Posts tagged neck and arm pain
Benefits Of Manipulation For Patients With Neck And Arm Pain

Thoracic manipulation by Physical Therapists has previously been shown to improve pain and function in patients with elbow, shoulder, and neck pain. Authors continue to research the mechanisms behind its’ effectiveness including a beneficial cascade of events in the peripheral and central nervous system, as well as, a possible biomechanical change in the spinal joints. Clinically, thoracic manipulation is also utilized in patients with neck and arm pain (cervical radicular pain or cervical radiculopathy). This painful condition is secondary to encroachment of the spinal nerves in the neck as they pass through their respective vertebrae. Patient’s with this condition can experience pain, numbness, and/or pins and needles into their shoulder blade, arm, and hand. If left untreated patients may also notice weakness in their hands. Physical Therapy treatments including manual therapy and exercise aim to improve spacing within the bony neck canals that contain the neck nerves, as well as, optimize movement in the body regions adjacent to the neck to reduce the demands in the affected neck vertebrae. A new recent study highlights the benefits of thoracic manipulation in this patient population.

A randomized controlled trial in the Journal of Orthopedic and Sports Physical Therapy was conducted by Young and colleagues to determine the effectiveness of thoracic manipulation in patients with neck and arm pain (2019). Authors randomized patients to one of two treatment groups including a single session of thoracic manipulation or sham (placebo) manipulation. They assessed immediate and short term (48-72 hours) changes in pain, pain location (centralization), function, neck range of motion and strength. As expected, patients provided with thoracic manipulation reported decreased pain, improved function, and demonstrated improved range of motion at both time points compared to the sham manipulation group.

Click Here to learn more on how spinal manipulation can reduce your symptoms.

Will traction help my neck and arm pain?

Arm pain referred from the cervical spine (cervical radiculopathy) often is the result of nerve root compression by either bone or soft tissue in the bony canals of the neck.  These canals protect the nerve roots as they exit from the spinal cord, but can also compress these neural structures leading to pain, numbness, pins and needles, or weakness in the arm and hand.  Physical Therapy interventions including manual therapy and exercise designed to optimize motion and reduce abnormal nerve contact have been shown to reduce pain and improve function in patients with neck and arm pain.  Another form of treatment, mechanical traction, has previously been shown to help in subsets of patients with neck and arm pain.  A recent systematic review examined the available evidence behind using traction for neck and arm pain.

In the journal Physical Therapy, researchers analyzed the available data on mechanical traction and patient's with cervical radiculopathy (Romeo et al. 2018).  Authors included 5 studies in the review and found both manual and mechanical traction improved pain in the short term.  Mechanical traction was shown to improve disability at intermediate follow up periods.  The authors concluded manual or mechanical traction may be helpful when combined with other Physical Therapy interventions in the short term.  Conversely, traction has a smaller effect at improving patient function. 

Consistent with our treatments, manual traction is best utilized as part of an effective short term program to reduce the symptoms of cervical radiculopathy.  Higher level exercises should be utilized once the symptoms are reduced to optimize patient function and prevent recurrence. 

Cervical Radiculopathy and Physical Therapy Solutions
Neck and Arm Pain Physical Therapy Interventions

Cervical Radiculopathy Injuries and Symptoms 

Cervical radiculopathy occurs when a nerve from the neck becomes irritated or compressed by space occu- pying lesion including fluid, soft or bony tissues as it exits the spine. Patients often complain of sharp, burning pain down the arm, numbness, tingling, or weakness.

This condition is most common in the 5th decade of life with an annual incidence of 83 per 100,000 individuals(2).

The C6 and C7 cervical nerve roots are most com- money involved(3). EMG/NCV testing is considered the gold standard for the diagnosis of this disorder.

A clinical prediction rule developed by Wainner et al. showed four clinical tests/measures are helpful for diagnosis of this condition:

1. (+) Spurling’s Test
2. (+) Distraction Test
3. Ipsilateral cervical rotation <60 degrees                                                                                                             4. (+) median nerve upper limb tension test

Authors reported a specificity of 94% and 100% for 3/4 and 4/4 variables, respectively(4). 

Physical Therapy Interventions 

Recent reviews of cervical radiculopathy suggest conservative treatments may be superior to surgical interventions(5,6).

Authors suggest evidence supports the utilization of short term epidural corticosteroid injections for patients with radicular pain(6).

A multimodal Physical Therapy treatment plan involving manual therapy (joint mobilization/ manipulation and soft tissue mobilization), exercise, mechanical traction, and education provides short and long term reductions in pain and disability. 

Neck and Arm Pain Physical Therapy Manual Treaments
Mechanical Traction in Physical Therapy

Physical Therapy Evidence for Cervical Radiculopathy

Literature reviews report the combination of manual therapy and exercise is effective at reducing pain and disability, as well as, increasing AROM in patients with cervical radiculopathy(5).

Cleland et al. demonstrated 91% of patients treated with manual therapy, exercise, and mechanical trac- tion had successful short and long term outcomes(7).

Fritz et al. reported mechanical traction and exercise was superior to exercise or exercise and over the door traction for reducing pain and disability. The group receiving mechanical traction and exercise was the only group to sustain the benefits of the 4 week treat- ment at 6 and 12 month follow ups(1).

Raney et al. suggested four variables may assist in determining which patients will best respond to cervical mechanical traction:

1. Peripheralization with manual therapy testing                                                                                                      2. (+) shoulder abduction test
3. Age >55 years old
4. (+) median nerve upper limb tension test                                                                                                               5. (+) neck distraction test                                                                                                                                            If 4/5 variables are met there was a 95% success rate(9). 

When to Seek Physical Therapy Treatment

Patient’s with neck and arm pain with or without symptoms of nerve root irritation including numbness, paresthesias, or weakness should be referred to PT for short and long term reduction of pain and disability.

Health Care practitioners may use Wainner’s CPR noted above for the clinical diagnosis of Cervical Radiculopathy.

Cleland et al. noted four variables help predict patients who will respond favorably to physical therapy interventions for cervical radiculopathy:

1. Age <54
2. Dominant arm not affected
3. Cervical flexion does not worsen symptoms                                                                                                          4. Patient received multimodal PT treatment

A 85% and 90% success rate was found if patients met 3/4 or 4/4 variables, respectively(8). 


1. Fritz et al. Exercise Only, Exercise With Mechanical Traction, or Exercise With Over-Door Traction for Patients With Cervical Radiculopathy, With or Without Consider- ation of Status on a Previously Described Subgrouping Rule: A Randomized Clinical Trial. JOSPT. 2014;44(2):45- 57.

2. Radhakrishnan K, Litchy WJ, O’Fallon WM, Kurland LT. Epidemiology of cervical radiculopathy: a population- based study from Rochester, Minnesota, 1976–1990. Brain 1994; 117:325–35.

3. Dillin W, Booth R, Cuckler J, Balderston R, Simeone F, Rothman R. Cervical radiculopathy: a review. Spine 1986;11:988–91.

4. Wainner RS, Gill H. Diagnosis and nonoperative manage- ment of cervical radiculopathy. J Orthop Sports Phys Ther 2000;30:728–44.

5. Boyles et al. Effectiveness of manual physical therapy in the treatment of cervical radiculopathy: a systematic review. J Man Manip Ther. 2011. 19(3):135-142.

6. Carragee, E. et al. Treatment of Neck Pain. Injections and Surgical Interventions. Spine. 2008. 33(45):S153-S169.

7. Cleland JA, Whitman JM, Fritz JM, Palmer JA. Manual physical therapy, cervical traction, and strengthening exercises in patients with cervical radiculopathy: a case series. J Orthop Sports Phys Ther 2005;35:802–11.

8. Cleland, J. et al. Predictors of Short-Term Outcome in People With a Clinical Diagnosis of Cervical Radiculopathy. JOSPT. 2007

9. Raney, N. Development of clinical prediction rule to identify patients with neck pain likely to benefit from cervical traction and exercise. Eur Spine J. 2009.