Some degenerative bone disorders are reported quite frequently in younger individuals as well as in elderly subjects. Cervical radiculopathy is one of the common degenerative conditions that primarily affects the elderly population with an overall incidence of about 203 cases per 100,000 in individuals over 50 years of age and an incidence of about 83 cases per 100,000 in younger subjects.
Cervical radiculopathy refers to the involvement of a nerve root at or around the cervical vertebral region due to compression of the nerve fibers leading to moderate to severe pain (that may be sharp shooting like in character) and associated with loss of sensory or motor sensation involving upper limbs or the shoulder region depending upon the extent and severity of nerve involvement. Other common symptoms that may follow cervical radiculopathy include loss of coordination of muscle movement in limbs, numbness of hands, shoulder or neck (depending upon the nerve damage) and/or tingling sensation in upper limbs and/or neck and shoulder region.
The involvement of the nerve root in most cases is an ongoing inflammatory or infectious process that affects the integrity of the nerve root leading to pain and loss of function. Most common risk factors in the setting of cervical radiculopathy are a space occupying lesion at the level of spinal joint (that may be a cyst or malignancy), a bony spur produced by long-standing spondylosis, development of cervical osteophytes, cervical compression fractures in the setting of spinal disc herniation and ruptured or prolapsed intervertebral disc due to sudden forceful trauma or injury to cervical spine.
Cervical radiculopathy symptoms can be controlled by pain killers and anti-inflammatory drugs; however, the pain relief is normally temporary and symptoms may return after the degradation of active drug molecules. Research conducted by Joshua A. Cleland that is published in Journal of Orthopedic and Sports Physical Therapy suggests that physical therapy intervention may play an important role in the acute management, prevention and rehabilitation of cervical radiculopathy.
Joshua A. Cleland conducted a study on 11 patients (with a mean age of about 51.7 years) to study the outcome of different physical therapy manipulations on the overall safety and therapeutic outcome of pinched nerves (or radiculopathy). He performed the standardized approach by utilizing cervical traction, manual physical therapy, and strengthening exercises for the stabilization of deep neck muscles (especially flexors of neck and scapulothoracic muscle). All the patients received almost 7 physical therapy sessions and along with a 6-month follow-up period after which almost 90% patients reported significant improvement in the symptoms and functional status assessed by the Neck Disability Index (NDI), numeric pain rating scale (NPRS) and Patient-Specific Functional Scale (PSFS).
Cleland explained that the physical therapy and manual traction helps in stabilizing the muscles and ligaments around the cervical joints, thereby improving the support and strength to the joints. Stretching of the spinal joints as part of traction helps in stimulating positional and movement proprioceptors that helps in the restoration of anatomical stability and repositioning of joints and ligaments.
Although, severe cervical disease may require long term physical therapy for relief, the results are generally promising and permanent, as opposed to most surgeries that are associated with a high risk of relapse. A study conducted by Heckmann suggests that over 26% of patients who underwent surgical correction for the management of cervical radiculopathy continue to experience functional and pathological deterioration of symptoms.
There are a number of lifestyle modifications that exert adjunctive effect when used in combination with physical therapy and cervical traction. For temporary and short term relief, soft collars can be worn for a couple of weeks to provide temporary cervical traction (it is advised not to wear collars for long due to potential weakening of cervical ligaments and muscles). Corticosteroid injections are employed in cases when the pain is severe and unbearable. These steroid injections decrease pain and inflammation. Narcotic pain killers are employed when pain is unresponsive to traditional pain therapies.
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