Pinched a nerve in your neck ? what you need to know to get better

Anatomy of the nerve in the neck

To begin with its worth looking at the anatomy of the neck and the nerves that come from it.

There are 8 pairs of spinal nerves that come from the spinal cord and exit between the cervical vertebrae.

As the nerve exits the spine there is a thickening of the nerve called the dorsal root ganglion.

It is this part of the nerve root that  is most vulnerable to injury and most likely to cause the painful symptoms associated with a pinched nerve.

 

 

 

At  each level in the neck there are are two nerve roots, one going to the left side of the body, the other going to the right side of the body.

These nerve roots then go on to branch off into many different directions, ultimately forming a network of nerves that supply the entire arm.

Where you feel the pain in the arm can give us a clue to what nerve root is causing the problem. This regions are called dermatomes

 

Here’s a short video explaining and demonstrating the anatomy of the cervical nerves

 

With that, dermatomes are defined as specific areas of the skin supplied by a single nerve root. The cervical nerve roots, which are the ones that come from your neck, generally supply skin to the head, some of the face, neck, shoulders, arms, and hands

Symptoms of the pinched nerve in the neck

Usually if you have a sensitised nerve from your neck you’ll find you have symptoms in certain parts of your arm depending on the nerve that is affected.

The symptoms of a pinched nerve or cervical nerve root issue can vary from intermittent annoying type pains to more severe constant symptoms.

Symptoms are often described as being anywhere from a heavy feeling, aching, sharp or stabbing  like feelings
to more unrelenting burning pain or deep “toothache” type symptoms.

Often cervical nerve root symptoms do  not in  fit into neat  patterns of pain  that Dr google may tell you and commonly we will see the following features when patients present with a pinched nerve in the neck:

• Pain in the lower neck spreading out towards the point of the shoulder, sometimes confused with shoulder pain.
• Pain in border of shoulder blade or the whole of the shoulder blade
• “patchy” type pain down the back or front of the arm, often in the triceps or bicep region. Not unusual to hear people talk about a gripping feeling at this area.
•  Pain in the  forearm that goes into the  into the hand sometimes mistaken as a tennis elbow.
• Pins and needles or numbness in the arm or specific fingers.

Symptoms are often more intense at particular sites and these are not necessarily  at the neck where all the action tends to be happening.

This is why its not uncommon for this condition to be confused with shoulder related pain  or tennis elbow if their symptoms are most intense in these regions.

A pinched nerve is an overly sensitive cervical nerve.

Nerves don’t really get pinched or trapped its more of a useful analogy of how we feel when it happens. The nerves can become very sensitive due to any one of these or even a combination of the following factors :

• sustained postures for too long , think sitting at a computer screen or looking overhead when painting ceilings
• Age related changes in the neck affecting the movement and space the nerve has to move in.
• Trauma that involving the neck. This is especially the case in motor vehicle whiplash type accidents or football stinger injuries.
• In younger individuals the cervical disc can also be a potential source .

As a result of one or a mix of these factors the nerve, or more specifically the dorsal root ganglion,  can  become sensitized and can get extremely angry and  cause quite intense pain in some cases.

Once the nerve is sensitized it is  often aggravated by certain types of stressors: This may be related to how the injury occurred such as sustained postures but can also be down to a bit of pot luck.

• Inflammation: If the nerve is sensitized by inflammatory chemicals there’s a good chance it will respond well to anti-inflammatory medication, and possibly icing.
• Stretch: these nerves don’t like being stretched or put in positions of sustained stretch. However  you can use this to your advantage with “flossing” type exercises in the early stages and progress to firmer stretches as symptoms settle.
• Compression: The opposite to stretch sensitive is being sensitive to compression or squashing type forces. This may be common in conditions that have been brought about by sustained neck postures.
• Emotions : If you’ve ever had nerve pain you are probably acutely aware of how your mood affects your symptoms. In fact sometimes it can be a major driver. Staying positive is key.

How to treat that pinched nerve in your neck

In many cases a thorough assessment can reveal what  is happening and why. Importantly it helps determine if we need to get any further investigations to help. The good news is that once we understand how the nerve is behaving we can establish an effective treatment path to settle it down again. The essential ingredients involve:

1. Knowledge and understanding of what’s happening and what helps and doesn’t help.
2. Appropriate medication
3. Exercise
4. Physiotherapy treatment

Essential ingredients for treating that pinched nerve / cervical nerve root pain.

A better understanding of the symptoms of your pinched nerve.

 

However they  can actually be fairly normal in nerve related pain and  are more an  indication of how the nerve  is “firing off” as a result of it being sensitized.

 

Symptoms often experienced include:

• Pins and needles , altered sensation in specific parts of the arm or hand.
• Sudden shooting pains for no reason.
• Twitching in the muscles.
• Odd sensations like crawling ants, running water or fluttering sensations
• How the pain may spread or appear patchy at times
• Heaviness or weakness in the arm
• Cant’ find a consistent position where it eases.

Medication for a “pinched nerve” / cervical nerve root pain

Medical management is an integral part of your treatment and as such is best discussed with your GP as they will provide the best advice.  This aspect of your care can be an important part in getting symptoms to settle and reduce the intensity. This in turn will allow you to move better and sleep better which in turn reduces the severity of the symptoms.

Often good pain relief management leads to better responses to interventions such as exercise and physiotherapy.

Identify postures and movements that aggravate the nerve.

Often in cases of a pinched nerve we find that there are certain postures or movements that aggravate the symptoms. if we can identify a pattern  we often find that movements in the opposite direction or posture can often relieve symptoms.

Common patterns that we see aggravate the nerve usually involve extension as this movement reduces the space that the nerve has to work in. Examples of aggravating postures or movements would be:

• Looking up and extending the neck
• sustained postures involving extension
• Chin tucking or cervical retraction type exercises
•  movements towards the painful side

In these cases the movements or postures are causing a narrowing of the space that the nerve has to work in.

Exercises to help with that “pinched nerve” / cervical nerve root pain

Mobility exercises for  cervical nerve root pain

In the early days if people have pain with extension based movements  we often find that flexion based postures and exercises that go away from the side of pain are far more comfortable for the patient. So quite simply try:

• looking to the opposite side x 10 reps
• Bending your neck away from painful side x 10 reps
• “Sniff your opposite armpit ! , ( combination of flexion , rotation and side flexion away from pain) x 10 reps
• Shoulder shrugs

As symptoms settle the we can start working into the movements and positions that stir us up. Its called “graded exposure” and is a simple yet effective way to get our nervous system used to the painful movements and make them less painful or provocative.

In later stage we can be a bit more firm and forceful with our exercises to further desensitize the nerve. Often we have to go hunting for these aches and pains.

Nerve flossing exercises for your cervical nerve root pain.

Nerve flossing type exercises can be awesome , especially for a stretch sensitive nerve. These exercises get blood flow back to the tissue  and re-educate the nerve that movement is good for it.  You may feel a bit self conscious about doing them in public though !

In the early days its not the best idea to push through the pain. i like to move just up to the edge of the pain, nudge into so to speak. You don’t want to aggravate the nerve at this stage.

As you get better and the symptoms are settling you can start pushing into it a bit more

Aerobic exercise and cervical nerve root pain.

I think exercise is possibly the most potent, important and  simplest way to treat nerve pain. Our nervous system is a greedy structure that demands around 20% of our oxygen supply despite only taking up 5% of our body mass. The purpose of exercise  is to get it more blood flow and oxygen to settle it down.

So with neck related nerve pain firstly i recommend brisk walking as the method of choice. its easy , its accessible and you may only need to do a few short bouts a day. Its also not asking too much of the nerve but still gives it a boost of oxygen.

Strength exercises and cervical nerve root pain.

Strengthening exercises for the upper limb  and thoracic regions are great options to introduce as soon as symptoms allow. These are just another way to nourish the nerve and get it to settle as well as address potential underlying causes.

 

As symptoms settle upper body strengthening exercises are excellent and the intensity of aerobic exercise can be increased as tolerated.

 

 How much exercise do i have to do to get better ?

Here are our rules for finding just the right level in the early days.

Just like Goldilocks you don’t want to do too little or too much, you want to do just the right amount.

• Start slow and easy to find your ideal level of exercise and work from there.  You don’t want to flare your symptoms up or push through the pain but you do need to get it moving. However you may have to prepare for an acceptable level of discomfort after exercise in the initial phase.
• The 50% rule : If you start walking 30 mins and that flares you up , try 15 mins and build from there.
• Small and regular bouts of exercise to begin with before doing longer and more vigorous sessions. Build up every few days as symptoms allow.
• Do something you enjoy or find easy e.g. going for a walk, a therapeutic splash in the pool , low back pain sufferers may find cycling easier. Just whatever works for you.

 Physiotherapy and pinched nerve / cervical root  nerve pain.

Physiotherapy can often be very effective in both the diagnosis and treatment of this condition. It can be essential to work out what is going on and what we need to do to get you on the road to recovery.

From a treatment perspective manual therapy can often be effective in settling symptoms and offering a window of opportunity where you can move more freely and with less fear of flare up.

We tend to find they are very effective when there is a definite reduction in neck movements due to pain.

Manual therapy should always be in conjunction with exercise and a better understanding of your condition  and rarely a stand alone treatment

I hope that helps the main message is that they do get better and a sensible guided approach is the key. Often we find that physio and exercise will get you to your happy place quicker than just waiting for it to go away.

If you have any problems with a pinched nerve i your neck or back you can contact us here

Dave