Physical Therapist's Guide to Cervical Radiculopathy

By Action PT

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24 Jun, 2020

Chronic pain is a condition that occurs when the brain concludes there is a threat to a person's well-being based on the many signals it receives from the body. This condition can and often does occur independently of any actual body tissue damage (due to injury or illness), and beyond normal tissue healing time. It is estimated that 116 million Americans have chronic pain each year. The cost in the United States is $560–$635 billion annually for medical treatment, lost work time, and lost wages. The causes of chronic pain vary widely. While any condition can lead to chronic pain, there are certain medical conditions more likely to cause chronic pain. These include: Trauma/injury Diabetes Mellitus Fibromyalgia Limb amputation Reflex Sympathetic Dystrophy Some diseases, such as cancer and arthritis, cause ongoing pain. With chronic pain, however, pain is created in the nervous system even after physical tissues have healed. Chronic pain affects each person experiencing it differently. In some cases, chronic pain can lead to decreased activity levels, job loss, or financial difficulties, as well as anxiety, depression, and disability. Physical therapists work together with chronic pain patients to lessen their pain and restore their activity to the highest possible levels. With treatment, the adverse effects of chronic pain can be reduced. For more resources on pain, and use of opioids for pain management, visit our Health Center on Pain and our Health Center on Opioid Use for Pain Management. The American Physical Therapy Association launched a national campaign to raise awareness about the risks of opioids and the safe alternative of physical therapy for long-term pain management. Learn more at our safe pain management page. What Is Chronic Pain? Pain is an unpleasant sensation that we usually associate with injury or tissue damage but can be present in the absence of tissue damage as well. Pain can be acute or chronic. Acute pain lasts for a short time – up to 12 weeks. It is a warning that tissue damage has occurred or may occur, or to help us prevent injury or disease. For instance, if we touch a hot stove, the body sends a danger message to the brain that there is a threat to tissues to prevent further injury. A sore foot can signal a need to change your footwear. In some cases, the danger messages may be due to some disease process, and your brain may interpret those messages as pain. This can cause you to seek medical attention – diagnosis and treatment – for what may be a serious condition. Signaling pain in this manner is the body's way of protecting us and is a good thing. Chronic pain is any discomfort or unpleasant sensation that lasts for more than three months – or beyond an expected normal healing time. Often, those who have chronic pain believe they have an ongoing disease or that their body has not healed, when this may not be the case. Chronic pain is likely not warning you of possible injury or danger; instead, the pain centers in the brain may be causing you to hurt even though there are no new causes of pain occurring in the body. Anyone can develop chronic pain at any age. The brain changes in chronic pain: When you are injured or develop a painful disease, nerves send information from the problem area to the brain. The brain analyzes this information coming from the body to determine if there is a threat to the body and whether action needs to be taken to prevent harm. When pain is constant or chronic, the brain and nervous system go on "high alert," becoming more sensitive. Cells that conduct sensation in the nervous system can also become more sensitive when on high alert, making it easier for the brain to interpret these sensations as a threat and thus cause you to have more pain. These changes in the brain and central nervous system induce and maintain chronic pain symptoms. When pain is chronic: Pain sensations are activated in the brain; The brain continues to interpret all sensations from the problem areas as a danger, even when there is no more tissue damage. This makes it easier for the pain centers in the brain to activate; Pain messages come from many different areas of the brain – areas that may control fight or fear reactions, movement, emotions, problem-solving, and learning. Almost any system of the body can be affected by chronic pain. The brain and nervous system continue reacting by causing you to continue to be in pain. This process increases sensations, emotions, or thoughts about the problem area. At this point, any sensory input can activate the pain centers. Even thinking about it or reading the word pain can trigger pain sensations. The pain is in the brain: To protect you, your brain is deciding to increase the alert level for sensations you feel. How Does It Feel? How chronic pain feels varies with each individual; it is very personal. How often it occurs, how severe it is, or how long it lasts is not predictable from one person to another. Common complaints related to chronic pain include: It may seem as if "everything hurts, everywhere." There may be sudden stabs of pain. It may seem as if the pain "has a mind of its own." You feel symptoms even if you are not doing anything to cause them. It feels worse when you think about it. It feels worse when you experience upsetting circumstances in your life. You may feel more anxious and depressed. You may feel your symptoms spread from one area to another area. You may feel fatigued, and afraid to do your normal activities. These complaints are common when you have chronic pain. However, it does not necessarily mean that your physical condition is worsening; it may just mean that your system has become more sensitive. Signs and Symptoms Research finds the following signs may be associated with a chronic pain syndrome: Fearfulness. It is easy to begin to fear increased pain when you have a chronic pain condition. As a result, you may begin to avoid activity. You may find that you rely more on family members to help with daily functions. Body stiffness when you try to become more active. Stiffness may make you feel as if your body is less able to perform daily activities. Deconditioning. Not moving your body results in less tolerance when you want to become more active. If you are inactive for a long time, muscles weaken and shrink from not being used. This can also increase your risk of falling. Decreased circulation. Lack of activity decreases the circulation of much-needed blood to your cells. Tissues in your body may not get as much oxygen as they need. As a result, they may not be as healthy as they can be. This can cause you to feel fatigued, and lack energy. Weight gain and/or a worsening of other conditions. Decreased activity can lead to unwanted weight gain. Added pounds and inactivity can aggravate symptoms of other conditions such as diabetes and high blood pressure. Chronic pain conditions are also commonly associated with feelings of anxiety or depression. Increased use of medication. Chronic pain patients can have the tendency to increase their medication over time to seek relief. Individual behaviors can include: Seeking out of many different doctors or health care providers and facilities to find relief. Difficulties with job performance. Some people with chronic pain even seek work disability. Avoidance of social situations or family members. When pain is ongoing, you may find you have feelings of bitterness, frustration, or depression. Some people report they have thoughts of suicide. If you are having these feelings, tell your doctor. This is important, so that you can get appropriate medications to help you feel better. How Is It Diagnosed? Your physical therapist will perform a thorough evaluation. He or she will: Ask specific questions about your past and present health and use of medication. Ask about your symptoms: their location, intensity, how and when the pain occurs, and other questions, to form a clear picture of your individual situation. Ask you to fill out pain and function questionnaires, to understand how the pain is affecting your daily life. Perform tests and movements with you. The tests help to identify problems with posture, flexibility, muscle strength, joint mobility, and movement. Special tests help to rule out any serious health problem such as pressure on a nerve or an underlying disease. Observe how you use your body for home, work, and social/leisure activities. This information helps your therapist prescribe a program that will boost your quality of life, and get you moving your best. Imaging tests such as x-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI) are often not helpful for diagnosing the cause of chronic pain. However, if your physical therapist suspects that your pain might be caused by any serious underlying condition, he or she will refer you to your physician for evaluation. Your physical therapist will work with your physician to provide the best diagnosis and treatment for your chronic pain. How Can a Physical Therapist Help? Your physical therapist will work with you to educate you on chronic pain, find solutions to improve your quality of life, and get you moving again! He or she will help you improve movement, teach you pain management strategies, and, in many cases, reduce your pain. Not all chronic pain is the same. Your therapist will evaluate your clinical examination and test results and design an individualized treatment plan that fits you best. Physical therapy treatments may include: Education to improve your knowledge and understanding of chronic pain -- how it occurs and what you can do about it. Your therapist will teach you how to manage your pain and help you work toward performing your normal daily activities again. Strengthening and flexibility exercises to help you move more efficiently with less discomfort. Your therapist will design a program of graded exercises for you -- movements that are gradually increased according to your abilities. Graded exercises help you improve your coordination and movement, reducing the stress and strain on your body and decreasing your pain. Carefully introducing a graded exercise program will help train your brain to sense the problem area in your body without increasing its danger messages. Manual therapy, which consists of specific, gentle, hands-on techniques that may be used to manipulate or mobilize tight joint structures and soft tissues. Manual therapy is used to increase movement (range of motion), improve the quality of the tissues, and reduce pain. Posture awareness and body mechanics instruction to help improve your posture and movement. This training enables you to use your body more efficiently while performing activities and even when you are resting. Your therapist will help you adjust your movement at work, or when performing chores or recreational activities, to reduce your pain and increase your ability to function. The use of ice, heat, or electrical stimulation has not been found to be helpful with chronic pain. Your physical therapist, however, will determine if any of these treatments could benefit your unique condition. www.choosept.com , the official consumer Website of the American Physical Therapy Association,© 2017

Oct 04, 2022

A series of connected bones (also known as vertebrae) and soft jelly-like discs make up your spine. These vertebrae together make a canal in which the spinal cord rests serving as a connection between your brain and body. Due to wear and tear or conditions like osteoarthritis, the spinal canal gets narrow and causes a medical condition known as spinal stenosis.

Do you need surgical treatment for Cervical Spinal Stenosis?

Conservative treatments do not provide a permanent solution for cervical spinal stenosis. Sometimes, surgical treatment is the only resort to treat spine conditions. If you have been experiencing cervical spine pain and are not sure what treatment you need, you can consult Dr. Moksha Ranasinghe at Southern California Brain & Spine Surgery. To schedule an appointment, fill out the contact form or call 213-369-4583.

About Cervical Spinal Stenosis

Spinal stenosis can occur in any part of the spine - upper, middle, or lower. If it occurs in the upper region of your spine (C1 - C7) i.e., neck, it is called cervical spinal stenosis. In some cases, stenosis can be severe enough to cause nerve compression or injury to the spinal cord leading to serious medical conditions. However, most of the patients can be treated or at least manage their stenosis pretty well with non-surgical treatments.

Causes

The most common cause of spinal stenosis is the deterioration of the spine that occurs over the years. Some people are also born with a condition in which the spinal canal is not fully developed. Other than these, the following are some of the causes of spinal stenosis;

Disc Herniation - Herniated disc or slipped disc can cramp the space in the spinal canal.
Osteophytes - Osteophytes also known as bone spurs are bony outgrowths developed along the vertebrae. These outgrowths, if large enough, can produce congestion within the spinal column.
Injuries - In case of vehicle accidents or any other event that causes injury to the spine, bones in the spine move out of place. It can result in swelling of the tissues which can put pressure on the nerves within the spine.
Tumors - Cancerous tumors can also be a cause of spinal stenosis as they produce compression in the spine.

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In what follows, you will be explained things to avoid with cervical spinal stenosis. Following these guidelines will help you recover from the condition without any invasive procedure.

Things to Avoid with Cervical Spinal Stenosis

Although cervical spinal stenosis is a musculoskeletal condition that cannot be properly treated but managed conservatively. To improve life quality, various conservative treatment protocols are adopted. Daily activities are monitored by patients themselves to accommodate their health conditions. The primary objective of the patients suffering from cervical stenosis is to avoid activities that elevate the symptoms. Hereinafter laid down are the things to avoid with cervical spinal stenosis;

Avoid neck rotation exercises

A patient suffering from cervical spinal stenosis is suggested to avoid exercises that stress the neck and escalate the pain and discomfort. Slight degrees of flexion, extension, and bending of the neck are recommended but rolling or rotation exercises are highly contraindicated in the patient suffering from cervical spinal stenosis. To strengthen the neck and maintain range of motion, a few exercises are preferred including chin tuck, side tilt, and shoulder circles.

Avoid neck strains

One of the major things to avoid with cervical spinal stenosis is to reduce the additional strain on the neck. Neck strain increases the chances of nerve impingement, muscular swelling, and muscle spasms which in turn lead to chronic cervical spinal stenosis. Strains on the neck can be escalated when you bend your neck while using mobiles and laptops for an extended period.

Avoid awkward neck postures

Multiple awkward neck postures are also common in patients suffering from cervical spinal stenosis. Avoid cradling your neck to your ear during calls, carrying overly heavy weights on your head, or one shoulder bag. These postures exert hyperextension stretches and impinge the nerve which in time paramount the joint stiffness and cervical spinal stenosis. Usage of hands-free and two-strap bags to expand weight on both shoulders symmetrically may reverse neurological damages.

Avoid Contact sports

Contact sports such as football, basketball, ice hockey, diving, jogging, and martial arts add additional trauma and are significantly risky to the cervical spine. In advanced cases, patients can face slipped discs and potential nerve impingement as well. Things to avoid with cervical spinal stenosis during contact sports are jerky movements, sudden ballistic movements, and whip-lash injuries which can worsen cervical spinal stenosis.

Avoid poor sleeping positions

Certain sleeping positions aggravate neck rotation which is extremely crucial for patients suffering from cervical spinal stenosis such as sleeping on your gut. Use appropriate neck braces to keep your cervical spine intact while you sleep.

Don’t ignore early symptoms

One of the mistakes people make with cervical spinal stenosis is ignoring indications when they are in the early stages. For example, while performing activities of daily living (ADLs) like dressing, bathing, and showering, if you feel persistent pain in your neck you must get yourself checked timely.

Avoid Alcohol consumption and smoking

Consumption of excessive alcohol impedes the healing process and it can worsen limb numbness and weakness. One of the major things to avoid in cervical spinal stenosis is chronic alcoholism. Similarly, smoking accelerates nerve damage by compromising the vascular supply to the nerve through atherosclerosis. Avoiding smoking habits diminish local hypoxia and nerve damage.

Avoid poor dietary habits

A healthy diet helps in maintaining healthy body weights and keeps the discs hydrated. However, poor dietary habits increase body weight and inflammation as well. Heavyweights and bulky muscles put extra pressure on the cervical spine. Thus, avoiding poor dietary habits help in mimicking pain in patients with cervical spinal stenosis.

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