| Severe neck pain with pain radiation into the arm and | | | | osteophytes present in an older person, sustaining or |
| hand is usually the result of a herniated disc or a | | | | repeating extension with rotation may cause nerve |
| traumatic injury causing the nerve exit to be | | | | irritation with a slower onset. |
| compromised, compressing the nerve. Most commonly | | | | People with root pain look tired due to poor sleep, don't |
| affected are the C6 nerve in 25% of cases and the | | | | find anything funny and guard their arm in a protective |
| C7 nerve in 60%. About 25% of arm pains are from | | | | posture against the abdomen or hold it out to the side |
| an acute prolapsed disc. In older people the cause is | | | | with their hand on the back of their neck or the other |
| more likely to be narrowing of the exit channel from | | | | side of the head. This may reduce the forces through |
| bony outgrowths, disc bulging, ligament infolding and | | | | the inflamed nerve root and so reduce pain. |
| arthritic enlargement of the facet joints. | | | | A postural abnormality is often present with the neck |
| Physiotherapists routinely assess and treat this kind of | | | | held side flexed or rotated away from the painful side. |
| neck pain. | | | | Examination by the physiotherapist includes recording |
| Factors making nerve root pain more likely are routine | | | | any muscle spasm, checking reflexes, sensibility and |
| lifting of weights above 25 pounds (12 kilograms), | | | | muscle power, any combined movements which might |
| driving or operating vibrating machinery and smoking. | | | | aggravate the pain and any easing factors such as |
| Cervical radiculopathy is not common and occurs | | | | manual traction. Acupuncture and cervical epidural |
| much less frequently than lumbar root lesions such as | | | | injections of steroids may be useful if physiotherapy |
| sciatica. | | | | cannot reduce the pain sufficiently. |
| There can be many reasons for the onset of nerve | | | | Posture is usually abnormal with the head tilted away |
| root neck pain or it can come on slowly without clear | | | | from the painful side and the neck held stiffly with |
| reason. If the neck is moved backwards, tipped to one | | | | reduced ranges of movement. The physio notes the |
| side and rotated to the same side this can sharply | | | | muscle spasm and tests the muscle power to |
| narrow the nerve exit space and injure the nerve, | | | | determine which nerve root is affected, looks for |
| occurring in a traumatic accident or a sporting injury. | | | | sensory and reflex loss and notes which combination |
| The opposite can occur with a quick side bend, | | | | of movements are provocative and if manual traction |
| combined with flexion or extension, tractioning the | | | | reduces symptoms. |
| nerve and causing injury. Sudden loading of the neck in | | | | Reducing the pain and inflammation is the first goal of |
| any posture can cause disc prolapse. There may be | | | | treatment and the physiotherapist can employ |
| degenerative changes in an older group and with | | | | analgesics such as NSAIDs, cryotherapy, mechanical |
| repetitive or sustained neck postures an osteophyte | | | | or manual traction and avoidance of aggravating |
| can impinge the nerve and give a slower development | | | | activities and postures. Limiting the forces transmitted |
| of arm pain. | | | | through the nerve root is an overall goal of |
| The onset of cervical radiculopathy can be insidious | | | | management, using a collar to reduce neck movement, |
| without obvious cause or after an incident. During sport | | | | a cervical pillow or collar at night and manual traction |
| or trauma like a fall the neck can be extended back, | | | | from the physio to distract the joints. After the acute |
| bent to one side and rotated, suddenly narrowing the | | | | phase has settled physiotherapy concentrates on |
| exit for the nerve and compressing it, causing an injury. | | | | regaining neck movement and muscle power, starting |
| Or a sudden bend to the opposite side with either | | | | with isometric exercises and moving on to isotonic and |
| cervical flexion or extension can traction the nerve on | | | | exercises for multiple muscle groups. Long term |
| the one side with consequent injury again. If there is a | | | | adherence to a regime of aerobic exercise, muscle |
| sudden load on the cervical spine, in any position, it's | | | | strengthening and stretching may be useful. |
| possible for a disc prolapse to occur. If there are | | | | |