Q: Doctor my mother is 46 years old, she is experiencing cervical radiculopathy, please guide.
A: Cervical radiculopathy is a medical condition marked by the compression or irritation of nerve roots in the cervical spine. This can occur due to herniated disc material or arthritic bone spurs that encroach upon the nerve space. The resulting impingement often leads to a variety of symptoms including neck pain, radiating arm pain or numbness, sensory deficits, and motor dysfunction in the neck and upper extremities.

The condition arises from various pathologies that impact the nerve roots. Common causes include herniated discs, foraminal narrowing, and degenerative spondylitic changes such as osteoarthritis. These degenerative changes can lead to stenosis, or narrowing, of the intervertebral foramen—the small openings through which nerve roots exit the spinal column. This narrowing can exert pressure on the nerve roots, resulting in the aforementioned symptoms.

Typically, cervical radiculopathy manifests unilaterally, meaning it affects one side of the body. However, in cases where severe bone spurs are present at a single level, it is possible for symptoms to appear bilaterally, impacting both sides due to nerve root compression on both sides of the spine. When there is peripheral radiation of pain, weakness, or a sensation of pins and needles, the location of these symptoms can often be traced back to the affected nerve root.

Cervical radiculopathy is a broad disorder with several underlying mechanisms and can affect individuals across a wide age range. However, it is most commonly seen in individuals between the ages of 40 and 50. The symptoms are varied and can include arm pain that follows a dermatomal pattern (specific areas of the skin supplied by specific nerve roots), neck pain, paresthesia (abnormal sensations like tingling or prickling), muscle weakness in a myotomal pattern (specific muscles controlled by specific nerve roots), impaired reflexes, headaches, scapular pain, and both sensory and motor dysfunction in the upper extremities and neck. Importantly, the absence of radiating pain does not rule out the presence of nerve root compression, as significant sensory and motor dysfunction can occur without major pain symptoms.

Diagnosing cervical radiculopathy typically involves a combination of imaging and electrophysiological studies. Radiographs (X-rays), MRI scans, and electrophysiological tests such as EMG (electromyography) and nerve conduction studies are commonly used to confirm the diagnosis and identify the exact location and cause of nerve root compression.

Physical therapy treatment options include: Education and Advice: Educating the patient about their condition, the causes of their symptoms, and the rationale behind the treatment plan is crucial for ensuring patient cooperation and compliance with rehabilitation efforts.

Manual Therapy: Techniques such as Passive Accessory Intervertebral Movements (PAIVMs), Passive Physiological Intervertebral Movements (PPIVMs), Natural Apophyseal Glides (NAGs), and Sustained Natural Apophyseal Glides (SNAGs) are used to alleviate symptoms by improving joint mobility and reducing nerve root compression.

Exercise Therapy: This includes exercises to promote Active Range of Motion (AROM), as well as stretching and strengthening exercises aimed at improving flexibility and muscle strength to support the spine and alleviate pressure on the nerve roots.

Postural Re-education: Teaching patients proper posture can help reduce strain on the cervical spine and prevent further nerve root irritation.

Patient education is a cornerstone of effective treatment. When patients understand their condition and the reasons behind their neck and arm pain, they are more likely to adhere to the recommended rehabilitation plan. Compliance with physical therapy is critical for improving outcomes and preventing the recurrence of symptoms. By combining education, manual therapy, exercise, and postural re-education, healthcare providers aim to relieve symptoms, improve function, and enhance the quality of life for individuals suffering from cervical radiculopathy.

Q: Doctor my brother experienced a car accident last month and the doctors have used a term whiplash injury, kindly guide what is the meaning of the term in detail and how physical therapist can help the patients.
A: whiplash injuries are commonly sustained in motor vehicle accidents due to sudden acceleration and deceleration movement of the cervical (neck) spine. There is proper diagnosis based on clinical picture of the patient in order to rule out any fracture, disc herniation, artery rupture, spinal cord injury, ligament injury or subluxations. A physical therapist takes detailed history with examination to proceed.

There are three stages of the injury, 1: Flexion (bending) of the cervical spine, 2: S shape cervical spine, 3: Extension (backward bending ) of the cervical spine which can lead to compression. The condition has been graded as 1: The patient has neck pain, stiffness or tenderness with no positive findings on physical examination, 2: Decreased range of the neck and tenderness, 3: Neurological sign and symptoms like sensory disturbances, muscle weakness etc. The condition is not only confined to motor vehicle accidents, it can also occur in sport injuries and falls. It is common in women as compared to men. The condition depends on various factors including impact, gender, age etc. The prognosis is variable for every case, there is complete recovery in most of the cases, in about 25% cases experience some disability.

A multidisciplinary program is initiated for the patients, a physical therapist encourages return to activity and utilizes relaxation techniques, mobilizations / manual techniques, strengthening, postural education etc to ensure maximum rehabilitation.