PIVD Cervical with Radiculopathy: Causes & Relief

Best PIVD cervical with Radiculopathy Treatment in Delhi

What is PIVD cervical with Radiculopathy ?

PIVD Cervical with Radiculopathy refers to a condition where a Prolapsed Intervertebral Disc (PIVD) in the cervical (neck) spine compresses or irritates a nearby nerve root, leading to symptoms that radiate into the arm. This is commonly known as a “pinched nerve” in the neck.

The intervertebral discs act as shock absorbers between the vertebrae. A PIVD occurs when the soft, gel-like inner material (nucleus pulposus) of the disc protrudes or herniates through the tougher outer layer (annulus fibrosus). When this protrusion occurs in the cervical spine and impinges upon a nerve root as it exits the spinal canal, it results in radiculopathy.

Causes of PIVD Cervical with Radiculopathy

Degenerative Changes (Wear and Tear): This is the most common cause, especially in middle-aged and older adults. Over time, discs can lose water content, become less flexible, and develop cracks in the outer layer, making them more susceptible to herniation.
Acute Trauma or Injury: Sudden forces like whiplash from a car accident, a fall, or heavy lifting can cause a disc to rupture or herniate.
Poor Posture: Prolonged poor posture, especially with the head tilted forward (e.g., “tech neck” from phone use), can increase stress on the cervical discs over time, contributing to degeneration and herniation.
Repetitive Stress: Certain occupations or activities involving repetitive neck movements or vibrations can contribute to disc wear and tear.
Genetic Predisposition: Some individuals may have a genetic predisposition to disc degeneration.

Symptoms of PIVD Cervical with Radiculopathy

Symptoms typically follow the path of the affected nerve root (dermatomal pattern) and depend on which cervical nerve root is compressed.

Neck Pain: Often localized to one side of the neck, potentially radiating to the shoulder blade area. This pain can range from a dull ache to a sharp, burning sensation and may worsen with certain neck movements.
Radiating Arm Pain: The hallmark symptom. Pain shoots down the arm, hand, and sometimes into the fingers. This pain can be sharp, shooting, burning, or electric shock-like.
Numbness or Tingling (Paresthesia): A “pins and needles” sensation or loss of feeling in the arm, hand, or specific fingers, corresponding to the affected nerve root.
Muscle Weakness: Weakness in specific muscles supplied by the compressed nerve. This can lead to difficulty with certain movements, grip weakness, or dropping objects.
Altered Reflexes: A decrease or absence of reflexes (e.g., biceps, triceps, brachioradialis reflexes) in the affected arm.
Headaches: Sometimes, pain can radiate up to the head, causing headaches, often at the base of the skull or in the temples.
Stiffness: Reduced range of motion in the neck due to pain and muscle guarding.
Aggravating Factors: Symptoms often worsen with activities that increase pressure on the disc or nerve, such as coughing, sneezing, straining, or certain neck positions (e.g., looking down, extending the neck).

Specific Nerve Root Involvement and Symptoms:

C5 Radiculopathy: Pain in the shoulder/outer arm; weakness in deltoid (shoulder abduction) and biceps; decreased biceps reflex.
C6 Radiculopathy: Pain radiating down the thumb side of the forearm into the thumb and index finger; weakness in biceps (elbow flexion) and wrist extensors; decreased brachioradialis reflex.
C7 Radiculopathy: Pain radiating down the middle of the forearm into the middle finger; weakness in triceps (elbow extension) and wrist flexors; decreased triceps reflex.
C8 Radiculopathy: Pain radiating down the little finger side of the forearm into the ring and little fingers; weakness in finger flexors and hand intrinsics.

Advanced Physiotherapy for PIVD Cervical with Radiculopathy (including Manual Therapy):

Postural Analysis: Identifying static and dynamic postural faults that contribute to neck stress.

Movement Analysis: Observing how neck and arm movements affect symptoms.
Pain Management and Inflammation Control:
Rest and Activity Modification: Educating on avoiding aggravating positions and activities in the acute phase.
Cryotherapy/Thermotherapy: Ice for acute inflammation, heat for muscle relaxation.
Transcutaneous Electrical Nerve Stimulation (TENS): For symptomatic pain relief.
Soft Cervical Collar: Short-term use may be considered for severe acute pain to provide rest and support.

Manual Therapy Techniques

Manual Cervical Traction: Applied by the therapist, involving gentle, sustained or intermittent pulling of the head away from the neck to create space between vertebrae, decompressing the nerve root. Allows for immediate feedback and adjustment.
Joint Mobilizations:
Gentle Oscillatory Mobilizations: To improve segmental mobility in the cervical and upper thoracic spine, addressing stiffness and hypomobility. This can include central posterior-anterior (PA) glides, unilateral PA glides, and transverse glides.
Sustained Natural Apophyseal Glides (SNAGs) or Mobilization with Movement (MWM): Applied by the therapist while the patient actively moves their neck, aiming to restore pain-free movement.

Soft Tissue Mobilization:

Trigger Point Release: Addressing taut bands and trigger points in cervical, thoracic, and shoulder musculature (e.g., upper trapezius, levator scapulae, scalenes, sternocleidomastoid, pectorals) that can contribute to pain and tightness.
Myofascial Release: To release restrictions in fascial tissues surrounding muscles.
Neural Mobilization (Nerve Glides):
Gentle, controlled movements of the arm and neck designed to mobilize the affected nerve, reducing irritation and improving its ability to glide through surrounding tissues. Performed cautiously, especially in acute stages.

Therapeutic Exercises:

Deep Neck Flexor Strengthening (Chin Tucks/Cervical Retraction): Essential for improving cervical stability and posture. Patients learn to draw their chin back, lengthening the back of the neck without nodding.
Cervical Range of Motion Exercises: Gradually progressing from pain-free active movements (flexion, extension, rotation, lateral flexion) to end-range movements as pain allows.
Scapular Stabilization Exercises: Strengthening muscles around the shoulder blade (e.g., rhomboids, lower trapezius, serratus anterior) to improve shoulder girdle stability and reduce stress on the neck. Examples include rows, YTW, and wall slides.
Postural Correction Exercises: Educating and strengthening muscles for optimal posture, especially the thoracic extensors.
Progressive Strengthening: Once initial pain is controlled, strengthening exercises for the neck, shoulder, and upper back are gradually introduced to improve endurance and prevent recurrence.

Postural Education and Ergonomics:

Workstation Assessment: Modifying computer setup, chair, and desk height to promote neutral spine posture.
Sleeping Posture: Advising on appropriate pillows and sleeping positions (e.g., supine with contoured pillow, side-lying with pillow between knees and proper head support).
Body Mechanics: Teaching proper lifting techniques and avoiding prolonged static postures.

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