The cervical spine (neck) is made up of 7 vertebrae, with each vertebra being separated by a gel-like disc. The purpose of the discs is to provide shock absorption for the spine. The spinal cord travels through a central canal in the cervical vertebrae. Nerve roots extend off of the spinal cord and branch off into specific locations into the arm and hand. These spinal nerves provide signals to our muscles to contract or relax, as well as provide sensory input such as pain, pressure, and temperature. If any type of abnormal pressure is placed on these spinal nerves, then we get an impingement, or “pinched nerve.” Some causes of impingement may be:
Herniated or bulging discs from wear and tear due to aging
Arthritis caused by wear and tear due to aging
Spinal stenosis, which is a narrowing of the spaces where the nerves exit
Tumor, either malignant or benign, that puts pressure on the nerve
When spinal nerves are impinged, they can not receive proper sensation or properly send signals from the muscles to the brain. This can affect the entire course of the spinal nerve, which is why an impingement in the neck can result in pain, weakness, pins and needles, or even numbness in the arm, even though the compression is in the neck. It’s much like getting a kink in a garden hose–even though the kink is in a specific spot, everywhere down the rest of the hose will be affected.
WHAT MIGHT NECK PAIN FEEL LIKE?
Symptoms may include:
Pain in the neck, shoulder, shoulder blade, upper chest, or arm–pain can also radiate into the fingers as well
General dull “ache” or numbness anywhere down the length of the arm/hand
Pain may be described as “sharp,” or “pins and needles”
Weakness in the shoulder, arm, or hand
Pain may possibly be relieved by lifting the arm over and behind the head
CAN YOU BE A LITTLE MORE SPECIFIC AS TO WHERE THESE SYMPTOMS ARE ORIGINATING FROM?
This has to do with the specific nerve root involved:
C5 nerve root (between vertebrae C4 and C5): Shoulder pain, numbness, weakness in upper arm (deltoid muscle, front and side of shoulder)
C6 nerve root (between vertebrae C5 and C6): Shoulder pain, weakness in biceps (muscle in the front of the upper arm) and wrist muscles; numbness on the thumb side of the hand
C7 nerve root (between vertebrae C6 and C7): Pain in shoulder; weakness in triceps (muscle in the back of the upper arm) and wrist; numbness/tingling in the back of the arm and the middle finger of the affected hand
C8 nerve root (between vertebrae C7 and T1): Weakness with hand grip; numbness/tingling in little finger
The most common nerve root levels are C6 and C7.
HOW IS NECK PAIN DIAGNOSED?
Your Physical Therapist should perform a comprehensive and thorough evaluation and ask questions about your pain and daily activities. Some of these questions may include:
How and when did the pain start?
Was there an immediate onset caused by trauma, or a gradual onset that became progressively worse over time?
Where are you experiencing the symptoms, and have they changed in terms of location?
What makes the symptoms better or worse?
What type of work do you do?
What do you enjoy doing for leisure that you can no longer enjoy because of discomfort?
Your Physical Therapist should then conduct a thorough exam to look at Range of Motion of the neck, shoulders, and back, check strength of the neck and upper extremities, check sensation of the upper extremities, check reflexes for the upper extremities, palpate for painful areas, and conduct other tests specific to the cervical spine/shoulder to rule out other conditions. In some cases, further diagnostic testing may be indicated, such as a MRI, if the Physical Therapist feels the problem is neurological rather than musculoskeletal. A referral to an orthopedic surgeon or neurosurgeon would also be recommended as well, but most of the time is not needed.
HOW CAN PHYSICAL THERAPY HELP WITH NECK PAIN?
In many instances, Physical Therapy is an effective treatment to alleviate neck/upper arm discomfort and can often times completely resolve symptoms. Your Physical Therapist should develop an individual treatment plan based on the findings of your initial evaluation and tailored to your specific needs/goals. This treatment plan may include:
MANUAL THERAPY–Techniques such as myofascial release, mobilization, manipulation, manual cervical traction, and massage may be utilized to help the muscles to relax, improve mobility of the neck and shoulder, as well as increasing circulation to the region, all helping to relieve pain and promote healing.
RANGE OF MOTION EXERCISES–These include gentle cervical mobility exercises to relieve your symptoms and allow for a return to normal movement. If you spend a great deal of your day sitting at a desk, you will be instructed in gentle stretches to relieve pressure off of your neck. It is extremely important that none of these exercises increase pain in the neck or tingling into the arm.
STRENGTHENING EXERCISES–These exercises will be specific to the weakness caused by the spinal nerves that are involved. When you no longer have radiating symptoms, then the exercises may be progressed to be more aggressive. Neck strengthening and scapular stability exercises will also be added.
POSTURAL AWARENESS/EDUCATION–This may be the most important part of rehab. You will be instructed in good postural habits to relieve stress and strain off of your neck and upper extremities. This often includes work station modification and ergonomic assessment which includes computer monitor placement, use of mouse, chair adjustment, etc. You will also receive instruction on how to properly bend, lift, and reach throughout the day in safe positions that minimize pressure on your neck/upper back.
FUNCTIONAL TRAINING–As your symptoms resolve, your Physical Therapist will work on functional exercises to help you return to your job, sport, or other daily activities.
CAN NECK PAIN BE PREVENTED?
Your Physical Therapist should educate you on the best ways to prevent neck pain from occurring or recurring. These may include:
Maintaining proper posture–this is extremely important with sitting at a desk or riding/driving in a car, and may include use of support pillows/cushions
Adjusting workstation to relieve stress/strain on the neck/spine. This may include use of a hands-free phone (headset), adjusting your chair/armrests to their proper height, adjusting computer monitor/mouse.
Perform regular exercise to maintain neck and spine flexibility and strength, including shoulders, upper back, and core
Maintain a proper weight by eating healthy to minimize placing undue stress on the neck/spine
If you or someone you know is experiencing neck pain, don’t wait to take action. Call my office at once at (302)691-9055 or visit my website at www.wildermanpt.com to schedule your FREE 30 minute consultation to see how Physical Therapy can help you. Don’t delay–schedule now!