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Help! I’ve got a pinched nerve in my neck!

As one of the UK’s leading London physiotherapists, I regularly write about injuries, treatment and assessment techniques.

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A pinched nerve in the neck – technically known as a cervical radiculopathy – is no fun. When a nerve is pinched or compressed, it sends distress signals along its length, to let your brain know there’s a problem. Nerve distress signals can include numbness or shooting pain (when the sensory part of the nerve is being pinched) and/or muscle weakness (when the motor part of the nerve is being pinched).

The nerves that start at the neck go into the neck, shoulder, arm and hand. So when I see a patient with numbness, shooting pain or painless weakness in their neck, shoulder, arm or hand (weakness associated with pain is more commonly caused by a strained or torn muscle, or a damaged bone or joint) then I suspect a pinched nerve.

As ever, though, that’s not the end of the story. By definition, a “pinched nerve” isn’t a diagnosis – it’s a symptom. Something (else) is pinching the nerve, it’s not doing it to itself. And whatever’s pinching the nerve, there must be a reason. It’s the reason that determines the most appropriate treatment.

Which structure is pinching the nerve?

The first step is to work out what is pinching the nerve? Well, we have options along the length of the nerve that we need to explore. It could be pinched at the spine, by a compressed disc or an inflamed facet joint. It could be pinched outside the spine, by tight muscle or connective tissue. It could be pinched further along the nerve, by a damaged or inflamed shoulder, elbow or hand joint. It could be tethered internally, by adhesions between the nerve and its sheath. Or it could have been compressed externally as a result of an accident (a common one is called Saturday Night Palsy, where you pass out after a few drinks, your arm hanging over the back of a chair, and your radial nerve compressed…)

Why is that structure misbehaving?

We then need to work out why the structure that’s pinching the nerve is doing so, and this (for me) is where the Integrated Systems Model often comes in. The thinking is “if the facet joint in the neck is pinching the nerve, what is causing the facet joint to become compressed?” (or whichever structure we need to deal with). A compressed facet joint in the neck could be the result of a whiplash injury to the neck – or it could be due to poor breathing technique related to stress, suboptimal control of the pelvic floor, or a stiff ankle! Everything in the body is connected and interdependent, and until we work out the cause of the compressed facet joint, then we will struggle to keep the nerve from being pinched again in the future.

What do we need to treat?

Once we’ve worked out the what and the why, it’s time to decide what to do about it. Often, we will need to address all three areas if we’re to get a really successful result:

  • the underlying cause of the compression (eg the stiff ankle, so that the compressed area stops compensating)
  • the compressed area (eg the facet joint in the neck, because I often find it has created habits that persist even after the trigger has been removed)
  • and then we need to restore function and glide to the nerve itself!

Finally, we have to retrain your movement patterns and habitual postures so that, going forward, you use your ankle, neck and nerve optimally, and don’t trigger the same issue again.

Useful treatment modalities, depending on the cause of the pinched nerve, may initially include hands-on treatment, heat, ice, and rest (and occasionally surgery, which is an option in very rare and severe cases) – but the ultimate solution lies in restoring your movement patterns – in other words, your physio prescribing the most appropriate exercises, and you practising them!

The earlier we can start the analysis and treatment, the easier a pinched nerve is to treat, because your body won’t have had time to develop too many bad habits. So if you’ve got pain, numbness or painless weakness in your neck, shoulder or arm – don’t delay and hope it’s going to get better. Just call my team on 0207 175 0150 and let’s get you moving properly again.

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