Radiculopathy or radicular pain is often called a “pinched nerve.” It is a pain that travels (radiates) down the arm, often from the shoulder down to the hand. The term pinched nerve comes from the fact that, in many cases, there is something in or around the spinal cord in the neck that is putting pressure on the spinal cord itself, or on the nerve leaving the spinal cord.
Sciatica is a radicular pain of the lower half of the body.
Disc pressure, bone spurs, and ligament injury can create radiculopathy
The irritation in the neck can come from the intervertebral disc in the neck, bone spurs, or even overgrowth of ligaments. It can be mildly irritating to debilitating pain. Often the radiculopathy patient experiences numbness and tingling when they aren’t experiencing pain.
In the majority of cases, some, if not all of the pain will resolve with conservative treatment over time and surgery is not necessary. Some people get scared, however, because they may receive a poor report on MRI.
Unfortunately, some authorities continue to suggest that patients like these shouldn’t receive chiropractic care due to disc bulges in the neck.
The two people below, a 49 year old female, and a 56 year old male each experienced improvement after addressing postural and structural problems in the neck and spine at this chiropractic practice. You will see that both have a reverse cervical curve.
In both instances, a concerning MRI and MRI report were assessed and discussed. Both patients agreed to follow a program of care to see if their symptoms could improve without a more invasive treatment.
Here is a summary of their experiences.
A 56 year old male with right shoulder pain radiating into the hand
A 56 year old engineer with a lot of time behind a desk (managing a large project) came in with right lower neck pain. That neck pain radiated into the region of the shoulder blade and down the arm into the hand.
When did it start? The radiation into the hand occurred one week before his first chiropractic appointment. However, an increasingly stiff and painful right shoulder slowly came on in the several months before the radiating pain.
What was his diagnosis? A medical provider suspected radiculopathy, and treated with a steroid injection. The patient didn’t have an MRI yet at the time of his first chiropractic assessment. He was unsure if the steroid injection had made any difference.
What did I find? He had a lot of structural stress of his neck. You can see it in the x-ray of the neck on this post. In fact he had so much stress he could not extend his head to look up. Any pressure to the shoulder made his symptoms worse, suggesting pressure on his brachial plexus (nerve roots going to the arm).
Did he get any relief? His first appointment was October 3, and his first sensation of any improvement, though temporary, was within the week of his first visit. It would take over a month for the stability in symptoms to remain.
Did his symptoms stabilize? By November 27, his pain relief became fully stable and he regained function of his right arm and shoulder with some limitations. He called his symptoms 80% better. Upon follow up with the patient several months later, he reported participating in a weight lifting program (under direction) where we was able to lift 250 pounds without any problems.
How was he treated?
- His posture was assessed, as was the mobility of his neck.
- Neck x-rays were performed, including views for upper cervical chiropractic care.
- Other x-ray views of his spine were also accomplished.
- The patient was given an frequency specific microcurrent device to use at home for one week, in an attempt to shorten the pain cycle.
- Gentle upper cervical, and whole cervical releases were accomplished that would not irritate the spinal disc.
- While the initial results were not sustainable beyond a day or so, the patient began sleeping better, and experiencing a slow decrease in pain.
- Over the following months, the patient received a combination of gentle upper cervical corrections, and whole cervical releases that focused on the alignment of fascia around the joints.
- Specific adjustments from Sacro-Occipital Technique were applied to reduce tension on the dura.
Did he get an MRI? The patient wanted an MRI and I agreed to help me visualize the locations of the disc pressure (if present). It would also make a decision about future care options easier if he didn’t respond to care. His MRI was the first week of November, four weeks after starting care.
What were the findings on the MRI? It may not be understandable to many readers, but I will provide the exact wording of his radiologist, so that those with similar symptoms can compare their own MRI findings.
The MRI reveals severe to moderate foraminal stenosis (narrowing space for the nerve root)
- Grade 1 anterolisthesis of C2 on C3 and C3 on C4 in the setting of degenerative change. (This means his neck bones were stuck forward of each other, which confirmed what I found on x-ray).
- C2-C3: Facet arthropathy (this means longstanding inflammation of the rearward joints. Arthropathy means joint inflammation.)
- C3-C4: Uncovertebral and facet joint arthropathy (this means longstanding inflammation of the rearward joints and forward body joints) causing bilateral foraminal stenosis (this means the holes where the nerve roots traveling are narrowing on the left and right.)
- C4-C5: Disc protrusion and endplate degenerative change (this means the disc is leaving its normal space, and the bone around the disc are breaking down). Mild spinal canal stenosis (this means that the middle channel for the spinal cord is being narrowed). There is also joint inflammation and narrowing of the space for the nerve roots like above.
- C5-C6: The same as C4-C5 above, but the nerve root spaces are only being narrowed on the right
- C6-C7: Same as above, but this time there is moderate to severe narrowing of the nerve root spaces on the rate (right foraminal stenosis).
Of all the above findings, the radiologist called out the narrowing on the right of C6-C7 as the most important.
The patient was able to improve and overcome his radiculopathy despite being diagnosed with moderate to severe foraminal stenosis on his MRI. The before and after neck x-ray show the structural changes back towards normal (including undoing the reverse neck curve) that helped him heal through this nerve pain.
49 year old female with arm pain on the left, and left hand numbness
This patient is a female with a history of neck and shoulder pain, with prior chiropractic care in my office. Her job is very active and involves a lot of lifting.
At the end of May of 2024 she contacted us to let us know here prior neck issues had escalated to a pinched nerve with terrible pain.
She came into the office and we re-evaluated and confirmed a possible radiculopathy. Her prior neck x-rays certainly showed enough degeneration and loss of cervical disc space for this to be possible. She also had a reverse cervical curve.
How did treatment start? The patient was in such pain and seeking immediate relief, so she was gently adjusted in the neck, and then sent home with frequency specific microcurrent to break the pain cycle. She confirmed that that pain was reduced with the microcurrent.
She worked with me for five more visits, but as expected, saw temporary improvements, but no sustainable change in the first four weeks. She pursued an MRI, and we rescheduled for a few weeks later in the second week of July.
What were here MRI results? Like above there are multiple levels of foraminal stenosis, and an disc bulge to the left at C6-C7. I will provide the exact wording of his radiologist down below, so that those with similar symptoms can compare their own MRI findings.
Based on the MRI results, neck (cervical) decompression was suggested to her. We discussed the possibility of decompression helping, but agreed that before she tried it, we should do a more intense investigation of her whole posture, and continue to release the neck.
What did the x-rays of her whole spine show? The patient’s mid-back had a minor curve with vertebrae rotation. This rotation was activating the fascia of her left shoulder and pulling down on the left shoulder complex at the junction of her neck and upper back. When we combined gentle stimulation and adjustment of the thoracic spine with gentle releases of the neck, the patient’s healing began to accelerate.
The patient was also given instruction in specific at-home traction with a recommended device.
When did her symptoms resolve? Her first nerve pain symptoms appeared in May. We had four to five visits in June. Her MRI was in the beginning of July, and we had several more visits spread over July into August. By the end of the month August she was symptoms free, including free of hand numbness, despite having a job with physical labor.
MRI shows narrowing of nerve root space, and disc bulge to the left
- C2-C3: Mild diffuse disc bulge. Disc desiccation. Moderate right neural foramen narrowing. Facet hypertrophy.
- C3-C4: Disc desiccation. Facet hypertrophy. Mild diffuse disc bulge. Mild right neural foramen narrowing.
- C4-C5: Disc desiccation. Mild diffuse disc bulge. Mild right and moderate left neural foramen narrowing. Moderate facet hypertrophy and mild narrowing of the central canal.
- C5-C6: Moderate disc height loss and desiccation. Diffuse disc bulge. Moderate narrowing of the central canal. Moderate to severe bilateral neural foramina stenosis. Moderate facet hypertrophy.
- C6-C7: Disc height loss and desiccation. Diffuse disc bulge, eccentric to the left. Mild right and moderate to severe left neural foramen narrowing. Moderate narrowing of the central canal and moderate facet hypertrophy.
Once again the patient was able to improve and overcome radiculopathy and hand numbness despite being diagnosed with foraminal stenosis on MRI.
Two stories of nerve pain in the arm: what can we learn?
Here are some takeaways from these two patients:
- Their arm and hand symptoms came on suddenly but there was evidence for neck problems long before their first radicular symptoms.
- Despite having disc bulges and moderate to severe narrowing of the space for nerve roots, these patients improved.
- Their symptom response occurred within the first week of care.
- Stability in the decrease of their symptoms didn’t occur for at least one month.
- It took several months of care and healing for both patients to return to prior activities without creating further problems.
- Frequency specific microcurrent for disc injury and nerve pain is effective for breaking the radicular pain cycle.
- Gentle chiropractic adjustments in the neck are possible, even with disc bulge and numbness and tingling, despite what may be reported by other authorities.
Picture Credits
Annotated diagram of preconditions for anterior cervical discectomy and fusion by Debivort, found here.
- How two patients found help with arm nerve pain (radiculopathy), even with a bad MRI - February 13, 2025
- Three things you think are helping your neck, but aren’t – Some controversial thoughts about the neck - January 13, 2025
- This is why we use the neckcare device to improve patient outcomes - December 11, 2024
