Cervical Radiculopathy (“Pinched” Nerve in Neck) : Treatment

You’ve been diagnosed with cervical radiculopathy (arm sciatica, “pinched” nerve in neck, cervicobrachial neuralgia), and you have a lot of questions about physical therapy, medical treatment, natural treatments or exercises ?

This article aims to provide a documented answer to the question of how to treat or relieve right, left or bilateral (2-sided) cervical radiculopathy.

I’d like to go further than simply listing the various treatments on offer. By informing you about the efficacy to be expected, and the possible side effects.

All of this is based on :

• my experience as a physiotherapist;
• my research and in-depth reading of international scientific publications on the management of CKD (all references at the end of this article).

I hope you’ll find the answers to your questions here!

♻️ Last update: 3 december 2024
👩‍⚖️ Declaration of financial interests: Amazon affiliate link. My complete declaration of financial interests is available in the legal notice section. Written by Nelly Darbois, physiotherapist and scientific editor

What are the symptoms of cervical radiculopathy that we are trying to alleviate?

If you have cervical radiculopathy (also known as cervical radicular pain or arm sciatica or “pinched” nerve in neck), this is probably the pain that bothers you most. And that you’re looking to relieve.

• Neck pain
• Pain in the shoulder, radiating down the arm, even to the hand and fingertips
• Pain that is present continuously, or more so at certain times (at night, or during the day when doing certain things, sometimes spontaneously with no obvious cause).

Other symptoms often accompany cervical radiculopathy, for which relief or cure is also desired:

• tingling, ant-like sensations or numbness in the arm or hand;
• a loss of sensitivity or a poorer or different sensitivity ;
• dizziness, fatigue ;
• more rarely, a lack of strength in certain parts of the arm.

Pain, sensory disturbance and dizziness are the symptoms of your cervical radiculopathy that you’re probably most keen to relieve or cure.

Relieving or treating cervical radiculopathy: what’s the difference?

In my experience, most people with cervical radiculopathy are naturally looking for a complete cure as soon as possible. So you’re probably more interested in treating your CBN than relieving it.

Curing BCN would therefore be :

• no symptoms at all;
• for life ;
• and, for some, no longer have any imaging or examination signs of the pathology that probably contributed to the neuralgia (often osteoarthritis or a herniated disc).

While it is quite possible to completely cure the symptoms of cervical radiculopathy, it is by definition impossible to cure some of its most common causes, osteoarthritis and herniated discs.

Osteoarthritis and hernia are not things that heal: they are permanent wear and tear on the joints.

The good news is that just because you have osteoarthritis or a hernia doesn’t mean you have pain ! Many people with this type of injury never experience any pain in their neck, shoulder or arm.

Even without a complete cure for the degenerative causes of cervical brachial neuralgia, you can reasonably expect to be completely free of pain and other symptoms.

The situation is not the same for everyone, and some people will find it difficult to completely cure all their BCN symptoms in the short term. In this case, you’ll probably be looking for relief from pain and other symptoms.

That’s what we’re going to look at now: treatments to treat or relieve the symptoms of cervical radiculopathy.

But first, I’ll give you a few figures on how long an ASC can evolve, no matter what you do.

How long does cervical radiculopathy usually last?

First, a factual piece of information that will reassure you: even when the evolution is long, there are generally no after-effects (Wong 2014).

As for the total disappearance of all symptoms, this occurs in 83% of people 2 to 3 years after the onset of symptoms. And even after just 8 to 12 weeks in 85% of people in the case of an acute episode, according to other studies (Magnus 2022).

This may seem like a long time if you’ve only been suffering for a few days or weeks, but :

• Keep in mind that some of these 83% recover much faster than in 2 to 3 years: in a few days or weeks;
• that these figures are the worst possible scenario, as people with mild forms of CKD do not necessarily consult and are not included in these studies;
• that pain is something that fluctuates, and that it doesn’t always remain intense or inconvenient for everyday life.

The relatively long evolution of cervical radiculopathy in some people should teach you something about treatment: there is no “miracle” or “radical” treatment that guarantees systematic effectiveness.

Just a range of possible treatments and management options, each with its own advantages and disadvantages. It’s up to you to make up your own mind, with the help of your healthcare professionals, whether to opt for one or the other (or to let natural evolution take its course).

You can read my more comprehensive article: How long does cervical radiculopathy usually last?

Symptoms of cervical radiculopathy can disappear within a few weeks. 85% of people are symptom-free after 8 to 12 weeks.

What is the medical or surgical treatment for cervical radiculopathy?

Once again, you can be reassured by one thing: cervical radiculopathy is a fairly well-studied condition, a source of concern for many research teams around the world.

Take a look at this graph, for example, which shows the number of scientific publications published about them each year:

This is to help you better identify the benefit/risk balance of each in your own case, in relation to your expectations and priorities.

Medical treatment of cervical radiculopathy: what to do?

You have probably consulted at least one of these healthcare professionals for your neuralgia:

• your general practitioner;
• a sports doctor ;
• a rheumatologist.

This professional has probably referred you to one of these 3 possible care options:

• answers to your questions, reassurance that this pathology is not serious, and that its natural evolution is favorable no matter what you do in the vast majority of cases. The doctor didn’t prescribe anything in particular (except physical therapy sessions) and recommended that you let time take its course.

  I personally appreciate this attitude, even if I know that some people are desperate for treatment and are not satisfied with this type of “care”.

  It’s called ” wait and see” . And it’s absolutely right, since 85% of people with ASC are symptom-free within 8 to 12 weeks, without treatment (Magnus 2022).

• prescription of pain-relieving medication. Or recommendations fornon-medicinal approaches (TENS, applying heat, etc.), or prescription of a cervical collar.

  This is known as conservative treatment;

• prescription for consultation with another, more “specialized” professional: rheumatologist, neurosurgeon, sports physician. Possibly for epidural corticosteroid infiltration.

I’ll tell you more about the treatments we offer:

• knowledge that in theory they could be of interest;
• of several studies evaluating their effectiveness on dozens or even hundreds of people.

Analgesics, anti-inflammatories

Here are the words of the best summary I’ve found on the subject of drugs to relieve the pain of a CKD.

Since the main cause of pain in cervical neuralgia is inflammation, the use of non-steroidal anti-inflammatory drugs (NSAIDs) for one to two weeks can not only relieve symptoms, but also treat the immediate cause.

The use of oral corticosteroids is controversial, and dosing should be short-term or non-existent.

Tricyclic antidepressants and drugs such as gabapentin can be useful adjuncts in the treatment of cervical radiculopathy.

Opioid analgesics are not recommended, but may be useful in the treatment of radicular pain. It should be noted that opioid use is a risk factor for slow healing and delayed return to work in patients for whom surgery is clinically necessary.

Magnus 2022

Wearing a cervical collar

There are 2 schools of thought on the subject:

• those who recommend the cervical collar if it relieves pain when worn. Only for a few days or weeks, but not all the time;
• those who insist on avoiding wearing a cervical collar. To avoid stiffening, loss of strength and fear of movement.

Studies on the subject are few and far between, and of low quality. And as always, the publication system means that we tend to publish more studies that show an effect on the thing we’re studying.

Here are the conclusions of the main study on the subject.

The results of this randomized clinical trial show a clinically relevant short-term reduction in pain in new-onset cervical brachial neuralgia with two therapeutic interventions – a semi-rigid cervical collar combined with rest (3-6 weeks) and physical therapy with home exercises – versus a wait-and-see policy.

We recommend wearing a semi-rigid cervical collar and resting in cases of recent cervical radiculopathy, as the costs are lower than those of physiotherapy, although the latter is a good alternative with almost similar efficacy.

Kuijper 2009

This study dates from the late 2010s. Resting is no longer really part of the consensus recommendations for musculoskeletal pain. The NCB is part of this category.

Physical therapists are among the healthcare professionals who can prescribe cervical collars.

Corticosteroid infiltrations

These infiltrations can bring short-term relief: half of patients treated reported relief of at least 50% in the weeks following injection (Magnus 2022).

However, this must be compared with how many people without this type of treatment, or with a treatment with fewer side effects, are relieved.

The evidence-based medicine journal Minerva has a more measured view of their value:

This study, which has significant methodological limitations, does not demonstrate the superiority of epidural corticosteroid infiltration, alone or in combination with conservative treatment using analgesics and physiotherapy, versus conservative treatment in non-acute cervicobrachialgia.

Minerva 2016

Surgical treatment of cervical radiculopathy: what to do?

Surgical treatment is far from immediately recommended. It is sometimes proposed to :

• who have already tried physical therapy and medical treatments;
• who have been suffering for several weeks or even months at a very high intensity;
• who also have associated sensory or motor disorders;
• who absolutely must try another treatment.

Here are the results of a synthesis of studies published on the subject. Produced by an international association of research teams working to the highest standards.

There is low-quality evidence that surgery can relieve pain faster than physiotherapy/physiotherapy or rigid collar immobilization in patients with cervical radiculopathy; but there is little or no long-term difference.

It is not certain that the short-term risks of surgery are offset by long-term benefits.

Nikolaidis 2010

There are a number of different surgical procedures. Here are the conclusions of a more recent synthesis of studies that compared the efficacy (and side effects) of different surgical techniques:

The best surgical treatment for cervical radiculopathy is a source of controversy.

Many factors influence the choice of surgery, in addition to clinical results and surgical safety.

In general, all surgical procedures can produce satisfactory results, and there is no statistical difference.

Gao 2022

The main complications of the operation are nerve paralysis, vascular disorders and laryngeal nerve damage.

What about physical therapy treatment for cervical radiculopathy?

Depending on the physical therapist you come across, you may be offered very different things. Often several. A small sample:

• advice on how to deal with pain and discomfort in your daily life, until it passes on its own. This is the attitude I adopt most often, and I refer people to other physiotherapists if they don’t agree with this approach;
• muscle-strengthening or stretching exercises. No particular approach, Pilates or McKenzie. I also offer self-rehabilitation exercises to people who explicitly request them;
• massage, mobilization/manipulation/manual therapy(e.g. cervical traction, nerve release/decompression techniques also known as neurodynamic mobilization), TENS, ultrasound or other techniques for short-term pain relief.

And some of the conclusions of studies that have looked into whether physical therapy really does make a difference, and where.

Mobilization (neurodynamic or otherwise), manual therapy

The conclusions of a synthesis of studies on all types of passive mobilization (physiotherapist mobilizes) evaluated :

This systematic review was unable to establish which manual therapy techniques are most effective for CKD.

Without this confirmation, the application of manual therapy, whatever the protocol applied and manual therapy technique chosen, appears to be effective in reducing chronic neck pain and lowering the neck disability index in short-term CKD.

Borrella 2021

And another from the Cochrane Collaboration:

Several sessions of cervical manipulations could produce greater pain relief and functional improvement than some drugs in immediate/medium/long-term follow-up.

Given that there is a risk of serious adverse effects, albeit rare, for manipulation, additional high-quality studies looking at mobilization and comparing mobilization or manipulation versus other treatment options are needed to guide clinicians towards the optimal therapeutic choice.

Cochrane 2015

Muscle-strengthening and stretching exercises

Another study summary, this time on the effect of active exercise, with or without physiotherapist supervision.

The use of specific strengthening exercises as part of routine practice can be beneficial for (…) BCN.

Research shows that the use of strengthening and endurance exercises of the cervico-scapulo-thoracic region and shoulders can be beneficial in reducing pain and improving function.

However, no beneficial effect can be expected from the use of stretching exercises alone.

Cochrane, 2015

Physical therapy treatment for cervical radiculopathy: what to do?

What can I learn from my own interpretation of these data (and others whose references you’ll find at the end of the article) and my experience of working with people with cervical radiculopathy?

What about natural treatments for cervical radiculopathy?

Here is a non-exhaustive list of grandmotherly solutions or remedies presented as natural and sometimes proposed by health or wellness professionals to relieve the pain of cervical radiculopathy:

• osteopathy;
• chiropractic ;
• a magnetizer;
• acupuncture;
• certain dietary supplements or diets;
• balms or creams to apply, especially plant-based ones.

Here’s what I think, quite honestly: it’s hard enough to be sure that there’s a significant effect from treatments that are better studied and have a more solid theoretical basis.

So these are not the treatments I suggest you turn to. Of course, you’re free to make up your own mind on the subject!

No treatment works… what can I do?

I understand that you may feel a little frustrated that there’s no “miracle cure” for neuralgia. Or even to relieve the pain for sure.

I find that some people accept that there is no cure for the common cold, only things to relieve the symptoms (and even then, sometimes nothing works, or only for too short a time).

I have the impression that for muscular or joint pain, these people are even rarer.

It‘s very hard to accept that there are few reliable ways of relieving the pain that really bothers us. And we’re often always on the lookout for another professional or another treatment that we may have missed… This quest can last a very long time: years, even decades.

With my patients, I simply encourage them to let time take its course. To be confident that symptoms will ebb and flow, and that all may be well in a matter of days or weeks.

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I sincerely hope that this article has provided you with some answers to your questions about the treatment of CKD.

Any comments or questions? Please use the comment space!

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