- Kiley Holmes, PT
Is Your Pain Coming From a Pinched Nerve?
Often someone will complain of pain in their neck, shoulder, arm, or upper traps, but it's actually radiating neck pain. The question you need to ask yourself is:
Are your symptoms aggravated by head and neck movements?
It's actually pretty hard for someone to tell the difference between muscle pain and radiating neck pain. Radiating neck pain can be nagging and painful - I have, on more than one occasion, had grown men cry because they have not been able to get sleep in weeks due to radiating pain. A lot of people think that numbness and tingling are the only symptoms that you can get from radiating pain - that is not the case. When studies are done to purposely bring on the radiating symptoms in test subjects they have found that the results are not necessarily consistent for everyone. Every segment of your spine can cause different symptoms and usually when it shows up you end up with other muscles getting involved, increasing the area that you're having symptoms in. The pain can be broad or it can be very specific.
Basically, if you have pain in your upper back, neck, shoulder, elbow, wrist, hand, or any combination of the above it may be radiating pain. Especially if you have tried to treat the actual area with very little results.
Radiating neck pain is actually one of my favorite things to treat because there have been so many studies on it so it comes down to statistics.
There is a cluster of four tests that will tell you whether or not being treated for radiating pain will fix your symptoms. It first came out in 2003 by Wainner et al and it has been proven time and time again. The best thing about this is that it's quick and the solution is quick. If it isn't positive, then I usually just move on with a client.
Test number 1: Spurling's
Side bend your head towards the affected side and then look up and back, if you have no symptoms with this go ahead and apply pressure with your opposite hand and hold for a couple of seconds, longer if you're symptoms are less severe. Does this increase your symptoms?
If yes, that is one point.
Test number 2: Distraction
Go ahead and hold on to your head and pull up, holding for a couple of seconds. Does this decrease your symptoms?
If yes, that is one point.
Test number 3: Upper Limb Tension Test a (ULTTA)
Point your hand in front of you, extend your wrist all the way back, and then slowly bring your arm back behind you, keeping it straight. Does this cause any numbness and tingling down your hand?
If yes, that is one point.
Test number 4: Cervical Rotation
Turn your head towards your affected side. Is your chin able to cross over to behind your collarbone while turning your head?
If no, that is one point.
If you ended up with four points there is a 95% chance that you're dealing with cervical radiculopathy, three points is a 79% chance.
The question is, what do we do about it?
I really like starting off with traction. If pulling up on your neck made it feel better then you probably already started doing it while continuing to read this blog post - don’t worry, there are dozens of ways to traction your neck, all of them easier than that.
There are really nice traction units on Amazon for about $300, I love them, however, if you haven't had a healthcare professional look at your neck you will want to be cleared before you start using a mechanical traction unit.
There are a lot of ways of having a friend or family member traction your neck for you.
My two favorite are these:
Have somebody put their arm right below your neck as you are laying on your back, then have them turn their hand from palm up to palm down while stabilizing your forehead. This increases the tension on the upper part of your neck. Hold between 30 seconds and 10 minutes to tolerance.
Have somebody lift up your head and keep their elbows down to stabilize while you are laying on your back. Hold between 30 seconds and 10 minutes.
Another thing that needs to be looked at is your thoracic mobility - a yoga wheel goes a long way.
Go ahead and sit in front of a yoga wheel and then just lean back and let your back rest into it.
Once you feel comfortable with that go ahead and lift your butt up so that you can lay on the yoga wheel, slowly start rolling back and forth on it. Most people are significantly stiff so it will take several days to be comfortable rolling on the yoga wheel. Take your time, otherwise you can worsen your symptoms instead of decreasing them.
Natural Apophyseal Glides (NAGs)
I love NAGS for so many reasons: basically, what you are going to do is find that spot in your neck that is painful then hook a sheet over it and turn towards that spot trying to get it to move using the sheet to hold it in place.
The other thing I give clients to start is cervical rotation: turn your head towards the unaffected side, I prefer starting with 20 repetitions, but slowly move that number up. As your symptoms decrease start turning towards the affected side in the non-painful range.
While this is a common cause of your symptoms, there are plenty of other factors that can be at play - try this out, if it's not going away please message me. We can figure this out together.