medications, or surgeries. The key to treatment is to solve the root cause of what is actually occurring at the neck that is causing your pinched nerve symptoms. Some root causes of a pinched nerve can be:

• A herniated disc
• A hypomobile facet joint
• Decrease neck range of motion causing pinching
• Thoracic outlet syndrome
• Neck protrusion and poor posture

These problems can also cause referred pain to shoot into your shoulder blade, mid back pain, and even referred to shoulder and arm pain. So when, and if you failed multiple treatment approaches, the clinician missed the real root cause of your pain and was just chasing the symptoms. The pain or symptom is the effect, not the cause. Solve the “root” cause, and the effect goes away Additionally, there is a common root cause that many clinicians misdiagnose. They treat the pinched nerve with a cookie cutter approach hoping it will work, thinking it is a simple hypomobile facet joint or herniated disc. However, often the root cause is actually the lack of neck retraction range of motion that goes undiagnosed. So many healthcare clinicians miss this and show poor treatment outcomes and neck pain that comes back because they missed the root cause of your neck pain and did not treat the decreased neck retraction range of motion. This is also the case when patients turn to injections, nerve blocks, and other surgeries that end up still not working because the neck retraction range of motion is still not treated A specific and individualized treatment approach for your type of neck pain can lead to a successful outcome for you and resolve your symptoms from a pinched nerve.

What happens if it goes untreated?

If you don’t get treatment for your neck pain, there are two possible outcomes. Minor case – If it is a minor injury, research shows that many acute cases of neck pain may spontaneously go away in 4-8 weeks. However, we still recommend that you get it checked out by a physical therapist to ensure that it is just a minor case. Severe case – If it is a more severe injury, your pain will start to worsen due to the compression on the nerve. The neck pain will increase because the root cause is not being treated. Many people turn to pain medication now but this only blocks the pain, but the pinched nerve is still there being pinched. Many people say after the pain medication is stopped, then usually the pain returns and sometimes it returns even worse. If the nerve is severely pinched, you may start to get referred pain into your shoulder blade area, shoulder, arm and into your hand, a headache, with a severe loss of neck range of motion to the side of the neck pain. If this continues to go untreated you may start experiencing neurological symptoms such as numbness and tingling, electric pain, muscle weakness, and a loss of reflexes. If it persists to this stage and left untreated, many people don’t respond to conservative treatments and may need surgery at this stage due to the neurological symptoms. If treated early and properly, surgery can be avoided and conservative treatments (ex. Manual therapy, stretching, joint mobilizations, and exercise) can show successful results. This is why it is crucial to take action early and resolve it before it gets to a chronic injury and doesn’t just hope your pain is going to go away. Research supports that early interventions lead to faster results and less time in pain.

What outcome can you expect from treatment?

The treatment outcome after a pinched nerve can vary depending on the medical professional you choose, their treatment approach, your participation and effort, and the severity of the pinched nerve. If you have an acute pinched nerve case: You should recover fast (within weeks) as treatment starts. With each session, pain should start to decrease and you should start to regain and increase your neck range of motion. Your radicular or radiating symptoms should resolve fast too. Gradually you will regain full neck range of motion and the pain should be almost resolved by then. Within a matter of 2-4 weeks, you should have a full range of motion, minimal to no pain, great strength, and the underlying risk factors are resolved. By 2-6 weeks depending on your case, you can return to your normal activities, sport, and your favorite hobbies. Overall, if treated correctly, this is an easy case, with great results, and you should recover fully. If you have a chronic pinched nerve case that has been going on for months or years: You can still get a great outcome, it just takes longer and more effort. First, we have to solve the root cause of your pain, de-sensitize the nervous system, decrease fear-avoidance beliefs, and then you should start seeing a decrease in pain within weeks. The next step is to restore joint mobility and range of motion. This will further decrease your pain and you should start noticing that you can turn your head farther and you have fewer days with severe pain. The next step is to start strengthening and to maximize your range of motion so a full active range of motion can be reached. This will strengthen your new full range of motion, help prevent re-injury, and get you back to your favorite activities without worrying whether your neck will be in pain. Many chronic cases can show a 75-100% recovery. It just takes time and every case is different. Some chronic cases may take as fast as 2 months and as long as 4-6 months. Regardless, you can still get a great outcome and the results your desire, if treated properly.

How is it diagnosed?

When you seek the help for a pinched nerve, the clinician will perform a comprehensive evaluation and ask questions about your pain and your daily activities. These may include:

• How and when the pain started: Did the pain begin spontaneously or was there any trauma or popping experienced in the cervical region?
• Where are the symptoms located, and have they changed location or intensity since the onset?
• What makes the symptoms better or worse?
• What type of work do you perform?
• What hobbies or household activities do you regularly perform?

Your physical therapist will gently test the movement of your neck and arms. The therapist will check your tendon reflexes and strength, and conduct special tests on your neck and upper extremity to determine which spinal nerve root(s) may be involved and to rule out other conditions. To provide a definitive diagnosis, your therapist may collaborate with an orthopedist or other healthcare provider. The orthopedist may order further tests, such as magnetic resonance imaging (MRI) or electromyography (EMG). An MRI can show soft tissues, including the spinal cord and nerve roots. This test can determine what is causing the compression on the nerves, including disc bulges or disc herniation. An EMG measures the nerve and muscle function. This test can tell how well your spinal nerves are communicating to your muscles. For most common cases, imaging is not needed and the diagnosis can be made with a simple physical evaluation. No need to waste thousands of dollars on un-needed diagnostic imaging. Many of the positive findings found on x-rays, MRI, and EMG may not be the root cause of your pain. What do you mean? Many positive findings on an MRI are also found in asymptomatic (pain-free) individuals, so how do you know if this is causing your pain or not.

How can a Physical Therapist treat it?

Physical therapy is an effective treatment for a pinched nerve and cervical radiculopathy, and in many cases, it completely resolves symptoms. Your physical therapist will develop an individual treatment plan based on the findings of your initial evaluation. The treatment plan may include: Pain Management. The first goal is to reduce the pain and inflammation in the area. Ice packs applied to the neck and scapular (shoulder blade) region during the first 24 to 48 hours following the onset of pain, help reduce inflammation. Moist heat such as a hot towel can be used after this time period to help the surrounding muscles relax. Your physical therapist may advise you to wear a soft cervical collar at times throughout the day, to allow the neck to relax. A cervical contoured pillow may be recommended to properly support the neck, and allow you to sleep more comfortably. Manual Therapy. Your physical therapist may use manual therapy techniques, such as manual cervical traction, to relieve pressure in the cervical (neck) region. This procedure can provide immediate relief of pain and numbness radiating into the arm. Gentle massage may also be performed on the muscles of the cervical spine and scapular (shoulder blade) region. This technique helps the muscles relax and improves circulation to the area, promoting healing and pain relief. Posture Education. Posture education is an important part of rehabilitation. Your physical therapist may suggest adjustments to your workstation and work habits to promote good posture to protect your neck. In the early stages of recovery this may mean sitting only 15 to 20 minutes at a time. You will also receive instructions on how to bend, reach, and lift throughout the day in safe positions that place minimal pressure on your spinal discs. Range-of-Motion Exercises. Your physical therapist will teach you gentle cervical mobility exercises to relieve your symptoms, and allow you to return to normal movement. In the beginning stages of recovery, it is important that none of these exercises increase the pain radiating down into your arm. It is important to communicate your symptoms accurately to your physical therapist. If you spend many hours sitting at a desk during your workday, your neck may become stiff. Your therapist will teach you neck stretches to take pressure off of your neck from extended periods of sitting to help improve your mobility. Strengthening Exercises. Your physical therapist will help you determine which muscle groups need to be strengthened based on which spinal nerves are involved in your particular case. When pain no longer radiates down your arm, you may begin more aggressive strengthening exercises. Neck stability (strengthening) exercises will also be performed. You will receive a home exercise program to continue strengthening your neck, shoulder, arm, and upper back long after your formal physical therapy has ended. Functional Training. As your symptoms improve, your physical therapist will work on functional exercises to help you return to your job, sport, or other daily activities. For example, if your job duties require overhead reaching, pushing, pulling, and long periods of sitting, you will be taught ways to perform these tasks to reduce undue stress to the neck.

How long does it take for a recovery?

Recovery time for a pinched nerve in the neck depends on multiple factors: the severity of your pinched nerve, how long you have been in pain for, the medical professional you choose, and how active you are in trying to resolve your pain. If you do nothing, acute cases may or may not resolve in 4-8 weeks spontaneously. If you get expert treatment, some cases resolve in 1-3 weeks and get you back to the sport, exercise, and your favorite activities without flare-ups and recurrences. If it is a complex case of chronic pain, this may take longer, but you can still get a good outcome. Some chronic cases can resolve as fast as 2 months and as long as 4-6 months. It varies with every patient because every case of neck pain or a pinched nerve is different.

How much does it cost?

The average cost of care for a case of spine pain in the US is $1800-$6600. This high price is thanks to the often inefficient and cumbersome approach to getting treated, often requiring multiple visits to different doctors and physical therapists until you get settled in and start treatment. We strive to end that unnecessary, expensive cycle. In fact, we are currently publishing our first-year data with the University of Central Florida that shows the cost-effectiveness of our treatment approach. The average cost of our care was shown to be $814. So if you have a deductible of $3000-$8,000, we can save you lots of money. Remember, every case of neck pain is different and not all neck pain is the same. So it is hard to predict and tell you how much your neck pain is going to cost you. But after a thorough evaluation, we can tell you exactly what is causing your neck pain, how long it is going to take, what is the best way to treat it, and exactly how much it is going to cost. We have no hidden fees, no co-pays, and no miscellaneous bills that you surprisingly receive 3 months later after you receive treatment. Your pain, your diagnosis, your goals, and what is best for you dictates your treatment and how much it will cost. It varies for every patient but it is still way cheaper than standard healthcare.

How long are sessions?

Our evaluations are 60-90 minutes long. We like to perform thorough evaluations so we can solve the root cause of your pain, identify all risk factors, and make sure that we do it right. After the evaluation, you will know your diagnosis, the root cause of why you have your pain and symptoms, your prognosis, an expected timeline of when you should see results, what the best way to treat your pain is, how much it will cost, and your expected recovery. We will have plenty of time for you to ask questions and make sure you fully understand why you have your pain and what is the best way to treat it. After the evaluation is completed, all treatment sessions are 60 minutes going forward and you and your physical therapist will design a customized treatment plan that works for you and that will achieve your goals.

How can it be prevented?

Your physical therapist will educate you on the best ways to prevent cervical radiculopathy from recurring, including:

• Maintaining proper posture. Use a supportive pillow and proper posture when sitting at a desk or in the car.
• Setting up your workstation to minimize undue forces on the spine. You may be advised to use a hands-free phone or adjust your computer monitor to avoid excessive twisting or extending of your neck in repetitive directions during the workday.
• Continuing with regular exercise to maintain spinal muscles flexibility and strength, including the upper body, middle back, and core muscles.
• Keeping a healthy weight to minimize unnecessary forces on the spine.

What are next steps?

If you’re ready to get pain free, give us a call at (407) 494-8835 or fill out the form below. We’re happy to answer any questions and get you back to doing what you love.