Physical Therapy for Cervical Disc Herniation
What is a Cervical Disc Herniation / Cervical Radiculopathy (pinched nerve)?
Cervical disc herniation is a painful neck condition where the nucleus pulposus (soft inner layer) of the cervical disc protrudes through the annulus fibrosus (rigid outer layer), resulting in compression of the nerve root or spinal cord. An analogy would be a jelly donut where the jelly protrudes out of the donut and compresses the nerve pathways that control pain, sensation, muscle recruitment, and reflexes. These patients may have localized neck pain, radiculopathy, or myelopathy. Read more about cervical disc herniations here.
Cervical radiculopathy or “pinched nerve” is a condition in which the nerve root of a spinal nerve is compressed or impaired, causing pain and symptoms to spread beyond the neck and radiate to other areas of the body, such as the arms, neck, chest, upper back, and shoulders. Due to the nerve impingement, muscle weakness and impaired deep tendon reflexes are often observed. Read more about cervical radiculopathy here.
Cervical myelopathy is a more serious condition where there is narrowing of the cervical spinal canal, compressing the spinal cord. These patients typically have digit/hand clumsiness, gait disturbance, spasticity (sustained muscle contractions), hyperreflexia (increased reflexes), or pathologic reflexes (abnormal reflexes). Without treatment, patients may progress to paralysis and loss of function. Read more about cervical myelopathy here.
It is important to get an accurate diagnosis from a physical therapist or a medical doctor.
What are common symptoms of Cervical Disc Herniation / Cervical Radiculopathy (pinched nerve) ?
Common cervical disc herniation / cervical radiculopathy symptoms include pain, numbness, and/or tingling that radiates into the shoulder, upper back, arm, forearm or hand. Symptoms are typically worse in the morning when waking up and with prolonged sitting (at work, at a desk, etc).
How do we diagnose Cervical Disc Herniation / Cervical Radiculopathy (pinched nerve)?
These are the clinical findings that our physical therapists use to diagnose cervical disc herniation / cervical radiculopathy:
Neck pain with associated radiating pain, numbness, and/or tingling in the involved upper extremity
Symptoms are reproduced or aggravated with cervical mobility testing, Upper Limb Tension Test A (median nerve bias), and/or Spurling test
Limited ipsilateral cervical rotation less than 60 degrees
Symptoms are reduced or eliminated with Cervical Distraction test
Potential signs of nerve root involvement (sensory, strength, or reflex deficits) in the involved upper extremity
The patient may report paresthesias (tingling, “pins and needles”), numbness, and/or weakness in the shoulder, upper back, arm, forearm or hand.
Why does Cervical Radiculopathy (pinched nerve) happen?
Cervical radiculopathy or “pinched nerve” occurs when there is a compression or irritation of the nerve roots in the neck. It can be caused by a cervical disc herniation, degenerative changes in the spine, and narrowing of the foramen (space) where the nerves exit the spine.
This compression or irritation of a spinal nerve creates nerve signals that are perceived as pain, numbness, and tingling along the nerve distribution in the upper extremity.
Can physical therapy treatment help with Cervical Disc Herniation / Cervical Radiculopathy (pinched nerve)?
Physical therapy can help with cervical disc herniation / cervical radiculopathy.
Treatment for cervical disc herniation / cervical radiculopathy typically includes:
Patient education in positions that reduce strain or compression to the involved nerve root(s) or nerves
Sleeping positions, pillow placements to maintain a neutral neck position, etc.
Manual or mechanical traction
These are techniques that create separation in the spinal joints to decompress the nerve roots
Manual therapy to improve mobility of the joints, muscle, and nerves surrounding the affected nerve
Nerve mobility exercises to improve the mobility of the sheath that surrounds the nerves
These should be performed in a pain-free and non–symptom-provoking range of motion
Therapeutic exercises to build strength and endurance in muscles that stabilize the neck, upper back, and shoulder
Deep neck flexor muscles
Rhomboids
Middle trapezius
Lower trapezius
Serratus anterior
Patient education on pain management strategies and desk/chair ergonomics
Best Exercises for Cervical Disc Herniation / Cervical Radiculopathy (pinched nerve)
Some of the best exercises for cervical disc herniation / cervical radiculopathy include pain-free repeated movements of the cervical and thoracic spine, and muscular recruitment of the deep neck flexor and periscapular muscles to provide a sense of stability around the neck.
Below are some of the exercises that we typically start with. Our therapists progress these exercises as our clients’ symptoms improve.
Cervical rotation AROM (active range of motion)
Progression: Cervical rotation AROM with Overpressure
Cervical Sidebending Stretch (repeated movements)
Thoracic Spine Extension on Foam Roller
Supine Chin Tuck
Quadruped Scapular Protraction/Retraction with Chin Tuck
Bilateral Scapular Retraction/Depression
Prone A’s
Cable / Band Row
Best Cervical Disc Herniation / Cervical Radiculopathy Stretches | Median Nerve Glides
Median Nerve Mobility Variations
Median Nerve Glide
(No Neck Movement)
Median Nerve Glide
(With Neck Movement)
Median Nerve Tensioner
It is important to perform these nerve glides within a pain-free range of motion. For example, don’t fully straighten the elbow if pain, numbness, or tingling increases during or after the exercise.
In cervical disc herniation / cervical radiculopathy, the median nerve is usually implicated. However, our physical therapists also include nerve glides for the radial nerve and ulnar nerve if needed based on the clinical examination.
Exercises to avoid with Cervical Disc Herniation / Cervical Radiculopathy (pinched nerve)
In the early stages of cervical disc herniation / cervical radiculopathy, you’ll want to temporarily avoid activities that excessively load the neck including repetitive overhead work, heavy lifting, prolonged driving, and vibrating tools that affect the upper limbs, according to this article.
Other activities you should avoid include tennis, golf, crossfit, boxing, swimming, and basketball, etc.
Exercises to avoid and their modifications include:
Bench press
Temporary modification: Floor press
Overhead press
Temporary modification: Horizontal dumbell press
Upper trap stretch
Temporary modification: Upper trap stretch repeated movements (pain-free range of motion)
Doorway pec stretch at 90 degrees
Temporary modification: Doorway pec stretch at 45 degrees
Cat cows
Temporary modification: Cat cows (with limited neck movement)
You can ease cervical disc herniation / cervical radiculopathy pain at home by optimizing your desk and ergonomic set up. According to this article, ergonomic training along with therapeutic exercise is highly recommended for neck pain.
Some ergonomic tips include having the monitor straight in front of you, keeping the top of the screen at eye level, keeping your elbow at 90 degrees underneath your shoulders, wrist and forearm supported on the desk, and using a detachable keyboard if using a laptop. You can read more about ergonomic training for neck pain here.
Having a head rest or cervical collar to support your neck will be helpful in the acute stages.
We also recommend changing positions often throughout the day. Avoiding prolonged sitting and driving to the best of your ability in the early stages.
You can also rely on ice/cold packs, anti-inflammatory or steroid medications as instructed by your doctor, and transcutaneous electrical nerve stimulation (TENS) for some temporary relief of symptoms. This won’t facilitate healing, but it will alleviate your symptoms and allow you to remain more functional as things heal.
How to Sleep with Cervical Disc Herniation / Cervical Radiculopathy (pinched nerve)
If you are having difficulty sleeping with cervical radiculopathy, you should try sleeping with a pillow that supports your neck in a neutral position so that your neck is not sidebending or rotating to one side. We also recommend that our patients sleep on their back with a pillow that doesn’t push the head too far forward. These are the common positions that can alleviate symptoms. You can also consider over the counter or prescription anti-inflammatory medication at night, as prescribed by your medical doctor.
How to prevent Cervical Disc Herniation / Cervical Radiculopathy (pinched nerve)
Preventing cervical disc herniation is multi-faceted, and includes working on nerve mobility, cervical and thoracic mobility, and deep neck flexor and periscapular strength. We also encourage our clients with cervical disc herniation to prioritize their overall health, including their stress adaptability, sleep optimization, and a minimally processed diet.
Closing Remarks
If you are experiencing a cervical disc herniation or cervical radiculopathy (pinched nerve) and would like to consult us, please contact us below to speak with a physical therapist.
Disclaimer: This is not intended to be formal medical advice. Your individual needs should be met by the appropriate health care practitioner. Please consult with a trusted provider.
Dr. Vincent Liu PT, DPT
Doctor of Physical Therapy
The Game Plan Physical Therapy