Feeling numbness and tingling on the fingers or hand? Having trouble holding a cup of coffee – you feel like you will drop the cup soon? Feeling weakness in hand? Are these complaints familiar to you? Cervical Disc Herniation with an impinged nerve is one the most common cause for PT visits. One vertebra protrudes posteriorly (backward), anteriorly (forward – less common) or sideways (medially or laterally – again rare), impinging a cervical nerve passing through the cervical foramen. This impingement or pressing down of the nerve brings symptoms that are uncomfortable.
Common symptoms of the cervical disc herniation are:
- Neck pain
- Neck stiffness
- A painful and limited range of motion of the neck
- Swelling in the cervical area (in acute cases – not always present)
- Radiating pain in arms, forearms, hands, and fingers
- weakness in arm, hand, and fingers
- Decrease fine motor and gross motor grips
X-ray of Cervical Spine: usually demonstrates protrusion of a cervical disc. Usually accompanied by arthritic changes in the cervical area.
C 5 – C 6 and C6- C7 are the most commonly impinged nerves in the Cervical region. It is also not uncommon to see the nerve impingement from C4 through C7.
Excluding arthritic changes and direct trauma, cervical nerve impingement is very common in surgeons, physicians and computer engineers than any other occupation due to positions and postures that theses occupants hold for several hours a day.
So How To Treat Cervical Nerve Impingement?
Physical therapy is your go-to treatment for cervical nerve impingement. Depending on your medical history, you may be asked to get diagnostic tests ( X-ray, MRI, CT Scan, blood test) done to rule out other conditions like a fracture or internal bleeding.
So here is the physical therapy approach to treat cervical disc herniation.
Physical Therapy Treatment for Cervical Disc Herniation:
A clinician will use traction, spinal mobilization, and spinal manipulation, as well as stabilization techniques to reduce the symptoms and possible, centralize the radiating pain. A physical therapist may choose to stretch and mobilize the vertebral space in order to improve the joint space and relieve the symptoms. These techniques are only done by licensed professionals.
1. Pain Management for Disc Herniation:
Managing pain is crucial, especially in acute condition. With severe radiculopathy pain, it is difficult to carry on with the daily routine. So patients are looking for some immediate pain relief prior to restoring the function. Here are a few ways to reduce the pain.
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Heat:
Heat usually does wonders with cervical pain. You just need to make sure there are no contraindications of using heat (like an open wound, active cancer, internal bleeding, very sensitive skin to name a few). You can use heat in many different forms like a heating pad, electric heat pad, hot shower or hot bath, hot patches, etc.
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Neck collar or braces:
Neck collar helps to provide some extra support to the cervical area. It helps to prevent that sudden neck movement and also assist with a range of motion.
Here are few neck braces that you may consider:
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Medicines to reduce pain and inflammation:
Yes, this is always going to be there. You can use some pain relievers, muscle relaxants as well as anti-inflammatory medicines to reduce some of the symptoms.
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Neck Isometric Exercises
As you already know, I love isometric exercises. They can be done as early as in day one post-op. You can do them while using a neck collar, or while at work. Anywhere, any time – really. Here are some examples of neck isometric exercises. I discussed the neck isometric exercises here in detail.
2. Posture Correction:
This is another important treatment and prevention measures. Forward head posture, round shoulder postures, or alteration in a normal cervical curve can cause cervical nerve impingement. Here are a few things you can do to correct the posture.
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Proper Ergonomics:
Practicing proper ergonomics on a daily basis is a base of proper posture. There are several ways to correct your posture. Using braces, splints, postural correction exercises, or adding a little assistance to use the computer makes a lot of difference in your posture.
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Taking break every half an hour from the desk:
This is important. Taking a break for a minute or even for 30 seconds after every half an hour or so is necessary to relax those postural muscles. You don’t have to jump out of your office to do any funny poses. Just look in all directions, rotate your neck in clockwise and anticlockwise, perform chin tuck, if possible, stretch a little in all direction and you are good. Now you can get back to your beloved computer. See, it only takes a minute or two to relax those muscles.
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Adaptive Equipment:
I discussed proper ergonomics along with some equipment that may help to achieve proper posture in my previous articles.
3. Exercises for Cervical Disc Herniation:
So now the main part. Exercises are important to reduce spasm, tightness, pain and improve range of motion. Below are few important exercises that you can perform.
Chin Tuck Exercises:
Keep your neck in a relaxed position. Try to tuck your chin to your sternum or neck area without holding your breath. You should feel a slight pull around the upper neck. Hold the position for 3 to 5 seconds, and gently bring your neck to a normal/ starting position. You can perform this for 10 to 12 times a day.
Neck Range of Motion in all direction :
Few movements available in the neck are flexion (looking down), extension (looking up), side flexion (touching ear to shoulder), rotation (looking over shoulder), moving in clockwise and anticlockwise (moving neck in a circle both direction). The picture below demonstrates these movements.
Stretching:
Stretching is very helpful to reduce tightness and improve flexibility. You can perform stretching of neck muscles, chest muscles, and shoulder girdle. Below is a few important stretching that you can perform.
- Back of Neck Stretch:
This is very simple. But it can feel great if you are holding a lot of tension/ stress at the back of the neck area. I like to do this stretch after a long day at work or after many hours in front of a computer. It increases blood supply to the brain as well. So you get double benefit out of this exercise.
Position: In sitting, relaxed position, knees hip-width apart and shoulder relaxed. Bend your neck forward as you are trying to touch the chin to chest.
You can hold here if you are already feeling stretch. To go little deep in the stretch, you can push your head down with your hands.
Hold for 15 to 20 seconds and repeat it to two to three times.
- Upper trap stretch:
This is the easiest stretch. You may have done it several times just to feel better without even realizing that you are stretching upper fibers of trapezius muscles.
Position: you can perform this stretch in sitting or in standing in a relaxed position. Bring the opposite side ear to opposite side shoulder of the side you want to feel stretch. In other words, for left side stretching, right ear tries to touch the right shoulder. You will feel a gentle stretch on the left side as shown in the picture below.
You can hold this for 15 to 20 seconds and repeat it three times.
SCM stretch/Side stretch:
Position: Sitting comfortably in a chair, feet resting on the ground, knees hip-width apart. The easiest way to remember this stretch is opposite side flexion and same side rotation to feel the SCM stretch. So in other words, let’s say you want to stretch left side SCM muscle. You bring right ear to the right shoulder and try to look down at the ceiling towards the right side. You will feel stretch on the left side of the neck.
A slight variation you can do with this stretch is looking up on the side you feel the stretch at. For example, for left side neck stretch, right ear to the right shoulder, and look up towards the left ceiling. This small change in rotation uses different fibers of muscles, Thus, stretching different area of the neck. Again, you need to try it to see where and how you feel with the stretching.
You can repeat on the opposite side. I like to hold the stretch for 15 to 20 second gently and repeat it to 3 times a day.
- Scapular/ Shoulder blade range of Motion Exercises
The elevation is Shoulder shrugging. Depression is bringing shoulder downwards/dropping them. Retraction is bringing both scapulars together. This is similar to chest expansion or opening exercises. Protraction is bringing both shoulder blades outwards, closing the chest or rounding the chest.
Rotation is lifting both shoulders (above 90 degrees) and bringing both of them down.
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Strengthening Exercises:
To perform strengthening exercises, you can use external weights with the use of dumbbells, thera band, medicine balls etc to perform resistance exercise. You can perform strengthening exercises of shoulder as well as neck to improve muscle strength.
I hope this article helps to find neck pain relief.