Rehab from Pinched Nerve in Cervical Spine/Neck

author : AMSSM

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What is a realistic recovery timeline from a cervical pinched nerve?

Member Question:

"I have a cervical pinched nerve and have decreased strength. How long was the recovery? Did it get better on its own or did you do PT?

About a month ago I started with major nerve pain in my right arm and was diagnosed with a pinched nerve in my neck (somewhere between C5-C7).

The pain has finally started to subside but I still have decreased strength in that arm; probably at 50-75%. I am 100% swimming right now and my pull is still really weak on that side. What kind of timeline should I expect? I am trying to remain patient but it is so challenging! I am trying to qualify for Master's Nationals so you can imagine an injury is frustrating."

Answer from Jeffrey Dela Cruz, MD
Member AMSSM

“Cervical pinched nerve”, also known as cervical radiculopathy, normally results in pain, sensory problems, loss of reflexes, and weakness in the affected nerve roots. Besides cervical radiculopathy, other diagnoses to consider which may produce similar symptoms are brachial plexopathy, spinal cord compression, cardiac pain, axial neck pain, rotator cuff injury, thoracic outlet syndrome, lateral epicondylitis, or peripheral entrapment neuropathy. Usually, history and physical examination are enough to make the diagnosis of cervical radiculopathy. Other modalities that can help make the diagnosis include MRI, CT myelography (for those with contraindications to MRI), or electromyography. The most commonly involved nerve roots involved in cervical radiculopathy are C6 and C7, but any root can be affected.

Cervical radiculopathy commonly occurs from mechanical compression of the nerve, neuropraxia, or chemical irritation of the nerve roots. Spondylosis, disk herniation, trauma, infection, and tumors can all potentially decrease the space available for the nerve to exit the vertebrae, causing the nerve to be compressed or irritated. Spondylosis, which refers to degenerative changes within the spine, is theorized to be caused by the loss of height of the vertebral disk as a person gets older. This in turn leads to increased stress at the vertebrae and causes bone “spurs” or osteophytes to form which can irritate the nerve roots. Herniated intervertebral disks release inflammatory cytokines which also explain the pain associated with cervical radiculopathy. Non-compressive causes of radiculopathy include diabetes, vasculitis with nerve root infarction, infection such as herpes zoster or Lyme disease, tumors such as lymphoma, and acute demyelination from processes such as Guillain-Barre syndrome.

Unfortunately, I cannot give you a definitive timeframe in which you should expect to recover, as studies show that this varies based on factors such as age, co-morbidities, and cause of the radiculopathy. Nonoperative care or conservative treatment is recommended for patients with new cervical radiculopathy in the absence of a significant motor function deficiency. Studies show that up to 90 percent will have improvement of their symptoms with nonoperative care. As I mentioned earlier, however, the timeframe varies. One study performed a review of the literature on studies that reported on patients who had herniated disks leading to radiculopathy, and it showed that the time to complete recovery ranged from 24 to 36 months. Another study of the natural history of cervical radiculopathy followed a certain number of patients over 2 to 19 years, which showed that 43 percent of patients had no further symptoms after a few months, 29 percent had mild or intermittent symptoms, and 27 percent had more severe symptoms.

There is not a lot of evidence to distinguish which nonoperative treatment works best for cervical radiculopathy, but the consensus seems to be that a combination of treatments may alleviate symptoms. A one-week course of neck immobilization with a cervical collar may reduce symptoms acutely. Cervical traction applied for 15 to 20 minute intervals may also be used to decrease impingement symptoms, especially in the chronic phase of the radiculopathy. In terms of medications, nonsteroidal anti-inflammatory drugs are first-line agents, although a short course of opioid medications (less than eight weeks), and oral steroids can also be used. For patients with chronic radicular pain who decline surgery, other medications can be used such as tricyclic antidepressants and neuropathic drugs such as gabapentin. A graduated physical therapy program may also help relieve symptoms of radiculopathy. In the first six weeks after the onset of pain, gentle range of motion and stretching exercises along with massage, head, ice, or electrical stimulation can be used. As the pain starts to improve, a strengthening program can be started to facilitate active range of motion and resistive exercises. Moreover, one recent clinical trial found that combining mechanical traction with an exercise protocol in patients with cervical radiculopathy resulted in superior six-month and one-year outcomes compared to exercise alone. Cervical and epidural corticosteroid injections have also been shown to help in some patients, but complications from the procedure can be debilitating.

If radicular symptoms persist without improvement for six to 12 weeks, motor weakness persists for more than six weeks, or neurologic deficits progressively worsen, then you may need to see a spine physician for possible surgical intervention. Surgery is usually a last resort, so consult your primary or sports physician regarding the nonoperative treatments listed above.

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date: November 28, 2015